Dynamic Changes in Breast Cancer Receptor Status: A Case Report Highlighting the Importance of Repeat Biopsies in Guiding Treatment Strategies
Breast cancer receptor status plays a critical role in treatment selection, yet receptor evolution throughout disease progression remains a significant challenge. This case describes a 58-year-old female initially diagnosed with estrogen receptor (ER)-positive (95%), progesterone receptor (PR)-negat...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-07-01
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| Series: | Journal of Investigative Medicine High Impact Case Reports |
| Online Access: | https://doi.org/10.1177/23247096251362974 |
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| author | Navkirat Kahlon MD, MPH Sujatha Baddam MD Nahush Bansal MD Zaheer Qureshi MD Jhansi Maradana MD |
| author_facet | Navkirat Kahlon MD, MPH Sujatha Baddam MD Nahush Bansal MD Zaheer Qureshi MD Jhansi Maradana MD |
| author_sort | Navkirat Kahlon MD, MPH |
| collection | DOAJ |
| description | Breast cancer receptor status plays a critical role in treatment selection, yet receptor evolution throughout disease progression remains a significant challenge. This case describes a 58-year-old female initially diagnosed with estrogen receptor (ER)-positive (95%), progesterone receptor (PR)-negative (<5%), human epidermal growth factor receptor 2 (HER2)-negative (immunohistochemistry [IHC] 0, fluorescence in situ hybridization-negative) invasive ductal carcinoma. Over 6 years, her tumor transitioned to triple-negative breast cancer at recurrence, then reacquired ER expression (80%) in metastatic mediastinal lymph nodes. HER2 status evolved from IHC 0 → HER2-low (IHC 1+ → IHC 2+), directly influencing therapy selection. These receptor changes led to major systemic treatment modifications, including endocrine therapy, immunotherapy, CDK4/6 inhibitors, and antibody–drug conjugates. Given the extended response duration and improved tolerability of targeted therapies, accurate receptor assessment is essential to ensure that patients receive the most effective treatment. Literature reports receptor discordance rates of ER loss (19%), PR loss (34%), and HER2 fluctuations (15%), reinforcing the necessity of biopsy-driven treatment adaptation. While serial biopsies remain invasive, they provide essential molecular insights that optimize systemic therapy choices, allowing patients to remain on the most appropriate, well-tolerated regimen for as long as possible. This case highlights the clinical significance of receptor evolution and advocates for biopsy-guided precision oncology in metastatic breast cancer management. Ensuring accurate receptor reassessment through periodic molecular profiling can maximize therapeutic efficacy, improving response rates, treatment tolerability, and overall patient outcomes. |
| format | Article |
| id | doaj-art-34821cf37f204885ba51fdc421f5e75d |
| institution | Kabale University |
| issn | 2324-7096 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Investigative Medicine High Impact Case Reports |
| spelling | doaj-art-34821cf37f204885ba51fdc421f5e75d2025-08-20T03:58:44ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962025-07-011310.1177/23247096251362974Dynamic Changes in Breast Cancer Receptor Status: A Case Report Highlighting the Importance of Repeat Biopsies in Guiding Treatment StrategiesNavkirat Kahlon MD, MPH0Sujatha Baddam MD1Nahush Bansal MD2Zaheer Qureshi MD3Jhansi Maradana MD4Mass General Cancer Center at Wentworth-Douglass Hospital, Dover, NH, USAInternal Medicine, Huntsville Hospital, AL, USAInternal Medicine,University of Toledo Medical Center, OH, USAThe Frank H. Netter M.D. School of Medicine, Quinnipiac University, Bridgeport, CT, USAMass General Cancer Center at Wentworth-Douglass Hospital, Dover, NH, USABreast cancer receptor status plays a critical role in treatment selection, yet receptor evolution throughout disease progression remains a significant challenge. This case describes a 58-year-old female initially diagnosed with estrogen receptor (ER)-positive (95%), progesterone receptor (PR)-negative (<5%), human epidermal growth factor receptor 2 (HER2)-negative (immunohistochemistry [IHC] 0, fluorescence in situ hybridization-negative) invasive ductal carcinoma. Over 6 years, her tumor transitioned to triple-negative breast cancer at recurrence, then reacquired ER expression (80%) in metastatic mediastinal lymph nodes. HER2 status evolved from IHC 0 → HER2-low (IHC 1+ → IHC 2+), directly influencing therapy selection. These receptor changes led to major systemic treatment modifications, including endocrine therapy, immunotherapy, CDK4/6 inhibitors, and antibody–drug conjugates. Given the extended response duration and improved tolerability of targeted therapies, accurate receptor assessment is essential to ensure that patients receive the most effective treatment. Literature reports receptor discordance rates of ER loss (19%), PR loss (34%), and HER2 fluctuations (15%), reinforcing the necessity of biopsy-driven treatment adaptation. While serial biopsies remain invasive, they provide essential molecular insights that optimize systemic therapy choices, allowing patients to remain on the most appropriate, well-tolerated regimen for as long as possible. This case highlights the clinical significance of receptor evolution and advocates for biopsy-guided precision oncology in metastatic breast cancer management. Ensuring accurate receptor reassessment through periodic molecular profiling can maximize therapeutic efficacy, improving response rates, treatment tolerability, and overall patient outcomes.https://doi.org/10.1177/23247096251362974 |
| spellingShingle | Navkirat Kahlon MD, MPH Sujatha Baddam MD Nahush Bansal MD Zaheer Qureshi MD Jhansi Maradana MD Dynamic Changes in Breast Cancer Receptor Status: A Case Report Highlighting the Importance of Repeat Biopsies in Guiding Treatment Strategies Journal of Investigative Medicine High Impact Case Reports |
| title | Dynamic Changes in Breast Cancer Receptor Status: A Case Report Highlighting the Importance of Repeat Biopsies in Guiding Treatment Strategies |
| title_full | Dynamic Changes in Breast Cancer Receptor Status: A Case Report Highlighting the Importance of Repeat Biopsies in Guiding Treatment Strategies |
| title_fullStr | Dynamic Changes in Breast Cancer Receptor Status: A Case Report Highlighting the Importance of Repeat Biopsies in Guiding Treatment Strategies |
| title_full_unstemmed | Dynamic Changes in Breast Cancer Receptor Status: A Case Report Highlighting the Importance of Repeat Biopsies in Guiding Treatment Strategies |
| title_short | Dynamic Changes in Breast Cancer Receptor Status: A Case Report Highlighting the Importance of Repeat Biopsies in Guiding Treatment Strategies |
| title_sort | dynamic changes in breast cancer receptor status a case report highlighting the importance of repeat biopsies in guiding treatment strategies |
| url | https://doi.org/10.1177/23247096251362974 |
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