Abstract PO5-01-04: HER2 Amplification Level and Focal/Broad Region Size as Predictors of Treatment Response in Neoadjuvant Chemotherapy and Anti-HER2 Therapy for HER2-Positive Breast Cancer

Abstract Background: Neoadjuvant chemotherapy combined with anti-HER2 therapy has become the standard treatment approach for HER2-positive breast cancer. However, not all HER2-positive patients can achieve pathological complete response after neoadjuvant therapy. This raises the question of which subset of HER2+ patients derive the greatest benefit from pre-operative HER2-targeted treatment. Therefore, this study aims to determine whether the level and amplification region size of HER2 amplification are associated with the efficacy of neoadjuvant chemotherapy combined with anti-HER2 therapy. Methods: A total of 523 breast cancer samples were collected from 2017 to 2018, among which 202 cases were HER2-positive patients. Among these, 55 HER2-positive patients received neoadjuvant chemotherapy combined with anti-HER2 targeted therapy. The amplification status of HER2 was assessed using immunohistochemistry/fluorescence in situ hybridization (IHC/FISH) and next-generation sequencing (NGS). The HER2/CEP17 ratio, determined by FISH, was used to represent the amplification level of HER2. The size of the amplification region was calculated using NGS and neighboring genes located in chr17q. Amplification regions smaller than 1 Mb were classified as focal amplification, while those larger than 1 Mb were classified as broad amplification. Results: We compared the HER2/ERBB2 status of 523 breast cancer patients using different detection methods and found a high concordance between ERBB2 amplification detected by NGS and HER2-positivity detected by IHC and FISH, with a sensitivity of 96.0%, specificity of 97.8%, and overall concordance of 97.1%. Based on the HER2/CEP17 ratio determined by FISH, we observed that using a threshold of 6 for classification, the high amplification group had a significantly higher pCR rate compared to the low amplification group (86.7% vs. 41.7%; p=0.037, odds ratio OR=0.121, 95% confidence interval CI: 0.009-0.919). Moreover, the focal amplification group showed a higher pCR rate compared to the broad amplification group (65.9% vs. 30.8%, p=0.051, OR=0.237, 95% CI: 0.045-1.035). Additionally, within the low amplification group (HER2/CEP17 6), the pCR rate was 66.7% for focal amplification and 20% for broad amplification, suggesting that focal amplification of ERBB2 may further guide clinical benefit in the low HER2/CEP17 ratio group. Conclusion: This study demonstrates a high concordance between ERBB2 amplification determined by NGS and HER2-positivity determined by IHC/FISH. High HER2/CEP17 ratio and focal amplification of ERBB2 are associated with a higher pCR rate in neoadjuvant chemotherapy combined with anti-HER2 targeted therapy. Citation Format: Ning Liao, Guochun Zhang, Xinze Lv, Kai Li, Ting Hou, Zhou Zhang. HER2 Amplification Level and Focal/Broad Region Size as Predictors of Treatment Response in Neoadjuvant Chemotherapy and Anti-HER2 Therapy for HER2-Positive Breast Cancer abstract. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-01-04.