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JNCI Journal of the National Cancer Institute 2003 95(2):142-153; doi:10.1093/jnci/95.2.142
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Journal of the National Cancer Institute, Vol. 95, No. 2, 142-153, January 15, 2003
© 2003 Oxford University Press


ARTICLE

Quantitative Association Between HER-2/neu and Steroid Hormone Receptors in Hormone Receptor-Positive Primary Breast Cancer

Gottfried Konecny, Giovanni Pauletti, Mark Pegram, Michael Untch, Sugandha Dandekar, Zuleima Aguilar, Cindy Wilson, Hong-Mei Rong, Ingo Bauerfeind, Margret Felber, He-Jing Wang, Malgorzata Beryt, Ram Seshadri, Herrmann Hepp, Dennis J. Slamon

Affiliations of authors: G. Konecny, G. Pauletti, M. Pegram, S. Dandekar, Z. Aguilar, C. Wilson, H.-M. Rong, M. Beryt, D. J. Slamon, Division of Hematology-Oncology, Department of Medicine, and Jonsson Comprehensive Cancer Center, University of California at Los Angeles School of Medicine, Los Angeles; M. Untch, I. Bauerfeind, M. Felber, H. Hepp, Department of Obstetrics and Gynecology, Klinikum Grosshadern, Ludwig Maximilians Universität München, München, Germany; H.-J. Wang, Department of Biomathematics, University of California at Los Angeles School of Medicine; R. Seshadri, Flinders Medical Centre, Flinders University of South Australia, Bedford Park.

Correspondence to: Dennis J. Slamon, M.D., Ph.D., Division of Hematology-Oncology, Department of Medicine, 11–934 Factor Bldg., UCLA School of Medicine, Los Angeles, CA 90095–1678 (e-mail: dslamon{at}mednet.ucla.edu).

Background: HER-2/neu, which encodes a receptor tyrosine kinase, is amplified and overexpressed in 20%–25% of human breast cancers. Such tumors are often resistant to hormone therapy. Despite a general inverse association between HER-2/neu amplification/overexpression and estrogen receptor (ER) and/or progesterone receptor (PR) expression, a fraction of patients are both HER-2/neu- and hormone receptor (HR)-positive. The efficacy of hormone therapy in this group is currently a matter of debate. To better understand the relationship between HER-2/neu positivity and HR expression, we analyzed HER-2/neu, ER, and PR as continuous variables in breast cancer cell lines and two cohorts of primary breast cancer patients. Methods: HER-2/neu and ER/PR expression was analyzed by enzyme-linked immunosorbent assay (ELISA) and enzyme immunoassay (EIA), respectively, in 14 human breast cancer cell lines, some of which had been transfected with the HER-2/neu gene. For the clinical study population, HER-2/neu protein levels were assessed by ELISA (cohort A, n = 665), and HER-2/neu gene copy number was determined using fluorescence in situ hybridization (cohort B, n = 894). ER/PR expression was analyzed by EIA (cohort A) or radioligand binding (cohort B). Associations between HER-2/neu and ER/PR expression were analyzed using Spearman’s rho correlation and the chi-square test, and absolute levels were compared using the Mann–Whitney U test. All statistical tests were two-sided. Results: HR-positive human breast cancer cell lines transfected with the HER-2/neu gene expressed statistically significantly lower levels of ER and PR than parental lines. In the clinical cohorts, levels of HER-2/neu overexpression and gene amplification were inversely correlated with ER/PR levels (Cohort A [n = 112]: for ER, r = –0.34, P<.001; for PR, r = –0.24, P = .010. Cohort B [n = 188]: for ER, r = –0.39, P<.001; for PR, r = –0.26, P<.001). Among patients with HR-positive tumors, HER-2/neu-positive tumors had statistically significantly lower ER/PR levels than HER-2/neu-negative ones (Cohort A: for ER, median = 25 fmol/mg [interquartile range {IQR} = 13–78] versus median = 38.5 fmol/mg [IQR = 17–99] and P = .031; for PR, median = 35 fmol/mg [IQR = 12–119] versus median = 88.5 fmol/mg [IQR = 22–236] and P<.001. Cohort B: for ER, median = 44 fmol/mg [IQR = 13–156] versus median = 92 fmol/mg [IQR = 35–235] and P<.001; for PR, median = 36 fmol/mg [IQR = 13–108] versus median = 84 fmol/mg [IQR = 24–250] and P<.001). Patients with higher levels of HER-2/neu overexpression or amplification had statistically significantly lower levels of ER/PR than patients with lower levels of HER-2/neu overexpression or amplification. Conclusion: Because absolute HR levels are strongly related to response to hormone therapy in primary and advanced breast cancer, reduced ER/PR expression may be one mechanism to explain the relative resistance of HER-2/neu-positive:HR-positive tumors to hormone therapy.



