Estrogen, Progesterone and HER2 Receptor Discordance Between Primary Tumor and Brain Metastases in Breast Cancer and Its Effect on Treatment and Survival

BACKGROUND: Breast cancer treatment is based on receptors for estrogen (ER), progesterone (PR) and human epidermal growth factor receptor 2 (HER2). At the time of metastasis, receptor status can be discordant from that at initial diagnosis. The purpose of this study was to determine the incidence of discordance and its effect on survival and subsequent treatment in patients with breast cancer brain metastases (BCBM). METHODS: A retrospective database of 316 patients who underwent craniotomy for BCBM between 2006 and 2017 was created. Discordance was considered present if the ER, PR or HER2 receptor status differed between the primary tumor and the BCBM. RESULTS: The overall receptor discordance rate was 132/316 (42%) and the subtype discordance rate was 100/316 (32%). Hormone receptors (HR, either ER or PR) were gained in 40/160 (25%) of patients with HR-negative primary tumors. HER2 was gained in 22/173 (13%) of patients with HER2-negative primary tumors. Subsequent treatment was not adjusted for most patients who gained receptors nonetheless median survival (MS) improved but did not reach statistical significance [HR (17 to 28 months, p=0.12), HER2 (15 to 19 months, p=0.39)]. MS for patients who lost receptors was worse [(HR (27 to 18 months, p=0.02), HER2 (30 to 18 months, p=0.08)). CONCLUSIONS: Receptor discordance between primary tumor and BCBM is common, adversely affects survival if receptors are lost and represents a missed opportunity for use of effective treatments if receptors are gained. Receptor analysis of BCBM is indicated when clinically appropriate. Treatment should be adjusted accordingly.