TY - JOUR
T1 - Estrogen Receptor and Progesterone Receptor As Predictive Biomarkers of Response to Endocrine Therapy: A Prospectively Powered Pathology Study in the Tamoxifen and Exemestane Adjuvant Multinational Trial
AU - Bartlett, John M. S.
AU - Brookes, Cassandra L.
AU - Robson, Tammy
AU - van de Velde, Cornelis J. H.
AU - Billingham, Lucinda J.
AU - Campbell, Fiona M.
AU - Grant, Margaret
AU - Hasenburg, Annette
AU - Hille, Elysee T. M.
AU - Kay, Charlene
AU - Kieback, Dirk G.
AU - Putter, Hein
AU - Markopoulos, Christos
AU - Kranenbarg, Elma Meershoek-Klein
AU - Mallon, Elizabeth A.
AU - Dirix, Luc
AU - Seynaeve, Caroline
AU - Rea, Daniel
PY - 2011/4/20
Y1 - 2011/4/20
N2 - PurposeThe Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial included a prospectively planned pathology substudy testing the predictive value of progesterone receptor (PgR) expression for outcome of estrogen receptor-positive (ER-positive) early breast cancer treated with exemestane versus tamoxifen.Patients and MethodsPathology blocks from 4,781 TEAM patients randomly assigned to exemestane versus tamoxifen followed by exemestane for 5 years of total therapy were collected centrally, and tissue microarrays were constructed from samples from 4,598 patients. Quantitative analysis of hormone receptors (ER and PgR) was performed by using image analysis and immunohistochemistry, and the results were linked to outcome data from the main TEAM trial and analyzed relative to disease-free survival and treatment.ResultsOf 4,325 eligible ER-positive patients, 23% were PgR-poor (Allred < 4) and 77% were PgR-rich (Allred >= 5). No treatment-by-marker effect for PgR was observed for exemestane versus tamoxifen (PgR-rich hazard ratio [HR], 0.83; 95% CI, 0.65 to 1.05; PgR-poor HR, 0.85; 95% CI, 0.61 to 1.19; P = .88 for interaction). Both PgR and ER expression were associated with patient prognosis in univariate (PgR HR, 0.53; 95% CI, 0.43 to 0.65; P < .001; ER HR, 0.66; 95% CI, 0.51 to 0.86; P = .002), and multivariate analyses (P < .001 and P = .001, respectively). A trend toward a treatment-by-marker effect for ER-rich patients was observed.ConclusionPreferential exemestane versus tamoxifen treatment benefit was not predicted by PgR expression; conversely, patients with ER-rich tumors may derive additional benefit from exemestane. Quantitative analysis of ER and PgR expression provides highly significant information on risk of early relapse (within 1 to 3 years) during treatment.
AB - PurposeThe Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial included a prospectively planned pathology substudy testing the predictive value of progesterone receptor (PgR) expression for outcome of estrogen receptor-positive (ER-positive) early breast cancer treated with exemestane versus tamoxifen.Patients and MethodsPathology blocks from 4,781 TEAM patients randomly assigned to exemestane versus tamoxifen followed by exemestane for 5 years of total therapy were collected centrally, and tissue microarrays were constructed from samples from 4,598 patients. Quantitative analysis of hormone receptors (ER and PgR) was performed by using image analysis and immunohistochemistry, and the results were linked to outcome data from the main TEAM trial and analyzed relative to disease-free survival and treatment.ResultsOf 4,325 eligible ER-positive patients, 23% were PgR-poor (Allred < 4) and 77% were PgR-rich (Allred >= 5). No treatment-by-marker effect for PgR was observed for exemestane versus tamoxifen (PgR-rich hazard ratio [HR], 0.83; 95% CI, 0.65 to 1.05; PgR-poor HR, 0.85; 95% CI, 0.61 to 1.19; P = .88 for interaction). Both PgR and ER expression were associated with patient prognosis in univariate (PgR HR, 0.53; 95% CI, 0.43 to 0.65; P < .001; ER HR, 0.66; 95% CI, 0.51 to 0.86; P = .002), and multivariate analyses (P < .001 and P = .001, respectively). A trend toward a treatment-by-marker effect for ER-rich patients was observed.ConclusionPreferential exemestane versus tamoxifen treatment benefit was not predicted by PgR expression; conversely, patients with ER-rich tumors may derive additional benefit from exemestane. Quantitative analysis of ER and PgR expression provides highly significant information on risk of early relapse (within 1 to 3 years) during treatment.
UR - http://www.scopus.com/inward/record.url?scp=79955033397&partnerID=8YFLogxK
U2 - 10.1200/JCO.2010.30.3677
DO - 10.1200/JCO.2010.30.3677
M3 - Article
SN - 0732-183X
VL - 29
SP - 1531
EP - 1538
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 12
ER -