Clinical characterization, prognostic, and predictive values of HER2-low in patients with early breast cancer in the PALLAS trial (ABCSG-42/AFT-05/BIG-14-13/PrE0109).

Humans Receptor, ErbB-2 / metabolism Female Breast Neoplasms / drug therapy Middle Aged Prognosis Biomarkers, Tumor / metabolism Pyridines / therapeutic use Adult Aged Antineoplastic Combined Chemotherapy Protocols / therapeutic use Piperazines / therapeutic use Receptors, Estrogen / metabolism Neoplasm Staging

Antibody–drug conjugates Breast cancer Endocrine therapy HER2-low Palbociclib

Journal

Breast cancer research : BCR

ISSN: 1465-542X

Titre abrégé: Breast Cancer Res

Pays: England

ID NLM: 100927353

Informations de publication

Date de publication:
07 Oct 2024

Historique:

received: 15 05 2024

accepted: 01 10 2024

medline: 8 10 2024

pubmed: 8 10 2024

entrez: 7 10 2024

Statut: epublish

Résumé

Bidirectional crosstalk between HER2 and estrogen receptor (ER) pathways may influence outcomes and the efficacy of endocrine therapy (ET). Low HER2 expression levels (HER2-low) have emerged as a predictive biomarker in patients with breast cancer (BC). PALLAS is an open, international, phase 3 study evaluating the addition of palbociclib for 2 years to adjuvant ET in patients with stage II-III ER-positive/HER2-negative BC. To assess the impact of HER2 expression on patient outcomes in the phase III PALLAS trial, we analyzed (1) the association between rate of HER2-low with demographic and clinicopathological parameters, (2) the prognostic value of HER2-low status on invasive disease-free survival (iDFS), distant relapse-free survival (DRFS), and overall survival (OS) and (3) HER2 expression's value as a predictive biomarker of response to palbociclib. HER2-low was defined as HER2 immunohistochemistry (IHC) 1 + or IHC 2 + with negative in situ hybridization (ISH). All pathologic evaluation was performed locally. Prognostic and predictive power of HER2 were assessed with Cox models. From the original PALLAS intention-to-treat population (N = 5753), 5304 patients (92.2%) were included in this analysis. Among these, 2254 patients (42.5%) were classified as having HER2 IHC 0 (HER2-0), and 3050 (57.5%) as having HER2-low disease (1838 with IHC 1 + and 1212 with IHC 2 +). Median follow-up was 59.8 months. HER2-low prevalence varied significantly across 21 participating countries (range 16.7% to 75.6%; p < 0.001) and was more frequent in patients enrolled in North America (63.1%) than in Europe (53.4%) or other regions (53.4%) (p < 0.001). HER2 status was not significantly associated with iDFS in a multivariable Cox model (hazard ratio 0.93, 95% confidence interval 0.81 - 1.06). No significant interaction was observed between treatment arm and HER2 status for iDFS (p = 0.43). Similar results were obtained for DRFS and OS. In this large, prospective, global patient cohort, no differences were observed in clinical parameters, prognosis, or differential benefit from palbociclib between HER2-0 and HER2-low tumors. Significant geographic variability was observed in the prevalence of HER2-low status, suggesting a high degree of variation in pathologic assessment of HER2 expression without impact on outcomes.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

PALLAS is an open, international, phase 3 study evaluating the addition of palbociclib for 2 years to adjuvant ET in patients with stage II-III ER-positive/HER2-negative BC. To assess the impact of HER2 expression on patient outcomes in the phase III PALLAS trial, we analyzed (1) the association between rate of HER2-low with demographic and clinicopathological parameters, (2) the prognostic value of HER2-low status on invasive disease-free survival (iDFS), distant relapse-free survival (DRFS), and overall survival (OS) and (3) HER2 expression's value as a predictive biomarker of response to palbociclib. HER2-low was defined as HER2 immunohistochemistry (IHC) 1 + or IHC 2 + with negative in situ hybridization (ISH). All pathologic evaluation was performed locally. Prognostic and predictive power of HER2 were assessed with Cox models.

