Comparison of HER2 expression in paired biopsies and surgical specimen of gastric and esophageal adenocarcinoma: Impact of neoadjuvant chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4069-4069
Author(s):  
Sarah Watson ◽  
Pierre Validire ◽  
Pascale Cervera ◽  
Nabila Zorkani ◽  
Frederic Lemay ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Esophageal Adenocarcinoma ◽  
Relative Increase ◽  
Her2 Status ◽  
Her2 Expression ◽  
Surgical Specimen ◽  
Metastatic Relapse ◽  
Previously Treated ◽  
Her 2 ◽  
Well Differentiated

4069 Background: HER2 is overexpressed in 10 to 20% of gastro-esophageal adenocarcinoma (GE-ADK), and is a target for trastuzumab in metastatic patients. We conducted a study to compare HER2 expression between diagnostic biopsies (DB) and surgical specimens (SS) of GE-ADK, and to determine the influence of non-trastuzumab containing neoadjuvant chemotherapy (NAC) on this expression. Methods: Pathological specimens from biopsies of 228 patients operated on with a curative aim in two French hospitals between 2004 and 2011 were collected. Two cohorts treated (n=141) or not (n=87) with a NAC were constituted. Two blind independent pathological HER2 analyses on DB and on SS were performed using IHC and CISH. HER-2 overexpression (HER2 +) was defined by a score 3+ in IHC, or 2+ with a positive CISH test, and according to the specific HER2 scoring guidelines for GE-ADK. Results: Paired HER2 status could be determined for 218 out of the 228 patients (95.6%). HER2 + rates were 13.3% on DB (29/218) and 14.7% on SS (32/218). HER2 + tumors were mainly cardial or esophageal adenocarcinomas, with a well-differentiated, intestinal histological type. HER2 status differed between DB and SS in 13 patients (6%). When DB analyses were added to SS analyses, 5 additional patients were HER2 +, the relative increase in HER2 + cases being 13.5% (17.1% for patients with NAC versus 7.1% for patients without NAC, p=0.4, NS). Differences between DB and SS HER2 expression could be explained by the intratumoral heterogeneity and also by a possible HER2 expression decrease in SS after NAC. Conclusions: The determination of HER2 status on DB provides results that complete those obtained with SS. Combining the analysis of DB and of SS enables to optimize the selection of trastuzumab-eligible patients in case of metastatic relapse, especially in patients previously treated with NAC. [Table: see text]

Comparison of HER-2 expression in diagnostic biopsies and surgical specimens of gastric and esophageal adenocarcinoma: Influence of neoadjuvant chemotherapy.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 18-18
Author(s):  
Sarah Watson ◽  
Pierre Validire ◽  
Pascale Cervera ◽  
Nabila Zorkani ◽  
Aurelie Scriva ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Esophageal Adenocarcinoma ◽  
Test Results ◽  
Trastuzumab Treatment ◽  
Paired Samples ◽  
Esophageal Tumors ◽  
Her 2 ◽  
Well Differentiated ◽  
Diagnostic Biopsies

18 Background: HER-2 is overexpressed in 15 to 20% of gastric and esophageal adenocarcinoma (ADK), and is a target for trastuzumab in metastatic patients (Bang YJ et al, Lancet 2010). The main objective of this study was to compare HER-2 expression between diagnostic biopsies and surgical specimens of gastric ADK, and to determine the influence of non-trastuzumab containing neoadjuvant chemotherapy (NAC) on this expression. Methods: Pathological specimens and biopsies of patients operated on with a curative aim in two French hospitals (Institut Mutualiste Montsouris and Saint-Antoine hospital) between 2004 and 2011 were collected; two cohorts treated or not with a NAC were constituted. Blind HER-2 analyses on biopsies and on surgical specimens were performed using IHC and ISH methods, with two independent pathological readings. HER-2 overexpression was defined by a score 3+ in IHC, or by a score 2+ in IHC with a positive ISH test. Results: Paired samples of 201 patients wereanalyzed. HER-2 overexpression rates were 16.4% on biopsies and 19.4% on surgical specimens. HER-2 positive tumors were mainly cardial or esophageal tumors, with a well-differentiated, intestinal histological type. Surgical specimens seemed to allow better identification of HER-2 positive tumors than diagnostic biopsies for patients that had not received NAC (13.5% of HER-2 positivity on biopsies versus 24.3% on surgical specimens), whereas this trend was reversed for patients with NAC (18.1% of HER-2 positivity on biopsies versus 16.5% on surgical specimens). HER-2 status differed between biopsies and surgical specimens in 10% of patients. Conclusions: The determination of HER-2 status on biopsies provides results that completed those obtained with the analysis of surgical specimens. Analyzed only on surgical specimens, HER-2 status is underestimated in particular after NAC. This study suggests the interest of repeating HER-2 evaluations to optimize the identification of patients that can benefit from trastuzumab treatment.

