How does PR status affect breast cancer treatment decisions?
Patient's Query
Hello doctor,
I was diagnosed with stage 3C invasive ductal carcinoma (IDC), Grade 3, Ki-67 score 30 to 35 %, estrogen receptor (ER)-positive, progesterone receptor (PR)-positive breast cancer, with multiple lymph nodes involved in the axilla, intramammary region, and one in the supraclavicular area. I underwent four cycles of dose-dense Doxorubicin and Cyclophosphamide (DDAC), followed by 12 cycles of Paclitaxel as neoadjuvant chemotherapy. Prior to surgery, a PET scan was repeated, showing a complete metabolic response to chemotherapy.
The pathology report post-surgery revealed three lymph nodes with macrometastases, extensive lymphovascular invasion (LVI), and a 0.98-inch invasive tumor. The largest lymph node metastasis measured 11 mm, and the tumor was Grade 2. I requested additional biomarker testing, which indicated ER-positive, PR-negative, and HER2-negative status, with a Ki-67 score of 8 to 10 %.
So, I want to ask the following:
- What is the implication of a positive PR status turning negative after chemotherapy? I have read research suggesting this may be a poor prognostic marker. Is that true?
- Is a low Ki-67 score post-chemotherapy a good indicator of longer survival outcomes?
- What is the role of progesterone receptor status in outcomes and subsequent treatment decisions?
Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and understood your concern.
I believe you have had a good response to chemotherapy. If the estrogen receptor (ER) is positive, it is generally considered that both ER and progesterone receptor (PR) are positive. Regarding the Ki-67 score after chemotherapy, a lower value can indicate slower growth of malignant cells, suggesting less aggressiveness. The positron emission tomography-computed tomography (PET–CT) scan reported a complete response to chemotherapy.
For maintenance treatment, I would suggest hormone therapy with close follow-up. The approach may also depend on your menopausal status. I was unable to find information on your human epidermal growth factor receptor 2 (HER2) status.
I hope this helps.
Please let us know if you have any further queries. We would be happy to answer.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
I have a couple of follow-up questions. I have attached the initial biopsy report and the surgical pathology report.
-
HER2 status: HER2 was negative in the initial biopsy before chemotherapy and also in the post-surgical pathology report.
-
Progesterone receptor (PR) status: PR was positive in the initial biopsy but negative post-chemotherapy in the surgical pathology report. I have read several articles stating that losing PR positivity after chemotherapy indicates a poor prognosis. Is this true? Should I be concerned?
-
Ki-67 score: The Ki-67 score now stands at 8 to 10 %. Does this reduction indicate a better outcome, considering it was higher before chemotherapy?
-
Residual disease: Considering I did not achieve a pathological complete response (pCR) and have some residual disease, is this normal? Does it increase my risk of recurrence?
Kindly help.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
As I mentioned earlier, your ER-positive and PR-negative status indicates hormone receptor positivity, even if the PR status is negative after chemotherapy (attachment removed to protect the patient's identity). The ER status is more significant in this context. The Ki-67 index reflects tumor cell proliferation. A reduction to around 10 % after chemotherapy is expected, as chemotherapy typically decreases cell proliferation. The long-term response depends on various factors. Your excellent response to chemotherapy suggests a favorable outcome, but no one can be certain. Let us remain hopeful for the best.
I hope this helps.
Please let us know if you have any further queries. We would be happy to answer.
Thank you.
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