RESULTS RESULTS

From the original PALLAS intention-to-treat population (N = 5753), 5304 patients (92.2%) were included in this analysis. Among these, 2254 patients (42.5%) were classified as having HER2 IHC 0 (HER2-0), and 3050 (57.5%) as having HER2-low disease (1838 with IHC 1 + and 1212 with IHC 2 +). Median follow-up was 59.8 months. HER2-low prevalence varied significantly across 21 participating countries (range 16.7% to 75.6%; p < 0.001) and was more frequent in patients enrolled in North America (63.1%) than in Europe (53.4%) or other regions (53.4%) (p < 0.001). HER2 status was not significantly associated with iDFS in a multivariable Cox model (hazard ratio 0.93, 95% confidence interval 0.81 - 1.06). No significant interaction was observed between treatment arm and HER2 status for iDFS (p = 0.43). Similar results were obtained for DRFS and OS.

CONCLUSIONS CONCLUSIONS

In this large, prospective, global patient cohort, no differences were observed in clinical parameters, prognosis, or differential benefit from palbociclib between HER2-0 and HER2-low tumors. Significant geographic variability was observed in the prevalence of HER2-low status, suggesting a high degree of variation in pathologic assessment of HER2 expression without impact on outcomes.

Identifiants

DOI: 10.1186/s13058-024-01899-2 PMID: 39375745

pubmed: 39375745

doi: 10.1186/s13058-024-01899-2

pii: 10.1186/s13058-024-01899-2

doi:

Substances chimiques

Receptor, ErbB-2 EC 2.7.10.1

ERBB2 protein, human EC 2.7.10.1

Biomarkers, Tumor 0

palbociclib G9ZF61LE7G

Pyridines 0

Piperazines 0

Receptors, Estrogen 0

Types de publication

Journal Article Clinical Trial, Phase III Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

140

Informations de copyright

Références

Aromatase inhibitors versus tamoxifen in early breast cancer. patient-level meta-analysis of the randomised trials. Lancet Lond Engl. 2015;386(10001):1341–52.

doi: 10.1016/S0140-6736(15)61074-1

Curigliano G, Burstein HJ, Gnant M, Loibl S, Cameron D, Regan MM, et al. Understanding breast cancer complexity to improve patient outcomes: The St. Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023. Ann Oncol [Internet]. 2023 Sep 6 [cited 2023 Sep 7];0(0)

Hortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, Hart L, et al. Overall survival with ribociclib plus letrozole in advanced breast cancer. N Engl J Med. 2022;386(10):942–50.

doi: 10.1056/NEJMoa2114663

Johnston S, Martin M, Di Leo A, Im SA, Awada A, Forrester T, et al. MONARCH 3 final PFS: a randomized study of abemaciclib as initial therapy for advanced breast cancer. Npj Breast Cancer. 2019;5(1):1–8.

doi: 10.1038/s41523-018-0097-z

Finn RS, Rugo HS, Dieras VC, Harbeck N, Im SA, Gelmon KA, et al. Overall survival (OS) with first-line palbociclib plus letrozole (pal+let) versus placebo plus letrozole (PbO+let) in women with estrogen receptor–positive/human epidermal growth factor receptor 2–negative advanced breast cancer (ER+/her2−ABC): Analyses from PALOMA-2. J Clin Oncol. 2022, 40: 003

Mayer EL, Demichele AM, Pfeiler G, Barry W, Metzger O, Rastogi P, et al. PALLAS: PALbociclib CoLlaborative adjuvant study: a randomized phase 3 trial of palbociclib with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone for HR+/HER2- early breast cancer. Annals Oncol. 2017;28:v66. https://doi.org/10.1093/annonc/mdx362.064 .

doi: 10.1093/annonc/mdx362.064

Johnston SRD, Toi M, O’Shaughnessy J, Rastogi P, Campone M, Neven P, et al. Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): results from a preplanned interim analysis of a randomised, open-label, phase 3 trial. Lancet Oncol. 2023;24(1):77–90.

doi: 10.1016/S1470-2045(22)00694-5

Slamon DJ, Stroyakovskiy D, Yardley DA, Huang C-S, Fasching PA, Crown J, et al. Ribociclib and endocrine therapy as adjuvant treatment in patients with HR+/HER2- early breast cancer: Primary results from the phase III NATALEE trial. J Clin Oncol. 2023;41(17_suppl):LBA500–LBA500. https://doi.org/10.1200/JCO.2023.41.17_suppl.LBA500 .