Responsiveness of adjacent ductal carcinoma in situ and changes in HER2 status after neoadjuvant chemotherapy/trastuzumab treatment in early breast cancer: Results from the GeparQuattro study (GBG 40).

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 6-6
Author(s):  
G. Von Minckwitz ◽  
S. Darb-Esfahani ◽  
S. Loibl ◽  
J. B. Huober ◽  
H. Tesch ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Her2 Status ◽  
Her2 Overexpression ◽  
Her2 Expression ◽  
Her2 Positive ◽  
Complete Eradication

6 Background: Adjacent ductal carcinoma in situ (DCIS) is in found in approximately 45% of invasive ductal carcinomas (IDC) of the breast. Pure DCIS overexpresses HER2 in approximately 45%. There is uncertainty whether adjacent DCIS impacts on the response to neoadjuvant chemotherapy and trastuzumab as well as whether HER2 expression in IDC component or adjacent DCIS changes throughout treatment. Methods: Core biopsies and surgical tissue from participants of the GeparQuattro study with HER2-positive IDC were centrally examined for the area of invasive ductal component and adjacent DCIS before and after receiving neoadjuvant anthracycline-taxane-trastuzumab containing chemotherapy. HER2 overexpression in IDC and adjacent DCIS was quantified separately by immunohistochemistry using the Ventana automated staining system. Pathological complete response (pCR) was defined as no residual invasive or non-invasive tumor tissue. Results: Fifty nine (37.3%) of 158 IDCs presented with adjacent DCIS at diagnosis. These tumors showed lower regression grades than pure IDC (p=0.033). Presence of adjacent DCIS was an independent negative predictor of pCR (odds ratio 0.42 [95% CI 0.2-0.9], p=0.027). Adjacent DCIS area decreased from pre-treatment to surgery (r=0.205) with 30 (50.8%) IDCs with adjacent DCIS showing complete eradication of adjacent DCIS. HER2 status of adjacent DCIS was highly correlated with HER2 status of IDC component before (r=0.892) and after treatment (r=0.676). Degree of HER2 overexpression of the IDC component decreased in 16 (33.3%) out of 49 patients without a pCR. These 16 IDCs showed lower RGs compared to the 33 IDCs with unchanged HER2 expression (p=0.055). Conclusions: HER2-positive IDCs with adjacent DCIS is less responsive to neoadjuvant chemotherapy and trastuzumab compared to pure IDC. However, complete eradication of adjacent DCIS is frequently observed. HER2-overexpression of the invasive ductal component decreases in a subset of tumors, which showed less tumor regression.

The reliability of HER2-status determination from core-needle-biopsies and surgical specimens: A comparison of two established test methods (IHC, CISH)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22141-e22141
Author(s):  
V. Wolf ◽  
R. Groβe ◽  
J. Erggelet ◽  
H. J. Holzhausen ◽  
S. Hauptmann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
In Situ Hybridisation ◽  
Test Method ◽  
Her2 Status ◽  
Surgical Specimen ◽  
Core Needle ◽  
Significant Difference ◽  
Her 2

