2024
A multi-modal single-cell and spatial expression map of metastatic breast cancer biopsies across clinicopathological features
Klughammer J, Abravanel D, Segerstolpe Å, Blosser T, Goltsev Y, Cui Y, Goodwin D, Sinha A, Ashenberg O, Slyper M, Vigneau S, Jané‐Valbuena J, Alon S, Caraccio C, Chen J, Cohen O, Cullen N, DelloStritto L, Dionne D, Files J, Frangieh A, Helvie K, Hughes M, Inga S, Kanodia A, Lako A, MacKichan C, Mages S, Moriel N, Murray E, Napolitano S, Nguyen K, Nitzan M, Ortiz R, Patel M, Pfaff K, Porter C, Rotem A, Strauss S, Strasser R, Thorner A, Turner M, Wakiro I, Waldman J, Wu J, Gómez Tejeda Zañudo J, Zhang D, Lin N, Tolaney S, Winer E, Boyden E, Chen F, Nolan G, Rodig S, Zhuang X, Rozenblatt-Rosen O, Johnson B, Regev A, Wagle N. A multi-modal single-cell and spatial expression map of metastatic breast cancer biopsies across clinicopathological features. Nature Medicine 2024, 1-14. PMID: 39478111, DOI: 10.1038/s41591-024-03215-z.Peer-Reviewed Original ResearchClinicopathological featuresLocal T cell infiltrationT cell infiltrationMetastatic breast cancerBreast cancer biopsiesCancer-related deathsEpithelial-to-mesenchymal transitionMetastatic diseaseClinically relevant discoveriesTumor biopsiesTumor microenvironmentCancer biopsiesBreast cancerAnatomical sitesMacrophage populationsSingle-nucleus RNA sequencingBiopsyH&E stainingConsecutive serial sectionsClinical annotationTumorSingle-cellSpatial expression characteristicsSerial sectionsCell type composition
2023
Association Between Biomarkers and Clinical Outcomes of Pembrolizumab Monotherapy in Patients With Metastatic Triple-Negative Breast Cancer: KEYNOTE-086 Exploratory Analysis
Loi S, Salgado R, Schmid P, Cortes J, Cescon D, Winer E, Toppmeyer D, Rugo H, De Laurentiis M, Nanda R, Iwata H, Awada A, Tan A, Sun Y, Karantza V, Wang A, Huang L, Saadatpour A, Cristescu R, Yearley J, Lunceford J, Jelinic P, Adams S. Association Between Biomarkers and Clinical Outcomes of Pembrolizumab Monotherapy in Patients With Metastatic Triple-Negative Breast Cancer: KEYNOTE-086 Exploratory Analysis. JCO Precision Oncology 2023, 7: e2200317. PMID: 37099733, DOI: 10.1200/po.22.00317.Peer-Reviewed Original ResearchConceptsMetastatic triple-negative breast cancerTriple-negative breast cancerClinical outcomesPembrolizumab monotherapyPD-L1Metastatic diseaseGEP signaturesBreast cancerStromal tumor-infiltrating lymphocytesT-cell-inflamed gene expression profileExploratory biomarker analysisMore systemic therapiesPD-L1 CPSTumor PD-L1PD-L1 statusTumor-infiltrating lymphocytesImproved clinical outcomesTumor mutational burdenSignature 3Mutational signature 3Cohort BDifferentiation 8Systemic therapyCohort ACombined cohort
2022
The feasibility of using an autologous GM-CSF-secreting breast cancer vaccine to induce immunity in patients with stage II–III and metastatic breast cancers
Anderson KS, Erick TK, Chen M, Daley H, Campbell M, Colson Y, Mihm M, Zakka LR, Hopper M, Barry W, Winer EP, Dranoff G, Overmoyer B. The feasibility of using an autologous GM-CSF-secreting breast cancer vaccine to induce immunity in patients with stage II–III and metastatic breast cancers. Breast Cancer Research And Treatment 2022, 194: 65-78. PMID: 35482127, PMCID: PMC9046531, DOI: 10.1007/s10549-022-06562-y.Peer-Reviewed Original ResearchConceptsBreast cancer vaccinesAutologous GM-CSFBreast cancerMetastatic diseaseGM-CSFStage IICancer vaccinesTumor cellsEvidence of diseaseStart of vaccinationInjection site reactionsMetastatic breast cancerUpper respiratory symptomsImmune cell infiltrationRole of vaccinationReplication-defective adenoviral vectorEvaluable patientsMethodsTumor cellsStable diseaseWeekly vaccinationsJoint painProgressive diseaseRespiratory symptomsFifth injectionTRIAL REGISTRATION
2021
Physical Activity, Weight, and Outcomes in Patients Receiving Chemotherapy for Metastatic Breast Cancer (C40502/Alliance)