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Correspondence about this Article

Re: Quantitative Association Between HER-2/neu and Steroid Hormone Receptors in Hormone Receptor-Positive Primary Breast Cancer
Frédérique Spyratos, Cécile Bouchet, Magali Ferrero-Poüs, Michèle Tubiana-Hulin, and Kamel Hacène
J Natl Cancer Inst 2003 95: 1417-1418. [Extract] [Full Text] [PDF]



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G. E. Konecny, Y. G. Meng, M. Untch, H.-J. Wang, I. Bauerfeind, M. Epstein, P. Stieber, J.-M. Vernes, J. Gutierrez, K. Hong, et al.
Association between HER-2/neu and Vascular Endothelial Growth Factor Expression Predicts Clinical Outcome in Primary Breast Cancer Patients
Clin. Cancer Res., March 1, 2004; 10(5): 1706 - 1716.
[Abstract] [Full Text] [PDF]


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JCOHome page
G. Ferretti, S. Di Cosimo, D. Giannarelli, P. Carlini, P. Papaldo, A. Alimonti, A. Fabi, M. Mandala, M. Milella, E. M. Ruggeri, et al.
HER2/neu Expression and Hormonal Therapy in Early Breast Cancer: Can Muddy Waters Become Clear?
J. Clin. Oncol., February 1, 2004; 22(3): 568 - 569.
[Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
G. E. Konecny, C. A. Wilson, and D. J. Slamon
Is There a Role for Epidermal Growth Factor Receptor Inhibitors in Breast Cancer Prevention?
J Natl Cancer Inst, December 17, 2003; 95(24): 1813 - 1815.
[Full Text] [PDF]


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Cancer Res.Home page
M. J. Ellis, A. Coop, B. Singh, Y. Tao, A. Llombart-Cussac, F. Janicke, L. Mauriac, E. Quebe-Fehling, H. A. Chaudri-Ross, D. B. Evans, et al.
Letrozole Inhibits Tumor Proliferation More Effectively than Tamoxifen Independent of HER1/2 Expression Status
Cancer Res., October 1, 2003; 63(19): 6523 - 6531.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
F. Spyratos, C. Bouchet, M. Ferrero-Pous, M. Tubiana-Hulin, and K. Hacene
Re: Quantitative Association Between HER-2/neu and Steroid Hormone Receptors in Hormone Receptor-Positive Primary Breast Cancer
J Natl Cancer Inst, September 17, 2003; 95(18): 1417 - 1418.
[Full Text] [PDF]


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Ann OncolHome page
G. Atalay, F. Cardoso, A. Awada, and M. J. Piccart
Novel therapeutic strategies targeting the epidermal growth factor receptor (EGFR) family and its downstream effectors in breast cancer
Ann. Onc., September 1, 2003; 14(9): 1346 - 1363.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
J. S. Ross, J. A. Fletcher, G. P. Linette, J. Stec, E. Clark, M. Ayers, W. F. Symmans, L. Pusztai, and K. J. Bloom
The HER-2/neu Gene and Protein in Breast Cancer 2003: Biomarker and Target of Therapy
Oncologist, August 1, 2003; 8(4): 307 - 325.
[Abstract] [Full Text] [PDF]



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