e22141 Background: A milestone of breast-cancer therapy was the discovery of HER-2 entailing special targeted therapy with improved prognosis. The HER-2-status is routinely assessed through immunohistochemistry (IHC; HercepTest) showing protein over-expression and is double-checked with in-situ-hybridisation (ISH) demonstrating gene amplification in equivocal cases. It is questioned whether these methods achieve identical results in core-needle-biopsies and in excisional tumor specimens. Methods: We performed a retrospective comparative study in order to address these questions. From 01/03–06/08 we collected the HercepTest results from both core-needle-biopsy and surgical specimen of 109 breast cancer patients in our institute and compared these to newly evaluated chromogenic ISH (CISH) results for both specimen types in order to assess the reliability of HER-2- diagnosis of both methodological approaches and of specimen type. Results: We found no significant difference in the HER- 2-status determined from either needle-biopsies or surgical specimens irrespective of the test used. For the overall comparison (218 specimens) of HercepTest and CISH we found only slight, non-significant deviations. Four cases were CISH-negative in spite of HercepTest scoring of 3+. Vice versa, five out of the total of 38 (17.4%) CISH-positives did not correspond to the HercepTest results of 0 or 1+. Conclusions: Though not significant, there is some inconsistency in the HER-2-determination depending on the test-method, leaving these cases equivocal. In accordance with the literature, we therefore recommend to at least double-check samples with 2+ in the HercepTest as it is the current standard. Our data support the use of core-needle-biopsy as a reliable tissue sample for HER-2-diagnosis. [Table: see text]

Implementing a Machine Learning Strategy to Predict Pathologic Response in Patients With Soft Tissue Sarcomas Treated With Neoadjuvant Chemotherapy

2021 ◽  
pp. 958-972
Author(s):  
Amandine Crombé ◽  
Sophie Cousin ◽  
Mariella Spalato-Ceruso ◽  
François Le Loarer ◽  
Maud Toulmonde ◽  
...  
Keyword(s):  
Machine Learning ◽  
Soft Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Standard Model ◽  
Cox Regression ◽  
Soft Tissue Sarcomas ◽  
Histologic Response ◽  
Surgical Specimen ◽  
Metastatic Relapse ◽  
The Standard Model

PURPOSE Neoadjuvant chemotherapy (NAC) has been increasingly used in patients with locally advanced high-risk soft tissue sarcomas in the past decade, but definition and prognostic impact of a good histologic response (GHR) are lacking. Our aim was to investigate which histologic feature from the post-NAC surgical specimen independently correlated with metastatic relapse-free survival (MFS) in combination with clinical, radiologic, and pathologic features using a machine learning approach. METHODS This retrospective study included 175 consecutive patients (median age: 59 years, 75 women) with resectable disease, treated with anthracycline-based NAC between 1989 and 2015 in our sarcoma reference center, and with quantitative histopathologic analysis of the surgical specimen. The outcome of interest was the MFS. A multimodel, multivariate survival analysis was used to define GHR. The added prognostic value of GHR was investigated through the comparisons with the standard model (including histologic grade, size, and depth) and SARCULATOR nomogram using concordance indices (c-index) and Monte-Carlo cross-validation. RESULTS Seventy-two patients (72 of 175, 41.1%) had a metastatic relapse. Stepwise Cox regression, random survival forests, and least absolute shrinkage and selection operator–penalized Cox regression all converged toward the same definition for GHR, ie, < 5% stainable tumor cells. The five-year MFS probability was 1 (95% CI, 1 to 1) in patients with GHR versus 0.73 (95% CI, 0.65 to 0.81) in patients without GHR (log-rank P = .0122). The final prognostic model incorporating the GHR was significantly better than the standard model and SARCULATOR (average c-index in testing sets = 0.72 [95% CI, 0.61 to 0.82] v 0.57 [95% CI, 0.44 to 0.70] and 0.54 [95% CI, 0.45 to 0.64], respectively; P = .0414 and .0091). CONCLUSION Histologic response to NAC improves the prediction of MFS in patients with soft tissue sarcoma and represents a possible end point in future studies exploring innovative regimens in the neoadjuvant setting.