doi: 10.1200/JCO.2023.41.17_suppl.LBA500

Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up†. Ann Oncol [Internet]. 2023 Dec 13 [cited 2023 Dec 26];0(0)

Gennari A, André F, Barrios CH, Cortés J, de Azambuja E, DeMichele A, et al. ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol Off J Eur Soc Med Oncol. 2021;32(12):1475–95.

doi: 10.1016/j.annonc.2021.09.019

Burstein HJ, Somerfield MR, Barton DL, Dorris A, Fallowfield LJ, Jain D, et al. Endocrine treatment and targeted therapy for hormone receptor-positive, human epidermal growth factor receptor 2–negative metastatic breast cancer: ASCO guideline update. J Clin Oncol. 2021;39(35):3959–77.

doi: 10.1200/JCO.21.01392

Pietras RJ, Arboleda J, Reese DM, Wongvipat N, Pegram MD, Ramos L, et al. HER-2 tyrosine kinase pathway targets estrogen receptor and promotes hormone-independent growth in human breast cancer cells. Oncogene. 1995;10(12):2435–46.

Xia W, Bacus S, Hegde P, Husain I, Strum J, Liu L, et al. A model of acquired autoresistance to a potent ErbB2 tyrosine kinase inhibitor and a therapeutic strategy to prevent its onset in breast cancer. Proc Natl Acad Sci U S A. 2006;103(20):7795–800.

doi: 10.1073/pnas.0602468103

Atanaskova N, Keshamouni VG, Krueger JS, Schwartz JA, Miller F, Reddy KB. MAP kinase/estrogen receptor cross-talk enhances estrogen-mediated signaling and tumor growth but does not confer tamoxifen resistance. Oncogene. 2002;21(25):4000–8.

doi: 10.1038/sj.onc.1205506

Guo S, Sonenshein GE. Forkhead box transcription factor FOXO3a regulates estrogen receptor alpha expression and is repressed by the Her-2/neu/phosphatidylinositol 3-kinase/Akt signaling pathway. Mol Cell Biol. 2004;24(19):8681–90.

doi: 10.1128/MCB.24.19.8681-8690.2004

Pegram M, Jackisch C, Johnston SRD. Estrogen/HER2 receptor crosstalk in breast cancer: combination therapies to improve outcomes for patients with hormone receptor-positive/HER2-positive breast cancer. NPJ Breast Cancer. 2023;9(1):45.

doi: 10.1038/s41523-023-00533-2

Johnston SRD, Hegg R, Im SA, Park IH, Burdaeva O, Kurteva G, et al. Phase III, randomized study of dual human epidermal growth factor receptor 2 (HER2) blockade with lapatinib plus trastuzumab in combination with an aromatase inhibitor in postmenopausal women With Her2-positive, hormone receptor-positive metastatic breast cancer: updated results of ALTERNATIVE. J Clin Oncol Off J Am Soc Clin Oncol. 2021;39(1):79–89.

doi: 10.1200/JCO.20.01894

Rimawi M, Ferrero JM, de la Haba-Rodriguez J, Poole C, De Placido S, Osborne CK, et al. First-Line trastuzumab plus an aromatase inhibitor, with or without pertuzumab, in human epidermal growth factor receptor 2-positive and hormone receptor-positive metastatic or locally advanced breast cancer (PERTAIN): a randomized, open-label phase ii trial. J Clin Oncol Off J Am Soc Clin Oncol. 2018;36(28):2826–35.

doi: 10.1200/JCO.2017.76.7863

Goel S, Wang Q, Watt AC, Tolaney SM, Dillon DA, Li W, et al. Overcoming therapeutic resistance in HER2-positive breast cancers with CDK4/6 inhibitors. Cancer Cell. 2016;29(3):255–69.

doi: 10.1016/j.ccell.2016.02.006

Gianni L, Bisagni G, Colleoni M, Del Mastro L, Zamagni C, Mansutti M, et al. Neoadjuvant treatment with trastuzumab and pertuzumab plus palbociclib and fulvestrant in HER2-positive, ER-positive breast cancer (NA-PHER2): an exploratory, open-label, phase 2 study. Lancet Oncol. 2018;19(2):249–56.

