Prognostic value of low HER2 expression in patients with early breast cancer


DOI: https://dx.doi.org/10.18565/pharmateca.2025.3.44-54

Bekkeldieva N.B., Semiglazov V.F., Kudaibergenova A.G., Emelyanov A.S., Nikolaev K.S., Mortada V.V., Zernov K.Yu., Raimzhanov Ch.A., Tabagua T.T., Pesotsky R.S., Bondarchuk Ya.I., Amirov N.S., Enaldieva D.A., Ulrikh D.G., Levchenko V.E., Krivorotko P.V.

N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
Background: More than 50% of breast cancer (BC) cases are currently defined with lower levels of HER2 protein expression (HER2-low): HER2–1+ or 2+ with negative ISH. Most of the available retrospective analyses have not found that low HER2 expression has significant prognostic value.
Objective: Comparative analysis of long-term treatment outcomes in patients with early BC depending on the HER2 expression level and HR status, analysis of survival rates in groups of patients with different HER2 expression levels, depending on menopausal status.
Materials and methods: The study included 265 patients with BC (stage II) who received treatment at the N.N. Petrov National Medical Research Center of Oncology from 2011 to 2019. The patients were divided into groups depending on the HER2 expression level and HR status. Then, all patients were divided into 2 groups depending on menopausal status, then into subgroups depending on the HER2 expression level and HR status.
Results: The data of 265 patients with BC were analyzed, including 97 (36.6%) cases with HER2-low, of which 71 were HR+ (73.2%) and 26 (26.8%) patients were HR-. No statistically significant differences were observed in the survival analysis, but the worst 5-year relapse-free survival (RFS) was 73.1% in patients with HR-/HER2-low versus 76% with HR-/HER2-0. Overall survival (OS) rates were 88.5% with HR-/HER2-low and 98%, respectively. Also, in the HR-/HER2+ subgroup, RFS rates were low – 71.4%, OS – 94.3%. In premenopausal patients, 5-year RFS was 74.3% in the HR+/HER2-low subgroup versus HR+/HER2+ – 93.9% (p=0.010). In postmenopausal patients, there were no statistically significant differences in the RFS and OS analysis.
Conclusion: The lowest RFS and OS rates were observed in patients with HR-/HER2-low BC. Premenopausal patients had lower RFS rates with HR+/HER2-low versus HR+/HER2+ (74.3% versus 93.9%). Further studies to assess the relationship between hormone receptors, their levels, and the magnitude of HER2 expression are required.
Keywords: overall and relapse-free survival, HER2 expression, breast cancer
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About the Autors

Nestan B. Bekkeldiyeva, Postgraduate Student, Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; bekkeldiyeva.n@bk.ru, ORCID: https://orcid.org/0009-0009-6055-720Х (corresponding author)
V.F. Semiglazov, Dr. Sci. (Med.), Corr. Member of the RAS, Professor, Head of the Scientific Department of Breast Tumors, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0003-0077-9619
A.G. Kudaibergenova, Cand. Sci. (Med.), Pathologist of the Pathological Anatomy Department, SeniorResearcher of the Scientific Laboratory of Tumor Morphology, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0001-7797-088X
A.S. Emelyanov, Cand. Sci. (Med.), Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID:
https://orcid.org/0000-0002-0528-9937
K.S. Nikolaev, Cand. Sci. (Med.), Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID:
https://orcid.org/0000-0003-3377-6369
V.V. Mortada, Cand. Sci. (Med.), Oncologist, Plastic Surgeon, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID: https: //orcid.org/0000-0002-1982-5710
K.Yu. Zernov, Cand. Sci. (Med.), Oncologist, Plastic Surgeon, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0002-2138-3982
Ch.A.Raimzhanov, Ultrasound Diagnostics Doctor, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia;
ORCID: https://orcid.org/0009-0004-1321-1269
T.T. Tabagua, Cand. Sci. (Med.), Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID:
https://orcid.org/0000-0003-1471-9473
R.S. Pesotsky, Cand. Sci. (Med.), Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID:
https://orcid.org/0000-0002-2573-2211
Ya.I. Bondarchuk, Postgraduate Student, Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0002-6442-0106
N.S. Amirov, Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0002-2421-3284
D.A. Enaldieva, Postgraduate Student, Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0002-2773-3111
D.G. Ulrikh, Oncologist, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0002-1346-933Х
V.E. Levchenko, Postgraduate Student, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia; ORCID:
https://orcid.org/0009-0003-6597-376Х
P.V. Krivorotko, Dr. Sci. (Med.), Professor, Head of the Department of Breast Tumors, N.N. Petrova, St. Petersburg, Russia; ORCID:
https://orcid.org/0000-0002-4898-9159


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