Ligibel JA, Huebner L, Rugo HS, Burstein HJ, Toppmeyer DL, Anders CK, Ma C, Barry WT, Suman V, Carey LA, Partridge AH, Hudis CA, Winer EP. Physical Activity, Weight, and Outcomes in Patients Receiving Chemotherapy for Metastatic Breast Cancer (C40502/Alliance). JNCI Cancer Spectrum 2021, 5: pkab025-. PMID: 33981951, PMCID: PMC8103727, DOI: 10.1093/jncics/pkab025.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAntineoplastic Agents, ImmunologicalAntineoplastic Combined Chemotherapy ProtocolsBevacizumabBody HeightBody Mass IndexBody WeightBreast NeoplasmsEpothilonesExerciseFemaleHumansMiddle AgedObesityPaclitaxelProgression-Free SurvivalProportional Hazards ModelsTreatment OutcomeYoung AdultConceptsProgression-free survivalMetastatic breast cancerBody mass indexOverall survivalPhysical activityBreast cancerMass indexMET hoursFirst-line taxane-based chemotherapyHormone receptor-positive cancersBaseline body mass indexFirst-line chemotherapyTaxane-based chemotherapyReceptor-positive cancersRecreational physical activityRates of obesityMetastatic diseaseCox modelingMedian ageOverall mortalityRandomized trialsTask hoursMetabolic equivalentsPatientsCancerPembrolizumab versus investigator-choice chemotherapy for metastatic triple-negative breast cancer (KEYNOTE-119): a randomised, open-label, phase 3 trial
Winer EP, Lipatov O, Im SA, Goncalves A, Muñoz-Couselo E, Lee KS, Schmid P, Tamura K, Testa L, Witzel I, Ohtani S, Turner N, Zambelli S, Harbeck N, Andre F, Dent R, Zhou X, Karantza V, Mejia J, Cortes J, investigators K. Pembrolizumab versus investigator-choice chemotherapy for metastatic triple-negative breast cancer (KEYNOTE-119): a randomised, open-label, phase 3 trial. The Lancet Oncology 2021, 22: 499-511. PMID: 33676601, DOI: 10.1016/s1470-2045(20)30754-3.Peer-Reviewed Original ResearchConceptsMetastatic triple-negative breast cancerTriple-negative breast cancerCombined positive scoreMedian overall survivalPD-L1 combined positive scoreTreatment-related adverse eventsPhase 3 trialChemotherapy groupOverall survivalPembrolizumab groupBreast cancerAdverse eventsPrimary endpointMetastatic diseaseEastern Cooperative Oncology Group performance statusPD-L1 tumor statusCommon grade 3Durable antitumour activityInvestigator-choice chemotherapyPrevious systemic treatmentSerious adverse eventsThird-line treatmentSubpopulation of patientsTreatment of patientsSingle-drug chemotherapy
2020
Weathering the Storm: Managing Older Adults With Breast Cancer Amid COVID-19 and Beyond
Freedman RA, Sedrak MS, Bellon JR, Block CC, Lin NU, King TA, Minami C, VanderWalde N, Jolly TA, Muss HB, Winer EP. Weathering the Storm: Managing Older Adults With Breast Cancer Amid COVID-19 and Beyond. Journal Of The National Cancer Institute 2020, 113: 355-359. PMID: 32449757, PMCID: PMC7313961, DOI: 10.1093/jnci/djaa079.Peer-Reviewed Original ResearchConceptsOlder patientsBreast cancerSevere acute respiratory syndrome coronavirus 2 exposureTreatment-related toxicityMultidisciplinary treatment approachBreast cancer patientsUnique clinical considerationsCOVID-19Chemotherapy toxicityMetastatic diseaseTreatment delayCancer patientsFunctional statusCare considerationsTreatment decisionsFunctional declineTherapeutic benefitTreatment prioritiesClinical considerationsTreatment approachesPatientsOlder adultsCOVID-19 pandemicCancerToxicityAssociation of tumor mutational burden (TMB) and clinical outcomes with pembrolizumab (pembro) versus chemotherapy (chemo) in patients with metastatic triple-negative breast cancer (mTNBC) from KEYNOTE-119.
Winer E, Lipatov O, Im S, Goncalves A, Muñoz-Couselo E, Lee K, Schmid P, Testa L, Witzel I, Ohtani S, Lunceford J, Karantza V, Mejia J, Cristescu R, Aurora-Garg D, Jelinic P, Huang L, Cortes J. Association of tumor mutational burden (TMB) and clinical outcomes with pembrolizumab (pembro) versus chemotherapy (chemo) in patients with metastatic triple-negative breast cancer (mTNBC) from KEYNOTE-119. Journal Of Clinical Oncology 2020, 38: 1013-1013. DOI: 10.1200/jco.2020.38.15_suppl.1013.Peer-Reviewed Original ResearchMetastatic triple-negative breast cancerTumor mutational burdenMut/MbClinical outcomesTriple-negative breast cancerChemo-treated patientsPrior systemic treatmentThird-line settingOverall study populationNumber of patientsTwo-sided p valuePD-L1 enrichmentReceiver operator characteristic analysisEstimates of efficacyOperator characteristic analysisP-valueFoundationOne CDxBaseline characteristicsMetastatic diseaseSystemic treatmentPotential positive associationTreatment armsClinical benefitCox regressionBreast cancer
2019
Clinical significance of circulating tumor cells (CTCs) in hormone receptor-positive (HR+) metastatic breast cancer (MBC) patients (pts) receiving letrozole (Let) or Let plus bevacizumab (Bev): CALGB 40503 (Alliance).