doi: 10.1016/S1470-2045(18)30001-9

Tolaney SM, Wardley AM, Zambelli S, Hilton JF, Troso-Sandoval TA, Ricci F, et al. Abemaciclib plus trastuzumab with or without fulvestrant versus trastuzumab plus standard-of-care chemotherapy in women with hormone receptor-positive, HER2-positive advanced breast cancer (monarcHER): a randomised, open-label, phase 2 trial. Lancet Oncol. 2020;21(6):763–75.

doi: 10.1016/S1470-2045(20)30112-1

Ciruelos E, Villagrasa P, Pascual T, Oliveira M, Pernas S, Paré L, et al. Palbociclib and Trastuzumab in HER2-positive advanced breast cancer: results from the Phase II SOLTI-1303 PATRICIA trial. Clin Cancer Res Off J Am Assoc Cancer Res. 2020;26(22):5820–9.

doi: 10.1158/1078-0432.CCR-20-0844

Loibl S, Metzger O, Mandrekar SJ, Mundhenke C, Seiler S, Valagussa P, et al. PATINA: A randomized, open label, phase III trial to evaluate the efficacy and safety of palbociclib + Anti-HER2 therapy + endocrine therapy (ET) vs. anti-HER2 therapy + ET after induction treatment for hormone receptor positive (HR+)/HER2-positive metastatic breast cancer (MBC). Ann Oncol. 2018 Oct 1;29: viii121

Viganò L, Locatelli A, Ulisse A, Galbardi B, Dugo M, Tosi D, et al. Modulation of the estrogen/erbB2 Receptors cross-talk by cdk4/6 inhibition triggers sustained senescence in Estrogen Receptor– and ErbB2-positive breast cancer. Clin Cancer Res. 2022;28(10):2167–79.

doi: 10.1158/1078-0432.CCR-21-3185

Burris HA, Rugo HS, Vukelja SJ, Vogel CL, Borson RA, Limentani S, et al. Phase II study of the antibody drug conjugate trastuzumab-DM1 for the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer after prior HER2-directed therapy. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(4):398–405.

doi: 10.1200/JCO.2010.29.5865

Modi S, Jacot W, Yamashita T, Sohn J, Vidal M, Tokunaga E, et al. Trastuzumab deruxtecan in previously treated her2-low advanced breast cancer. N Engl J Med. 2022;387(1):9–20.

doi: 10.1056/NEJMoa2203690

Wang J, Liu Y, Zhang Q, Feng J, Fang J, Chen X, et al. RC48-ADC, a HER2-targeting antibody-drug conjugate, in patients with HER2-positive and HER2-low expressing advanced or metastatic breast cancer: A pooled analysis of two studies. J Clin Oncol. 2021 May 20;39(15_suppl):1022–1022

Banerji U, van Herpen CML, Saura C, Thistlethwaite F, Lord S, Moreno V, et al. Trastuzumab duocarmazine in locally advanced and metastatic solid tumours and HER2-expressing breast cancer: a phase 1 dose-escalation and dose-expansion study. Lancet Oncol. 2019;20(8):1124–35.

doi: 10.1016/S1470-2045(19)30328-6

Enhertu | European Medicines Agency [Internet]. [cited 2023 Dec 18]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/enhertu

Center for Drug Evaluation and Research. FDA approves fam-trastuzumab deruxtecan-nxki for HER2-low breast cancer. FDA [Internet]. 2022 Aug 5 [cited 2023 May 22]; Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-fam-trastuzumab-deruxtecan-nxki-her2-low-breast-cancer

Andre F, Hamilton EP, Loi S, Im S-A, Sohn J, Tseng L-M, et al. Dose-finding and -expansion studies of trastuzumab deruxtecan in combination with other anti-cancer agents in patients (pts) with advanced/metastatic HER2+ (DESTINY-Breast07 [DB-07]) and HER2-low (DESTINY-Breast08 [DB-08]) breast cancer (BC). J Clin Oncol. 2022;40(16_suppl):3025–3025. https://doi.org/10.1200/JCO.2022.40.16_suppl.3025 .

doi: 10.1200/JCO.2022.40.16_suppl.3025

Konecny G, Pauletti G, Pegram M, Untch M, Dandekar S, Aguilar Z, et al. Quantitative association between HER-2/neu and steroid hormone receptors in hormone receptor-positive primary breast cancer. J Natl Cancer Inst. 2003;95(2):142–53.

doi: 10.1093/jnci/95.2.142

Tarantino P, Jin Q, Tayob N, Jeselsohn RM, Schnitt SJ, Vincuilla J, et al. Prognostic and biologic significance of ERBB2-Low expression in early-stage breast cancer. JAMA Oncol. 2022;8(8):1177–83.

