Aims Neoadjuvant treatment has now become the standard of care for oesophageal and gastric cancer. The aim of this study was to investigate the influence of neoadjuvant therapy on the expression of human epidermal growth factor receptor 1 (HER1/EGFR), HER2 and HER3, in oesophageal and gastric adenocarcinoma.
Methods Immunohistochemical expression of EGFR, HER2 and HER3 was examined and compared in pretreatment biopsies, post-treatment surgical resection specimens and metastases in a retrospective cohort of 166 patients with adenocarcinoma of the oesophagus or stomach. The relationship between expression of the investigative markers and histopathological response to neoadjuvant treatment, overall survival (OS) and recurrence free survival (RFS) was analysed.
Results Conversion of protein expression between pretreatment biopsy and post-treatment surgical resection was seen in 4.6% of the cases for EGFR, 5.9% for HER2% and 19.4% for HER3. Histopathological response to neoadjuvant treatment was significantly and stepwise associated with OS and RFS . High HER3 protein expression in post-treatment surgical resection specimens was significantly associated with a prolonged OS in univariable analysis (HR=0.39; 95% CI 0.17 to 0.93), but did not remain significant in multivariable analysis. Expression of EGFR and HER2 in post-treatment surgical resection specimens was not prognostic. No correlation between pretreatment HER-protein expression and histopathological response was seen.
Conclusions The results from this study underscore the need for further studies on the influence of neoadjuvant treatment on biomarker expression, as this may influence treatment strategy as well as prognosis. Histopathological response is validated as a useful prognostic factor.
- in situ hybridisation
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Handling editor Runjan Chetty.
Contributors CH, KJ: histopathological re-evaluation. BN, CH: TMA construction. BN: immunohistochemistry. CH, KJ: evaluation of immunohistochemistry. CH, DB, KJ: statistical analyses. CH, KJ, EK, DB, JE: manuscript drafting. KJ, JE: conception and design.
Funding This study was supported by grants from the Swedish Cancer Society, the Crafoord Foundation, the Olle Engkvist Foundation, the Anna Lisa and Sven Eric Lundgren Foundation, Lund University Faculty of Medicine and University Hospital Research Grants and the Swedish Government Grant for Clinical Research.
Competing interests None declared.
Ethics approval The regional ethical board of Lund University (ref nr 445/07).
Provenance and peer review Not commissioned; internally peer reviewed.
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