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Breast cancer and hormone receptor status

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

When clinicians manage breast cancer they consider various prognostic factors, including hormone receptor status and HER2 status

  • hormone receptors include oestrogen receptors and progesterone receptors
  • tumours that express either oestrogen receptors or progesterone receptors are commonly referred to as being hormone receptor positive
    • estimated that 60% and 80% of all breast cancers in premenopausal and postmenopausal women respectively are hormone receptor positive.
    • people with hormone receptor- positive breast cancer generally have a better prognosis than those with hormone-receptor-negative breast cancer

  • tumours that overexpress the human epidermal growth factor receptor 2 (HER2) protein (HER2+) grow and divide more quickly, so women with HER2+ tumours generally have a worse prognosis than women with HER2 negative tumours
    • approximately 20-30% of people with metastatic breast cancer have HER2+ tumours, of which about 50% will also be hormone receptor positive

Aim of treatment in metastatic breast cancer is to palliate symptoms, prolong survival and maintain a good quality of life with minimal adverse

  • choice of treatment depends on previous therapy, hormone receptor status, HER2 status and the extent of the disease

Notes:

  • exposure to epidermal growth factor (EGF) leads to modifications in several aspects of the cellular behavior related to the development of cancer
  • the overactivation of the human epidermal growth factor receptor (HERs), a family of tyrosine kinase receptors, leads to the development of cancer
  • EGF binds to HER1 (also known as EGF receptor or ErbB1), which is the prototype of a family that includes three additional members:
    • HER2 (also known as neu or ErbB2), HER3 and HER4 (also known as ErbB3 and ErbB4, respectively)
    • the generation of HER homo- or hetero oligomers induces the activation of the intrinsic tyrosine kinase activity of the receptors
      • the subsequent phosphorylation of intracellular tyrosine residues leads to the recruitment of factors that transfer the signal from the plasma membrane to the nucleus
        • induces changes in the expression of genes that coordinately regulate proliferation, migration, adhesion, differentiation and apoptosis
    • the involvement of HER receptors, and particularly HER2, in the development of a variety of cancers, including breast tumors, has led the implementation of different therapeutic strategies
      • include monoclonal antibodies directed against the ectodomain of the receptors, such as Herceptin (also known as Trastuzumab), and small-molecule tyrosine kinase inhibitors (1)
      • Amplification of the HER2 gene (also known as ERBB2) is present in 10-20% of tumours in patients with early-stage breast cancer and is associated with aggressive cancers and an increased risk of disease recurrence
      • Trastuzumab, a humanised IgG1 monoclonal antibody that targets the extracellular domain of the HER2 protein, improves progression-free survival and overall survival when administered in combination with chemotherapy in HER2-positive metastatic breast cancer (3)
        • benefits are also seen with trastuzumab added to chemotherapy in non-metastatic breast cancer
        • adding trastuzumab to chemotherapy for early-stage, HER2-positive breast cancer reduces recurrence of, and mortality from, breast cancer by a third

Reference:


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