Tolaney Sara M, Garrett-Mayer Elizabeth, White Julia, Blinder Victoria S, Foster Jared C, Amiri-Kordestani L, et al. Updated standardized definitions for efficacy end points (STEEP) in Adjuvant breast cancer clinical trials: STEEP Version 2.0. J Clin Oncol. 2021;39(24):2720–31. https://doi.org/10.1200/JCO.20.03613 .

doi: 10.1200/JCO.20.03613

Rüschoff J, Friedrich M, Nagelmeier I, Kirchner M, Andresen LM, Salomon K, et al. Comparison of HercepTest™ mAb pharmDx (Dako Omnis, GE001) with Ventana PATHWAY anti-HER-2/neu (4B5) in breast cancer: correlation with HER2 amplification and HER2 low status. Virchows Arch. 2022;481(5):685–94.

doi: 10.1007/s00428-022-03378-5

Scott M, Vandenberghe ME, Scorer P, Boothman AM, Barker C. Prevalence of HER2 low in breast cancer subtypes using the VENTANA anti-HER2/neu (4B5) assay. In: Journal of Clinical Oncology [Internet]. 2021 [cited 2023 Dec 18]. p. 1021–1021. Available from: https://ascopubs.org/doi/ https://doi.org/10.1200/JCO.2021.39.15_suppl.1021

Wolff AC, Somerfield MR, Dowsett M, Hammond MEH, Hayes DF, McShane LM, et al. Human epidermal growth factor receptor 2 Testing in breast cancer: ASCO-college of american pathologists guideline update. J Clin Oncol Off J Am Soc Clin Oncol. 2023;41(22):3867–72.

doi: 10.1200/JCO.22.02864

Peiffer DS, Zhao F, Chen N, Hahn OM, Nanda R, Olopade OI, et al. Clinicopathologic Characteristics and Prognosis of ERBB2-Low Breast Cancer Among Patients in the National Cancer Database. JAMA Oncol. 2023;9(4):500–10.

doi: 10.1001/jamaoncol.2022.7476

Carvalho FM, Bacchi LM, Pincerato KM, Van de Rijn M, Bacchi CE. Geographic differences in the distribution of molecular subtypes of breast cancer in Brazil. BMC Womens Health. 2014;29(14):102.

doi: 10.1186/1472-6874-14-102

Geukens T, Schepper MD, Richard F, Maetens M, Baelen KV, Mahdami A, et al. Intra-patient and inter-metastasis heterogeneity of HER2-low status in metastatic breast cancer. Eur J Cancer [Internet]. 2023 May 6 [cited 2023 May 21];0(0). Available from: https://www.ejcancer.com/article/S0959-8049(23)00227-7/fulltext

Curigliano G, Hu X, Dent RA, Yonemori K, Barrios CH, O’Shaughnessy J, et al. Trastuzumab deruxtecan (T-DXd) vs physician’s choice of chemotherapy (TPC) in patients (pts) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 (HER2)-low or HER2-ultralow metastatic breast cancer (mBC) with prior endocrine therapy (ET): Primary results from DESTINY-Breast06 (DB-06). J Clin Oncol. 2024 Jun 10;42(17_suppl):LBA1000–LBA1000

Bardia A, Barrios C, Dent R, Hu X, O’Shaughnessy J, Yonemori K, et al. Abstract OT-03–09: Trastuzumab deruxtecan (T-DXd; DS-8201) vs investigator’s choice of chemotherapy in patients with hormone receptor-positive (HR+), HER2 low metastatic breast cancer whose disease has progressed on endocrine therapy in the metastatic setting: A randomized, global phase 3 trial (DESTINY-Breast06). Cancer Res. 2021 Feb 15;81(4_Supplement):OT-03–09

Tarantino P, Viale G, Press MF, Hu X, Penault-Llorca F, Bardia A, et al. ESMO expert consensus statements (ECS) on the definition, diagnosis, and management of HER2-low breast cancer. Ann Oncol Off J Eur Soc Med Oncol. 2023;34(8):645–59.

