HR+/HER2- mBC Online Consensus

Risk Evaluation and Biomarker Testing (I)

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Consensus StatementQuality of EvidenceStrength of Rec.Key Ref
1. Single hormone receptor-positive (ER-/PR+ and ER+/PR-) metastatic breast cancer is associated with worse OS than double hormone receptor-positive metastatic breast cancer.IIA1,4,5
2. Histological type (lobular vs. ductal) is inconsistently associated with worse OS and PFS.IIB1
3. High Ki67 in primary tumor or metastatic site is associated with worse OS and PFS.IIB1,7
4. Disease-free intervala < 2 years is associated with worse OS and PFS.IIA1,6,11
5. De novo metastasis is associated with better OS compared with relapsed disease.bIIA1,6,8
6. Oligometastasis is associated with better OS and PFS.IIA1,6,12

  1. Disease-free interval or recurrence-free interval is often defined as the date of surgery for early breast   cancer to the date of first recurrence.
  2. Late recurrence with disease free interval > 5 years has similar survival outcome with de novo metastasis6.
  3. Liver metastasis in HR+ HER2- breast cancer has poor outcome13.
  4. With more modern or advanced endocrine-based treatment approaches, endocrine resistance might be better defined more by the nature of the resistance and the availability of precision medicine tools to address it, but less by the relapse or progression-free interval15.

References

  1. Prognostic Factors in Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative (HR+/HER2-) Advanced Breast Cancer: A Systematic Literature Review. Gebra Cuyún Carter , Maitreyee Mohanty , Keri    Stenger , Claudia Morato Guimaraes , Shivaprasad Singuru , Pradeep Basa , Sheena Singh , Vanita Tongbram, Sherko Kuemmel , Valentina Guarneri , Sara M TolaneyCancer Management and Research 2021:13 6537–6566.
  2. Endocrine-Based Treatments in Clinically-Relevant Subgroups of Hormone Receptor-Positive/HER2-Negative Metastatic Breast Cancer: Systematic Review and Meta-Analysis. Francesco Schettini , Mario Giuliano, Fabiola Giudici , Benedetta Conte , Pietro De Placido , Sergio Venturini , Carla Rognoni , Angelo Di Leo , Mariavittoria Locci , Guy Jerusalem , Lucia Del Mastro , Fabio Puglisi , PierFranco Conte , Michelino De Laurentiis , Lajos Pusztai , Mothaffar F Rimawi , Rachel Schiff , Grazia Arpino , Sabino De Placido , Aleix Prat, Daniele GeneraliCancers (Basel) . 2021 Mar 22;13(6):1458. DOI: 10.3390/cancers13061458.
  3. Is progression-free survival a more relevant endpoint than overall survival in first-line HR+/HER2 − metastatic breast cancer? Anna Forsythe , David Chandiwana , Janina Barth , Marroon Thabane , Johan Baeck , Anastasiya Shor , Gabriel Tremblay Cancer Management and Research 2018:10 1015–1025. DOI: 10.2147/CMAR.S162714.
  4. Prognostic factors for stage IV hormone receptor-positive primary metastatic breast cancer. Akiko Kawano1 , Chikako Shimizu, Kenji Hashimoto, Takayuki Kinoshita, Hitoshi Tsuda, Hirofumi Fujii, Yasuhiro Fujiwara Breast Cancer . 2013 Apr;20(2):145-51. DOI: 10.1007/s12282-011-0320-3. Epub 2011 Dec 3.
  5. Poor prognosis of single hormone receptor- positive breast cancer: similar outcome as triple-negative breast cancer. Soo Youn Bae, Sangmin Kim, Jun Ho Lee, Hyun-chul Lee, Se Kyung Lee, Won Ho Kil, Seok Won Kim, Jeong Eon Lee and Seok Jin Nam. BMC Cancer . 2015 Mar 18:15:138. DOI: 10.1186/s12885-015-1121-4.
  6. Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis. Leone BA, Vallejo CT, Romero AO, Machiavelli MR, Pérez JE, Leone J, Leone JP. Breast Cancer Res Treat. 2017 Feb;161(3):537-548. doi: 10.1007/s10549-016- 4066-7.
  7. Ki67 expression in the primary tumor predicts for clinical benefit and time to progression on first-line endocrine therapy in estrogen receptor-positive metastatic breast cancer.Delpech Y, Wu Y, Hess KR, Hsu L, Ayers M, Natowicz R, Coutant C, Rouzier R, Barranger E, Hortobagyi GN, Mauro D, Pusztai L. Breast Cancer Res Treat. 2012 Sep;135(2):619-27. doi: 10.1007/ s10549-012-2194-2.
  8. Survival with metastaticbreast cancer based on initial presentation, denovo versus relapsed. den Brok WD,Speers CH, Gondara L, Baxter E, TyldesleySK, LohrischCA. BreastCancer ResTreat. 2017 Feb;161(3):549-556. doi: 10.1007/s10549-016-4080-9.
  9. The prognostic impact of circulating tumor cells in subtypes of metastatic breast cancer.Wallwiener M, Hartkopf AD, Baccelli I, Riethdorf S, Schott S, Pantel K, Marmé F, Sohn C, Trumpp A, Rack B, Aktas B, Solomayer EF, Müller V, Janni W, Schneeweiss A, Fehm TN. Breast Cancer Res Treat. 2013 Jan;137(2):503-10. doi: 10.1007/s10549-012-2382-0.
  10. Prognostic value of circulating tumor cells according to immunohistochemically defined molecular subtypes in advanced breast cancer . Munzone E, Botteri E, Sandri MT, Esposito A, Adamoli L, Zorzino L, Sciandivasci A, Cassatella MC, Rotmensz N, Aurilio G, Curigliano G, Goldhirsch A, Nolè F.. Clin Breast Cancer. 2012 Oct;12(5):340-6. doi: 10.1016/j.clbc.2012.07.001.
  11. Distinct Characteristics and Metastatic Behaviors of Late Recurrence in Patients With Hormone Receptor-positive/Human Epidermal Growth Factor Receptor 2-negative Breast Cancer: A Single Institute Experience of More Than 10 Years. Chen X, Fan Y, Xu B. . Clin Breast Cancer. 2018 Dec;18(6):e1353-e1360. doi: 10.1016/j.clbc.2018.07.014.
  12. 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4). Cardoso F, Senkus E, Costa A, Papadopoulos E, Aapro M, André F, et al. Ann Oncol. 2018 Aug;29(8):1634–57.
  13. Endocrine-Resistant Breast Cancer: Mechanisms and Treatment. Hartkopf AD, Grischke EM, Brucker SY. Endocrine-Resistant Breast Cancer: Mechanisms and Treatment. Breast Care (Basel). 2020 Aug;15(4):347-354. doi:10.1159/000508675.
  14. Risk and prognostic factors of breast cancer with liver metastases.Ji L, Cheng L, Zhu X, Gao Y, Fan L, Wang Z. BMC Cancer. 2021 Mar 6;21(1):238. doi: 10.1186/s12885-021-07968-5.
  15. Abstract Book of The Advanced Breast Cancer Seventh International Consensus Conference (ABC7).Lisa A. Carey. The Breast 2023 Oct. Vol 71, Supplement 1. page S22.

(2025 UPDATE)