Changes in tumor biological markers during primary systemic chemotherapy (PST)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20035-20035
Author(s):  
E. Solomayer ◽  
H. Neubauer ◽  
V. Beck ◽  
J. Huober ◽  
U. Vogel ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Therapy Response ◽  
Pathological Response ◽  
Receptor Expression ◽  
Her2 Status ◽  
Cytotoxic Therapy ◽  
Primary Systemic Therapy ◽  
Ki 67 ◽  
Surgical Specimen

20035 Background: Tumorbiological factors including HER2, estrogen receptor and progesterone receptor status are routinely determined prior neoadjuvant chemotherapy. Based on these results adjuvant treatment decisions regarding trastuzumab and endocrine therapy are made. However, the expression of these markers may be altered by cytotoxic therapy. Therefore, tumorbiological factors including HER2, ER, PR, ki-67 were studied in 87 patients treated before and after primary systemic therapy. Method: Corresponding cut-core biopsies and postchemotherapy surgical specimens were available from 87 patients treated with neoadjuvant chemotherapy. HER2, ER, PR and ki-67 were immunohistochemically assessed. Results: Pathological response rate was 69%. No significant changes were seen for ER receptor expression. Four tumors positive for ER changed to ER negative. In contrast, 13 initially PR-positive tumors were classified PR-negative after cytotoxic therapy (p < 0.05). A significant change was also observed for HER2 status. Eleven tumors which were negative prior to PST did overexpress HER2 in the post chemotherapy surgical specimen. Median ki-67 index decreased from 30% before PST to 13% after treatment (p < 0.01). Only reduction of ki-67 was associated with pathological response to PST. Conclusion: HER2 status as well as ER and PR status should be reevaluated on post-chemotherapy surgical specimens since changes can be observed. The clinical relevance of these changes regarding therapy response to adjuvant endocrine therapy or trastuzumab has yet to be determined. No significant financial relationships to disclose.

HER2 as a Predictive Factor for Successful Neoadjuvant Anthracycline Chemotherapy of Locally Advanced and Early Breast Cancer

2014 ◽  
Vol 29 (3) ◽  
pp. 187-192
Author(s):  
Jiayu Wang ◽  
Binghe Xu ◽  
Peng Yuan ◽  
Qing Li ◽  
Pin Zhang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Objective Response ◽  
Locally Advanced ◽  
Eastern Cooperative Oncology Group ◽  
Disease Free Survival ◽  
Her2 Status ◽  
Her2 Overexpression ◽  
Her2 Expression ◽  
Primary Tumors

Objective The aim of this study was to look for predictive and prognostic factors in anthracycline-based neoadjuvant chemotherapy. Methods Three hundred and nine patients with early-stage or locally advanced breast cancer were enrolled in this study and preoperatively treated with neoadjuvant chemotherapies in intense dose-dense (cyclophosphamide + epirubicin) or conventional (paclitaxel + epirubicin) regimens. Outcome parameters included overall objective response rate, as well as factors for determining pathological features influencing the efficacy of chemotherapy, such as estrogen receptor, progesterone receptor, and HER2 status, Eastern Cooperative Oncology Group (ECOG) score, tumor size, tumor inflammation, and lymph node metastasis. Results The overall pathological complete response (pCR) rate was 14.3%, and the main factor affecting the efficacy of chemotherapy was HER2 expression. The pCR rate was significantly higher for patients with HER2 overexpression, compared with patients with low HER2 expression (27.5% vs. 9.6%, p<0.001). The recurrence risk for patients with pCR decreased 1.12-fold compared with patients without pCR (5-year disease-free survival [DFS]: 81.8% vs. 65.7%, p=0.038). Patients in the HER2 overexpression subgroup benefited more from pCR than those in the HER2 low expression group (5-year DFS: 86.4% vs. 62.1%, p=0.049). Conclusion HER2 overexpression in primary tumors might be a predictive marker for good efficacy of anthracycline-based neoadjuvant chemotherapy. The pCR is a suitable prognostic factor, even for patients with HER2 overexpression.

Effect of neoadjuvant chemotherapy on oestrogen, progesterone, and HER-2 receptor expression in breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11588-e11588
Author(s):  
T. Sircar ◽  
S. Chaudhri ◽  
A. Francis
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Core Biopsy ◽  
Locally Advanced ◽  
Receptor Expression ◽  
Her2 Status ◽  
Her2 Positive ◽  
Usual Practice ◽  
Surgical Specimen

