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Neoadjuvan Kemoterapi Alan Meme Kanseri Hastalarında Progesteron Reseptör Düzeyinin Tedavi Yanıtına Etkisi

Yıl 2025, Cilt: 47 Sayı: 6, 1022 - 1028, 26.09.2025
https://doi.org/10.20515/otd.1660913

Öz

Östrojen reseptörü(ER) pozitif meme kanseri hastalarında neoadjuvan kemoterapi(NACT) kullanımına karar vermede, klinisyenler olası düşük etkinlik nedeniyle zorlanmaktadır. Progesteron reseptörü(PR), meme kanserli hastalarda NACT öncesi rutin olarak değerlendirilen bir biyobelirteç olmasına rağmen, tedavi kararındaki rolüyle ilgili yeterli klinik veri ve kılavuz önerileri bulunmamaktadır. Bu çalışma, NACT alan ER-pozitif meme kanseri hastalarında PR durumunun patolojik tam yanıt üzerindeki etkisini değerlendirmeyi amaçlamıştır. Çalışmamız, NACT alan 52 ER-pozitif hastayı incelemiştir. Katılımcılar, PR düzeylerine göre üç kohort halinde gruplandırılmıştır: %1'den az, %1-9 ve %10 ve üzeri. Genel sağkalımın önemli bir göstergesi olan patolojik tam yanıt oranı, bu üç grup arasında karşılaştırılmıştır. Çalışmamızın sonuçları, PR düzeyleri %1'in altında olan hastalarda istatistiksel olarak anlamlı derecede daha yüksek patolojik tam yanıt oranı olduğunu göstermiştir. Bu bulgular, bu hasta grubunda NACT etkinliğinin daha yüksek olabileceğini düşündürmektedir. Çalışmanın bulguları, ER-pozitif meme kanseri hastalarında PR durumunun NACT kararında rol oynayabileceğini göstermektedir.

