HR+, HER2- Early Breast Cancer

Understanding Recurrence: High-Risk Features for Patients With Early Breast Cancer

Early breast cancer (EBC) recurrence: some clinical features of high-risk disease

Patients with hormone receptor–positive (HR+), HER2-negative (HER2-) EBC at high risk of recurrence may present with 1-3 positive ALNs with grade 3 disease or tumor size ≥5 cm, or ≥4 positive ALNs,.¹

Factors associated with a high risk of recurrence in EBC

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Putting it into practice: EBC patient case studies

Samantha*

Age: 52 years
Menopausal status: Perimenopausal, irregular menses in the past 7 months
Occupation: Supervisor at a retail store
Marital status: Divorced with 1 adult child
Presentation: Presents with right breast nodule discovered during a mammogram test; patient has not had a routine checkup in 3 years
Comorbidities: None relevant

*Hypothetical patient

Immunohistochemistry profile

ER: 85%
PgR: 80%
HER2- IHC 0
No clinical or radiographic evidence of distant metastases

Mammography, ultrasound, biopsy, and clinical examination

4 Positive ALNs

Right breast nodule, size 6.5 cm

Invasive ductal carcinoma, grade 3

Diagnosis

Samantha is diagnosed with stage 3B (T4N2M0) HR+, HER2- breast cancer and is at a high risk of recurrence during treatment with adjuvant therapy.

Clara*

Age: 50 years
Menopausal status: Postmenopausal
Occupation: Tax firm executive
Marital status: Married with 2 adult children
Presentation: Presents with right breast nodule discovered during magnetic resonance imaging after sports injury
Comorbidities: Type 2 diabetes

*Hypothetical patient

Immunohistochemistry profile

ER: 75%
PgR: 95%
HER2- IHC 0
No clinical or radiographic evidence of distant metastases

Mammography, ultrasound, biopsy, and clinical examination

1 Positive ALN

Right breast nodule, size 4 cm

Invasive ductal carcinoma, grade 3

Diagnosis

Clara is diagnosed with stage 2B (T2N1M0) HR+, HER2- breast cancer and is at a high risk of recurrence during treatment with adjuvant therapy.

Related Resources

Downloadable PDFs

INFOGRAPHIC: EBC Patients at a High Risk of Recurrence Case Studies

Hormone receptor positive, HER2 negative breast cancer is a spectrum disease, and we do have patients at particularly high risk for recurrence in the first 5 years. That is generally what we think about when we think about high-risk disease, at least initially in the clinic. And these are patients generally with larger cancers, nodes positive, particularly high nodal burden, 4 or more lymph nodes positive, but also grade 3 disease, or one of a high-risk score on one of our genomic signatures, so 21 gene or 70 gene signatures.

Defining high-risk HR+, HER2- early breast cancer

Dr. O’Shaughnessy describes risk factors for HR+, HER2- breast cancer disease recurrence with in the first five years such as larger cancers, high nodal burden, grade 3 disease, Ki-67 score, and certain gene signatures.

Women at high risk of recurrence with HR positive, HER2 negative breast cancer really do need to avail themselves of all of the proven treatment strategies we have available. And the way I get across is I tell women what their risk of systemic recurrence of disease is, what their risk of loco-regional recurrence is, and I really kind of quantitatively lay out for them what their improvement in outcome will be with each of the proven treatment strategies we have for the patient. So, I write it down and I really make it very clear that every single thing we have that is proven is going to get them the highest possible chance of remaining disease-free.

Conveying risk for recurrence & importance of optimizing therapy to decrease that risk in HR+, HER2- EBC

Dr. O’Shaughnessy shares how she educates her patients on their risk of recurrence with HR+, HER2- early breast cancer (EBC).

References

Shefﬁeld KM, et al. Future Oncol. 2022;18(21):2667-2682.

VV-MED-154879

Understanding Recurrence: High-Risk Features for Patients With Early Breast Cancer

Early breast cancer (EBC) recurrence: some clinical features of high-risk disease

Putting it into practice: EBC patient case studies

Immunohistochemistry profile

Mammography, ultrasound, biopsy, and clinical examination

Diagnosis

Immunohistochemistry profile

Mammography, ultrasound, biopsy, and clinical examination

Diagnosis

Defining high-risk HR+, HER2- early breast cancer

Conveying risk for recurrence & importance of optimizing therapy to decrease that risk in HR+, HER2- EBC

References

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