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Introduction <p>The optimal management of oestrogen receptor (ER)-low HER2-negative breast cancer (BC) is unclear. We surveyed current approaches of UK clinicians in ER-low BC, and also present outcomes of ER-low early BC at single centre.</p> Methods <p>Survey: We conducted an anonymised online survey of clinicians treating BC in the UK between 6&#xa0;May and 5&#xa0;June 2024. Participants were presented with clinical scenarios of ER-low (Allred ER3/ER4) BC with multiple-choice and free-text questions. Clinical audit: Patients diagnosed with stage&#xa0;I–III, ER2–4 HER2-negative BC undergoing neoadjuvant treatment (chemotherapy vs. chemo-immunotherapy) from 1&#xa0;January 2017 to 31&#xa0;December 2023 were included. Clinical data was collected retrospectively at Barts Health NHS Trust, London, UK. The primary endpoint was pathological complete response (pCR).</p> Results <p>Survey: Of 72 survey respondents, 40% recommended neoadjuvant chemo-immunotherapy for ER3 disease vs. 10% for ER4 disease; 57% recommended adjuvant endocrine therapy for ER3 disease, and 90% for ER4 disease. In the advanced setting 75% recommended chemo-immunotherapy for PD-L1-positive ER3 disease with 7% recommending CDK4/6 inhibitors. For PDL1-positive ER4 disease, these percentages were 32% and 51% respectively. In PDL1-negative disease, chemotherapy rates were 81% for ER3 and 36% for ER4 disease. Clinical audit: Sixty-six patients receiving neoadjuvant treatment were included, with 29 belonging to the ER2, 30 belonging to the ER3 and 7 belonging to the ER4 groups respectively; 33% received neoadjuvant chemo-immunotherapy. pCR rate was 61%, with no association with ER score for chemotherapy (<i>p</i> = 0.319) and chemo-immunotherapy (<i>p</i> = 0.603).</p> Conclusions <p>There is marked variation in approach to ER-low in the UK. The audit data suggests treating ER-low BC as triple-negative BC.</p>

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The Management of ER-Low, HER2-Negative Breast Cancer in the United Kingdom: A Survey of Current Clinical Practice

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月13日

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  • Ka Chai Sit,
  • Alison M. Berner,
  • Conor McCahill,
  • Sarah Atkinson,
  • Melissa M. Phillips,
  • Kathryn Hawkesford,
  • Vasileios Angelis,
  • Peter E. Hall

摘要

Introduction

The optimal management of oestrogen receptor (ER)-low HER2-negative breast cancer (BC) is unclear. We surveyed current approaches of UK clinicians in ER-low BC, and also present outcomes of ER-low early BC at single centre.

Methods

Survey: We conducted an anonymised online survey of clinicians treating BC in the UK between 6 May and 5 June 2024. Participants were presented with clinical scenarios of ER-low (Allred ER3/ER4) BC with multiple-choice and free-text questions. Clinical audit: Patients diagnosed with stage I–III, ER2–4 HER2-negative BC undergoing neoadjuvant treatment (chemotherapy vs. chemo-immunotherapy) from 1 January 2017 to 31 December 2023 were included. Clinical data was collected retrospectively at Barts Health NHS Trust, London, UK. The primary endpoint was pathological complete response (pCR).

Results

Survey: Of 72 survey respondents, 40% recommended neoadjuvant chemo-immunotherapy for ER3 disease vs. 10% for ER4 disease; 57% recommended adjuvant endocrine therapy for ER3 disease, and 90% for ER4 disease. In the advanced setting 75% recommended chemo-immunotherapy for PD-L1-positive ER3 disease with 7% recommending CDK4/6 inhibitors. For PDL1-positive ER4 disease, these percentages were 32% and 51% respectively. In PDL1-negative disease, chemotherapy rates were 81% for ER3 and 36% for ER4 disease. Clinical audit: Sixty-six patients receiving neoadjuvant treatment were included, with 29 belonging to the ER2, 30 belonging to the ER3 and 7 belonging to the ER4 groups respectively; 33% received neoadjuvant chemo-immunotherapy. pCR rate was 61%, with no association with ER score for chemotherapy (p = 0.319) and chemo-immunotherapy (p = 0.603).

Conclusions

There is marked variation in approach to ER-low in the UK. The audit data suggests treating ER-low BC as triple-negative BC.