Kaynakça

  • 1. Shannon C, Smith I. Is there still a role for neoadjuvant therapy in breast cancer? Critical reviews in oncology/hematology. 2003;45(1):77-90.
  • 2. Schwartz GF, Hortobagyi GN, Committee CC. Proceedings of the consensus conference on neoadjuvant chemotherapy in carcinoma of the breast, April 26–28, 2003, Philadelphia, Pennsylvania. Cancer. 2004;100(12):2512-32.
  • 3. Kaufmann M, Hortobagyi GN, Goldhirsch A, Scholl S, Makris A, Valagussa P, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update. Journal of Clinical Oncology. 2006;24(12):1940-9.
  • 4. Mamtani A, Barrio AV, King TA, Van Zee KJ, Plitas G, Pilewskie M, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study. Annals of surgical oncology. 2016;23:3467-74.
  • 5. Heater NK, Somayaji K, Gradishar W. Treatment of residual disease following neoadjuvant therapy in breast cancer. Journal of surgical oncology. 2024;129(1):18-25.
  • 6. Yee D, DeMichele AM, Yau C, Isaacs C, Symmans WF, Albain KS, et al. Association of event-free and distant recurrence–free survival with individual-level pathologic complete response in neoadjuvant treatment of stages 2 and 3 breast cancer: three-year follow-up analysis for the I-SPY2 adaptively randomized clinical trial. JAMA oncology. 2020;6(9):1355-62.
  • 7. Hammond MEH, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Journal of Clinical Oncology. 2010;28(16):2784-95.
  • 8. Waks AG, Winer EP. Breast cancer treatment: a review. Jama. 2019;321(3):288-300.
  • 9. Ring A, Smith I, Ashley S, Fulford L, Lakhani S. Oestrogen receptor status, pathological complete response and prognosis in patients receiving neoadjuvant chemotherapy for early breast cancer. British journal of cancer. 2004;91(12):2012-7.
  • 10. Johnston SR, Toi M, O'Shaughnessy J, Rastogi P, Campone M, Neven P, et al. Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): results from a preplanned interim analysis of a randomised, open-label, phase 3 trial. The lancet oncology. 2023;24(1):77-90.
  • 11. Yao N, Song Z, Wang X, Yang S, Song H. Prognostic impact of progesterone receptor status in Chinese estrogen receptor positive invasive breast cancer patients. Journal of breast cancer. 2017;20(2):160-9.
  • 12. Bae SY, Kim S, Lee JH, Lee H-c, Lee SK, Kil WH, et al. Poor prognosis of single hormone receptor-positive breast cancer: similar outcome as triple-negative breast cancer. BMC cancer. 2015;15:1-9.
  • 13. Cancello G, Maisonneuve P, Rotmensz N, Viale G, Mastropasqua M, Pruneri G, et al. Progesterone receptor loss identifies Luminal B breast cancer subgroups at higher risk of relapse. Annals of oncology. 2013;24(3):661-8.
  • 14. Makanjuola DI, Alkushi A, Al Anazi K. Defining radiologic complete response using a correlation of presurgical ultrasound and mammographic localization findings with pathological complete response following neoadjuvant chemotherapy in breast cancer. European Journal of Radiology. 2020;130:109146.
  • 15. Dai D, Wu H, Zhuang H, Chen R, Long C, Chen B. Genetic and clinical landscape of ER+/PR-breast cancer in China. BMC cancer. 2023;23(1):1189.
  • 16. Kabos P, Finlay-Schultz J, Li C, Kline E, Finlayson C, Wisell J, et al. Patient-derived luminal breast cancer xenografts retain hormone receptor heterogeneity and help define unique estrogen-dependent gene signatures. Breast cancer research and treatment. 2012;135:415-32.
  • 17. Zheng Z-Y, Bay B-H, Aw S-E, Lin VC. A novel antiestrogenic mechanism in progesterone receptor-transfected breast cancer cells. Journal of Biological Chemistry. 2005;280(17):17480-7.
  • 18. Mohammed H, Russell IA, Stark R, Rueda OM, Hickey TE, Tarulli GA, et al. Progesterone receptor modulates ERα action in breast cancer. Nature. 2015;523(7560):313-7.
  • 19. Cui X, Schiff R, Arpino G, Osborne CK, Lee AV. Biology of progesterone receptor loss in breast cancer and its implications for endocrine therapy. Journal of clinical oncology. 2005;23(30):7721-35.
  • 20. Arpino G, Weiss H, Lee AV, Schiff R, De Placido S, Osborne CK, et al. Estrogen receptor–positive, progesterone receptor–negative breast cancer: association with growth factor receptor expression and tamoxifen resistance. Journal of the National Cancer Institute. 2005;97(17):1254-61.
  • 21. Creighton CJ, Kent Osborne Cv, van de Vijver MJ, Foekens JA, Klijn JG, Horlings HM, et al. Molecular profiles of progesterone receptor loss in human breast tumors. Breast cancer research and treatment. 2009;114:287-99.
  • 22. Paakkola N-M, Karakatsanis A, Mauri D, Foukakis T, Valachis A. The prognostic and predictive impact of low estrogen receptor expression in early breast cancer: a systematic review and meta-analysis. ESMO open. 2021;6(6):100289.
  • 23. Mermut O, Inanc B, Gursu RU, Arslan E, Trabulus DC, Havare SB, et al. Factors affecting pathological complete response after neoadjuvant chemotherapy in breast cancer: a single-center experience. Revista da Associação Médica Brasileira. 2021;67(06):845-50.
  • 24. Kwak Y, Jang SY, Choi JY, Lee H, Shin DS, Park YH, et al. Progesterone receptor expression level predicts prognosis of estrogen receptor-positive/HER2-negative young breast cancer: a single-center prospective cohort study. Cancers. 2023;15(13):3435.
  • 25. Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, et al. 21-gene assay to inform chemotherapy benefit in node-positive breast cancer. New England Journal of Medicine. 2021;385(25):2336-47.
  • 26. Chaudhary LN, Jawa Z, Szabo A, Visotcky A, Chitambar CR. Relevance of progesterone receptor immunohistochemical staining to Oncotype DX recurrence score. Hematology/oncology and stem cell therapy. 2016;9(2):48-54.