doi: 10.1016/j.annonc.2023.05.008

Frey P, Mamilos A, Minin E, Banisch R, Günther S, Schmidt C, et al. AI-based HER2-low IHC scoring in breast cancer across multiple sites, clones, and scanners. In: Journal of Clinical Oncology [Internet]. Wolters Kluwer; 2023 [cited 2023 Dec 18]. p. 516–516. Available from: https://ascopubs.org/doi/abs/ https://doi.org/10.1200/JCO.2023.41.16_suppl.516

Bortot L, Basile D, Palmero L, Dri A, Cucciniello L, Buriolla S, et al. Liquid biopsy–based biomarkers for the characterization of hormone receptor-positive (HR+) HER2-Low metastatic breast cancer (mBC). Ann Oncol. 2022;33((Bortot L.; Palmero L.; Dri A.; Cucciniello L.; Buriolla S.; Pastò B.; Mazzeo R.; Damante G.) Department of Medicine (DAME), University of Udine, Udine, Italy):S656–7

Miladinova D. Molecular imaging of HER2 receptor: targeting HER2 for imaging and therapy in nuclear medicine. Front Mole Biosci. 2023. https://doi.org/10.3389/fmolb.2023.1144817 .

doi: 10.3389/fmolb.2023.1144817

Schettini F, Chic N, Brasó-Maristany F, Paré L, Pascual T, Conte B, et al. Clinical, pathological, and PAM50 gene expression features of HER2-low breast cancer. NPJ Breast Cancer. 2021;7(1):1.

doi: 10.1038/s41523-020-00208-2

Molinelli C, Jacobs F, Agostinetto E, Nader-Marta G, Ceppi M, Bruzzone M, et al (2023) Prognostic value of HER2-low status in breast cancer: a systematic review and meta-analysis. ESMO Open [Internet]. [cited 2023 Jul 9]; 8(4). Available from: https://www.esmoopen.com/article/S2059-7029(23)00826-8/fulltext#secsectitle0030

Tang Y, Shen G, Xin Y, Li Z, Zheng Y, Wang M, et al. The association between HER2-low expression and prognosis of breast cancer: a systematic review and meta-analysis. Ther Adv Med Oncol. 2023;15:17588359231156668.

doi: 10.1177/17588359231156669

Tarantino P, Gupta H, Hughes ME, Files J, Strauss S, Kirkner G, et al. Comprehensive genomic characterization of HER2-low and HER2-0 breast cancer. Nat Commun. 2023;14(1):7496.

doi: 10.1038/s41467-023-43324-w

Li H, Wu Y, Zou H, Koner S, Plichta JK, Tolaney SM, et al (2024) Clinical efficacy of CDK4/6 inhibitor plus endocrine therapy in HR-positive/HER2–0 and HER2-low-positive metastatic breast cancer: a secondary analysis of PALOMA-2 and PALOMA-3 trials. eBioMedicine [Internet]. [cited 2024 Aug 23]; 105. Available from: https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(24)00221-4/fulltext?rss=yes

Mouabbi JA, Raghavendra AS, Bassett RL, Hassan A, Tripathy D, Layman RM. Histology-based survival outcomes in hormone receptor-positive metastatic breast cancer treated with targeted therapies. NPJ Breast Cancer. 2022;8(1):131.

doi: 10.1038/s41523-022-00499-7

Stover D, Hlauschek D, Mayer EL, Symmans F. (GS03–07) Protocol-defined biomarker analysis in the PALLAS (AFT-05) adjuvant trial: Genomic subtype derived from RNA sequencing of HR+/HER2- early breast cancer. In: 2023 [cited 2023 Dec 19]

Turner N, Reis-Filho JS, Goetz M. (GS03–06) Genomic and transcriptomic profiling of primary tumors from patients with HR+, HER2-, node-positive, high-risk early breast cancer in the monarchE trial. In: San Antonio Breast Cancer Symposium. 2023

Chen Z, Wang Y, Warden C, Chen S. Cross-talk between ER and HER2 regulates c-MYC-mediated glutamine metabolism in aromatase inhibitor resistant breast cancer cells. J Steroid Biochem Mol Biol. 2015;149:118–27.

doi: 10.1016/j.jsbmb.2015.02.004