e11588 Background: Neoadjuvant chemotherapy(NC) is used in treating locally advanced operable breast cancer. After surgery, further adjuvant treatment is offered based on the estrogen receptor (ER), progesterone receptor (PR) and HER2 status. Treatment post operatively can be based on the ER/PR/HER2 status of the core biopsy taken preoperatively. It is not a usual practice in the United Kingdom to repeat these markers on the surgical specimen. However a change in ER/PR or HER2 status following NC could have a profound effect on adjuvant treatment with the real possibility of appropriate therapy being unknowingly withheld. The aim of our study was to determine the percentage of patients whose ER/PR, HER2 receptor expression change with NC and if these changes lead to change in their adjuvant treatment. Methods: This is a retrospective study of 32 patients with locally advanced breast cancer who had NC followed by breast conservation surgery or mastectomy. Quick score (Q score) for ER/PR and the HER2 expression was measured both from the preoperative core biopsy and from the excision specimen following NC. Results: After NC, 5 patients had complete pathological response and 2 patients had residual ductal carcinoma in situ. 25(78%) patients had residual invasive malignancy. Quantitative change in Q scores for ER and PR was seen in 6 patients(24%) and 10 patients (40%) respectively. ER status changed from positive to negative in 1 patient(4%). PR status changed from positive to negative in 4 patients(16%) and from negative to positive in one patient (4%). One patient(4%) changed from HER2 negative to HER2 positive after NC. Conclusions: Change in 1 patient(4%) from HER2 negative to HER2 positive lead to change in adjuvant treatment who would have otherwise not received transzutumab.Q scores changed in 24% and 40% for ER and PR respectively, however, no change was observed with regards to hormonal adjuvant treatment. A study with a bigger cohort might address this issue. We suggest that ER/PR/HER2 status should routinely be checked in both core biopsy sample and also resection specimen. No significant financial relationships to disclose.

Comparison of ER, PR, HER2 in primary and paired relapsed/metastatic lesions of metastatic breast cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1063-1063
Author(s):  
E. Sari ◽  
G. Guler ◽  
M. Hayran ◽  
K. Altundag ◽  
I. Gullu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Metastatic Breast ◽  
Her2 Status ◽  
Her2 Overexpression ◽  
Her2 Expression ◽  
Metastatic Lesions ◽  
Er Positive ◽  
Her 2 ◽  
Er Expression

1063 Background: The assessment of ER, PR and HER2 is made routinely in every breast cancer patient to have information about prognosis and to select patients (pts) who are candidates for hormonal and anti-HER2 therapy. Recent studies have shown some degrees of discordance in ER, PR, and HER-2 expression between primary and recurrent/metastatic lesions (RML). In this study we compared the ER, PR, and HER2 status of the primary and paired RML in metastatic breast cancer pts. Methods: Analysis was made on 79 metastatic breast cancer pts whose ER, PR, and/or HER2 status were known both on the tissue samples of primary and RML. ER, PR, and HER2 status were determined by immunohistochemistry and/or fluorescence-in-situ hybridization. Results: Among the RML sites, 24% were locoregional, 76% were distant metastatic sites. Among 72 pts with known ER expression on both primary and RML, 36% showed discordance on ER expression. Most of the change occurred from negative to positive ER status (15 of 48 ER positive primaries had ER negative paired metastasis and 11 of 24 ER negative primaries had ER positive paired metastasis). Among 68 pts with known PR expression on both primary and RML, 51.5% showed discordance on PR expression. Change in PR status from positive to negative and negative to positive was similar (23 of 45 PR positive primaries had PR negative paired metastasis and 12 of 23 PR negative primaries had PR positive paired metastasis). Among 58 pts with known HER2 expression on both primary and RML, 15.5% showed discordance on HER2 expression. Six pts with HER-2 negative primaries, showed HER2 overexpression in their paired RML. Four pts who had HER2 overexpressing primary did not show HER2 expression in the paired RML. Conclusions: A proportion of pts show discordances in hormonal receptor and HER2 expression between the primary tumor and the paired RML. As these discordant results make changes in treatment decision, a biopsy of the metastatic lesion could be recommended in metastatic breast cancer pts when feasible. No significant financial relationships to disclose.