The Effect of Progesterone Receptor Level on Treatment Response in Breast Cancer Patients Receiving Neoadjuvant Therapy

Yıl 2025, Cilt: 47 Sayı: 6, 1022 - 1028, 26.09.2025
https://doi.org/10.20515/otd.1660913

Öz

Clinicians face challenges in deciding on the use of neoadjuvant chemotherapy(NACT) for patients with estrogen receptor(ER)-positive breast cancer due to the potential for low efficacy. Progesterone receptor(PR) is a biomarker routinely evaluated in breast cancer patients prior to NACT, but there is a lack of sufficient clinical data and guideline recommendations regarding its role in treatment decision-making. This study aimed to evaluate the impact of PR status on pathological complete response in ER-positive breast cancer patients receiving NACT. Our study examined 52 ER-positive patients who received NACT. Participants were grouped into three cohorts based on PR levels: less than 1%, 1-9%, and 10% and above. The pathological complete response rate, an important indicator of overall survival, was compared across these three groups. The results of our study showed a statistically significant higher pathological complete response rate in patients with PR levels below 1%. These findings suggest that NACT may be more effective in this patient subgroup. The study findings indicate that PR status may play a role in the decision-making process for NACT in ER-positive breast cancer patients.

Kaynakça

  • 1. Shannon C, Smith I. Is there still a role for neoadjuvant therapy in breast cancer? Critical reviews in oncology/hematology. 2003;45(1):77-90.
  • 2. Schwartz GF, Hortobagyi GN, Committee CC. Proceedings of the consensus conference on neoadjuvant chemotherapy in carcinoma of the breast, April 26–28, 2003, Philadelphia, Pennsylvania. Cancer. 2004;100(12):2512-32.
  • 3. Kaufmann M, Hortobagyi GN, Goldhirsch A, Scholl S, Makris A, Valagussa P, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update. Journal of Clinical Oncology. 2006;24(12):1940-9.
  • 4. Mamtani A, Barrio AV, King TA, Van Zee KJ, Plitas G, Pilewskie M, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study. Annals of surgical oncology. 2016;23:3467-74.
  • 5. Heater NK, Somayaji K, Gradishar W. Treatment of residual disease following neoadjuvant therapy in breast cancer. Journal of surgical oncology. 2024;129(1):18-25.
  • 6. Yee D, DeMichele AM, Yau C, Isaacs C, Symmans WF, Albain KS, et al. Association of event-free and distant recurrence–free survival with individual-level pathologic complete response in neoadjuvant treatment of stages 2 and 3 breast cancer: three-year follow-up analysis for the I-SPY2 adaptively randomized clinical trial. JAMA oncology. 2020;6(9):1355-62.
  • 7. Hammond MEH, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Journal of Clinical Oncology. 2010;28(16):2784-95.
  • 8. Waks AG, Winer EP. Breast cancer treatment: a review. Jama. 2019;321(3):288-300.
  • 9. Ring A, Smith I, Ashley S, Fulford L, Lakhani S. Oestrogen receptor status, pathological complete response and prognosis in patients receiving neoadjuvant chemotherapy for early breast cancer. British journal of cancer. 2004;91(12):2012-7.
  • 10. Johnston SR, Toi M, O'Shaughnessy J, Rastogi P, Campone M, Neven P, et al. Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): results from a preplanned interim analysis of a randomised, open-label, phase 3 trial. The lancet oncology. 2023;24(1):77-90.
  • 11. Yao N, Song Z, Wang X, Yang S, Song H. Prognostic impact of progesterone receptor status in Chinese estrogen receptor positive invasive breast cancer patients. Journal of breast cancer. 2017;20(2):160-9.
  • 12. Bae SY, Kim S, Lee JH, Lee H-c, Lee SK, Kil WH, et al. Poor prognosis of single hormone receptor-positive breast cancer: similar outcome as triple-negative breast cancer. BMC cancer. 2015;15:1-9.
