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Should liver metastases of breast cancer be biopsied to improve treatment choice?

Abstract # CRA 1008. Should liver metastases of breast cancer be biopsied to improve treatment choice?. M. A. Locatelli , G. Curigliano, L. Fumagalli, V. Bagnardi, G. Aurilio, P. Della Vigna, L. Monfardini, S. Giudici, G. Viale, A. Goldhirsch European Institute of Oncology, Milan, Italy.

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Should liver metastases of breast cancer be biopsied to improve treatment choice?

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  1. Abstract # CRA 1008 Should liver metastases of breast cancer be biopsied to improve treatment choice? M. A. Locatelli, G. Curigliano, L. Fumagalli, V. Bagnardi, G. Aurilio, P. Della Vigna, L. Monfardini, S. Giudici, G. Viale, A. Goldhirsch European Institute of Oncology, Milan, Italy Chicago, June 08, 2010

  2. Purpose • To evaluate the rate of discordance of estrogen receptor (ER), progesterone receptor (PgR) and HER2 receptor status between primary breast cancer (BC) and liver metastases • To evaluate its potential impact on treatment choice

  3. Background • Determination of ER, PgR and HER2 status in the primary tumor is clinically relevant to define: • the BC subtypes • the clinical outcome • the choice of therapy

  4. Background • Nonetheless, currently the acquisition of tissue from metastatic lesions is not recommended as a routine practice

  5. Patients and Methods • Retrospective analysis of 1250ultrasound guided liver biopsies performed at IEO from August 1999 to March 2009 • 255/1250were identified as consecutive female BC • The occurrence of ER, PgR and HER2 discordance in liver metastasis and primitive BC was evaluated

  6. Patients and Methods: Inclusion Criteria • Histological diagnosis of primary BC • Unilateral BC with development of liver metastasis • Recorded expression status of ER, PgR, HER2 in both primary BC and liver metastasis • Any form of therapy: surgical, systemic, and radio

  7. Patients and Methods: Exclusion Criteria • Bilateral BC • Male Gender • Ductal carcinoma in situ as initial diagnosis • Synchronous metastases

  8. Characteristics of patient study population 203 cases (79.6%) endocrine responsive tumor expressing ER and/or PgR

  9. Characteristics of patient study population * 16 pts had liver synchronous mts and were not considered

  10. ResultsQualitative changes in ER status p=0.001 Overall discordance rate (95% CI): 14.5% (10.4-19.4)

  11. ResultsQualitative changes in PgR status p<0.0001 Overall discordance rate (95% CI): 48.6% (42.3-54.9)

  12. ResultsQualitative changes in Her-2/neu status* p<0.001 Overall discordance rate (95% CI): 13.9% (9.1-20.1) *83 pts with missing value at primary or at liver biopsy were not considered

  13. Impact of the receptor status discordance on therapy choices

  14. Summary • “In the era of continuing biological and therapeutic advances should we continue to use a historical pathological snapshot of the primary tumor or should we reassess biology of metastatic disease?”

  15. Summary • In our study discordance for ER, PgR, and HER2 status between primary tumor and liver metastases was 14.5%, 48.6%, and 13.9% respectively, which led to a change of the therapy for 31 out of 255 pts (12.1%) • The main limitation is related to the retrospective analysis • Another limitation is related to the manual scoring of ER, PgR and HER2

  16. Conclusions • There is emerging evidence that tumor receptor status may change dynamically during the natural history of the disease • When safe and easy to perform, a biopsy of the metastatic lesion should be considered in all patients, particularly when there is a long interval from the first diagnosis, since it is likely to impact treatment choice.

  17. Acknowledgements: • Aron Goldhirsch • Giuseppe Curigliano • Giuseppe Viale • Luca Fumagalli • Vincenzo Bagnardi • Simona Giudici • Gaetano Aurilio • Paolo Della Vigna • Lorenzo Monfardini … and to all patients

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