Changes of estrogen receptor, progesterone receptor and HER2 expression in breast cancer with/without neoadjuvant chemotherapy or endocrine therapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14699-e14699
Author(s):  
Shigeto Maeda
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Neoadjuvant Chemotherapy ◽  
Progesterone Receptor ◽  
Endocrine Therapy ◽  
Medical Center ◽  
Predictive Marker ◽  
Her2 Status ◽  
Surgical Specimen ◽  
Initial Biopsy

e14699 Background: Concordance in hormone receptor and Human Epidermal Growth Factor Type 2 (HER2) status in breast cancer was observed between initial biopsy and surgical specimens. This study aimed to analyze the correlation in Estrogen receptor (ER), Progesterone receptor (PR) and HER2 status of the initial biopsy and surgical specimen in non-neoadjuvant therapy (CON), neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy (NAE). Secondary aim is to know the changed expression of ER, PR and HER2 as predictive marker for overall survival. Methods: We retrospectively analyzed 1265 surgical specimens from April 2007 to January 2018 in National Nagasaki Medical Center. Out of 1265 patients, 752 CON, 144 NAC and 28 NAE pairs of samples from initial core biopsy and surgical specimen were compared to the expression of the ER, PR and HER2 by immunohistochemically. Spearman’s rank correlation coefficient is calculated. Results: See table. Conclusions: ER and PR expression percentage is highly correlated between core needle biopsy and surgical specimen. After neoadjuvant chemotherapy, PR lost 8.2% after NAC and 40.8% after NAE. PR loss may become predictive marker after systemic therapy.[Table: see text][Table: see text]

Neoadjuvant chemotherapy versus neoadjuvant hormonal therapy in postmenopausal women with ER-positive, HER2/neu negative locally advanced breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 595-595
Author(s):  
Tadeu Frantz Ambros ◽  
Isildinha M. Reis ◽  
Dilprit Bagga ◽  
Jose Caetano Villasboas ◽  
Clifford Blieden ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Postmenopausal Women ◽  
Hormonal Therapy ◽  
Tumor Size ◽  
Locally Advanced ◽  
Surgical Specimen ◽  
Neoadjuvant Hormonal Therapy ◽  
Er Positive ◽  
Her 2

595 Background: Postmenopausal women with large ER+/HER-2 negative tumors frequently receive neoadjuvant chemotherapy (NC), but pathological complete response (pCR) rates are low. Neoadjuvant hormonal therapy (NH) may offer benefit in this setting. Methods: Retrospective review of medical records from University of Miami/Jackson Memorial Hospital from 1998-2011. Primary outcomes: pCR (absence of invasive tumor in breast and lymph nodes at surgery), recurrence free survival (RFS) and tumor size reduction evaluated through comparison of palpable breast mass size at presentation with pathological tumor size in surgical specimen, and categorized as good response (GR) ≥ 30% reduction or no response (NR) < 30%. The Kaplan-Meier method and the log-rank test were used in the analysis of RFS. Results: Data from 151 post-menopausal women with ER+/HER-2 negative BC who received NC (57%) or NH (43%) was analyzed. Median follow-up among alive patients with no evidence of disease was 5.4 years in NC and 2.9 years in NH. Mean age was higher in the NH group (63.3 vs 56.1, p<0.0001). There were no racial or ethnic differences between the groups. Clinical stage was comparable in NC and NH (IIA 5.8% vs 9.2%, IIB 25.6% vs 20%, IIIA 37.2% vs 29.2%, IIIB/IIIC 31.4% vs 41.5%, p=0.775). Tumor histology was predominantly ductal in both groups (NC 85.7% and NH 78.5%, p=0.247). pCR was similar in NC and NH (4.7% vs 0%, p=0.078) along with RFS (median 8.5 yrs vs 6.0 yrs, p=0.946). In the NC group, GR was significantly more frequent (77.9% vs 60%, p=0.017). Among patients in the NH group, having GR was predictive of longer RFS (5-year rate 83.7% vs 50.5%, p=0.014). Breast only pCR occurred at equivalent rates between NC and NH (9.3% vs 3.1%, p=0.189) as did the absence of lymph node metastasis (29.1% vs 26.2%, p=0.606). In the NH cohort 38.5% received no adjuvant chemotherapy. Conclusions: NH provides an effective alternative to NC and, if there is a GR, may preclude the need for chemotherapy in over one third of postmenopausal women with large ER positive/HER-2 negative breast cancer.

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