  • 13. Cancello G, Maisonneuve P, Rotmensz N, Viale G, Mastropasqua M, Pruneri G, et al. Progesterone receptor loss identifies Luminal B breast cancer subgroups at higher risk of relapse. Annals of oncology. 2013;24(3):661-8.
  • 14. Makanjuola DI, Alkushi A, Al Anazi K. Defining radiologic complete response using a correlation of presurgical ultrasound and mammographic localization findings with pathological complete response following neoadjuvant chemotherapy in breast cancer. European Journal of Radiology. 2020;130:109146.
  • 15. Dai D, Wu H, Zhuang H, Chen R, Long C, Chen B. Genetic and clinical landscape of ER+/PR-breast cancer in China. BMC cancer. 2023;23(1):1189.
  • 16. Kabos P, Finlay-Schultz J, Li C, Kline E, Finlayson C, Wisell J, et al. Patient-derived luminal breast cancer xenografts retain hormone receptor heterogeneity and help define unique estrogen-dependent gene signatures. Breast cancer research and treatment. 2012;135:415-32.
  • 17. Zheng Z-Y, Bay B-H, Aw S-E, Lin VC. A novel antiestrogenic mechanism in progesterone receptor-transfected breast cancer cells. Journal of Biological Chemistry. 2005;280(17):17480-7.
  • 18. Mohammed H, Russell IA, Stark R, Rueda OM, Hickey TE, Tarulli GA, et al. Progesterone receptor modulates ERα action in breast cancer. Nature. 2015;523(7560):313-7.
  • 19. Cui X, Schiff R, Arpino G, Osborne CK, Lee AV. Biology of progesterone receptor loss in breast cancer and its implications for endocrine therapy. Journal of clinical oncology. 2005;23(30):7721-35.
  • 20. Arpino G, Weiss H, Lee AV, Schiff R, De Placido S, Osborne CK, et al. Estrogen receptor–positive, progesterone receptor–negative breast cancer: association with growth factor receptor expression and tamoxifen resistance. Journal of the National Cancer Institute. 2005;97(17):1254-61.
  • 21. Creighton CJ, Kent Osborne Cv, van de Vijver MJ, Foekens JA, Klijn JG, Horlings HM, et al. Molecular profiles of progesterone receptor loss in human breast tumors. Breast cancer research and treatment. 2009;114:287-99.
  • 22. Paakkola N-M, Karakatsanis A, Mauri D, Foukakis T, Valachis A. The prognostic and predictive impact of low estrogen receptor expression in early breast cancer: a systematic review and meta-analysis. ESMO open. 2021;6(6):100289.
  • 23. Mermut O, Inanc B, Gursu RU, Arslan E, Trabulus DC, Havare SB, et al. Factors affecting pathological complete response after neoadjuvant chemotherapy in breast cancer: a single-center experience. Revista da Associação Médica Brasileira. 2021;67(06):845-50.
  • 24. Kwak Y, Jang SY, Choi JY, Lee H, Shin DS, Park YH, et al. Progesterone receptor expression level predicts prognosis of estrogen receptor-positive/HER2-negative young breast cancer: a single-center prospective cohort study. Cancers. 2023;15(13):3435.
  • 25. Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, et al. 21-gene assay to inform chemotherapy benefit in node-positive breast cancer. New England Journal of Medicine. 2021;385(25):2336-47.
  • 26. Chaudhary LN, Jawa Z, Szabo A, Visotcky A, Chitambar CR. Relevance of progesterone receptor immunohistochemical staining to Oncotype DX recurrence score. Hematology/oncology and stem cell therapy. 2016;9(2):48-54.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Onkoloji
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Mustafa Ersoy 0000-0001-9035-4846

Adalet Nur Yilmaz 0009-0009-4181-395X

Yayımlanma Tarihi 26 Eylül 2025
Gönderilme Tarihi 19 Mart 2025
Kabul Tarihi 16 Eylül 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 47 Sayı: 6

Kaynak Göster

Vancouver Ersoy M, Yilmaz AN. The Effect of Progesterone Receptor Level on Treatment Response in Breast Cancer Patients Receiving Neoadjuvant Therapy. Osmangazi Tıp Dergisi. 2025;47(6):1022-8.


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