Magbanua M, Oleksandr Savenkov O, Asmus E, Ballman K, Scott J, Park J, Dickler M, Partridge A, Carey L, Winer E, Rugo H. Clinical significance of circulating tumor cells (CTCs) in hormone receptor-positive (HR+) metastatic breast cancer (MBC) patients (pts) receiving letrozole (Let) or Let plus bevacizumab (Bev): CALGB 40503 (Alliance). Journal Of Clinical Oncology 2019, 37: 1049-1049. DOI: 10.1200/jco.2019.37.15_suppl.1049.Peer-Reviewed Original ResearchProgression-free survivalOverall survivalCTC statusHormone receptor-positive metastatic breast cancer patientsPredictive valueLonger median progression-free survivalImproved progression-free survivalMedian progression-free survivalMetastatic breast cancer patientsWorse progression-free survivalAddition of BevFirst-line therapyCox regression analysisEarly breast cancerInitiation of treatmentBreast cancer patientsPotential predictive valueML of bloodMetastatic diseaseMultivariable analysisCancer patientsClinical significanceBreast cancerUS FDATumor cellsPembrolizumab monotherapy for previously treated metastatic triple-negative breast cancer: cohort A of the phase II KEYNOTE-086 study
Adams S, Schmid P, Rugo HS, Winer EP, Loirat D, Awada A, Cescon DW, Iwata H, Campone M, Nanda R, Hui R, Curigliano G, Toppmeyer D, O’Shaughnessy J, Loi S, Paluch-Shimon S, Tan AR, Card D, Zhao J, Karantza V, Cortés J. Pembrolizumab monotherapy for previously treated metastatic triple-negative breast cancer: cohort A of the phase II KEYNOTE-086 study. Annals Of Oncology 2019, 30: 397-404. PMID: 30475950, DOI: 10.1093/annonc/mdy517.Peer-Reviewed Original ResearchConceptsMetastatic triple-negative breast cancerTriple-negative breast cancerDisease control ratePD-L1Positive populationPembrolizumab monotherapyMetastatic diseaseControl rateBreast cancerTreatment-related adverse eventsEnd pointManageable safety profileObjective response ratePrimary end pointSecondary end pointsProgression-free survivalSubset of patientsDurable antitumor activityDuration of responseLine of treatmentEligible patientsMedian OSMedian PFSAdverse eventsMedian duration
2018
Unraveling the clinicopathological features driving the emergence of ESR1 mutations in metastatic breast cancer
Kuang Y, Siddiqui B, Hu J, Pun M, Cornwell M, Buchwalter G, Hughes ME, Wagle N, Kirschmeier P, Jänne PA, Paweletz CP, Lin NU, Krop IE, Barry WT, Winer EP, Brown M, Jeselsohn R. Unraveling the clinicopathological features driving the emergence of ESR1 mutations in metastatic breast cancer. Npj Breast Cancer 2018, 4: 22. PMID: 30083595, PMCID: PMC6072793, DOI: 10.1038/s41523-018-0075-5.Peer-Reviewed Original ResearchMetastatic breast cancerESR1 mutationsBreast cancerMetastatic settingClinicopathological featuresPIK3CA mutationsAromatase inhibitorsER-positive metastatic breast cancerDetailed clinical dataSpecific systemic treatmentMetastatic treatmentDistant recurrenceMetastatic diseaseSystemic treatmentPrimary diseaseEndocrine resistanceCDK4/6 inhibitorsPathological featuresFulvestrant treatmentClinical dataPrior treatmentSignificant associationPatientsCancerPrevalenceHomologous recombination deficiency and host anti-tumor immunity in triple-negative breast cancer
Telli ML, Stover DG, Loi S, Aparicio S, Carey LA, Domchek SM, Newman L, Sledge GW, Winer EP. Homologous recombination deficiency and host anti-tumor immunity in triple-negative breast cancer. Breast Cancer Research And Treatment 2018, 171: 21-31. PMID: 29736741, DOI: 10.1007/s10549-018-4807-x.Peer-Reviewed Original ResearchMeSH KeywordsAnimalsAntineoplastic AgentsB7-H1 AntigenBiomarkers, TumorDisease SusceptibilityDNA DamageDNA RepairFemaleGene Expression Regulation, NeoplasticGenes, BRCA1Genes, BRCA2Germ-Line MutationHomologous RecombinationHumansImmunityImmunomodulationMolecular Targeted TherapyProgrammed Cell Death 1 ReceptorTriple Negative Breast NeoplasmsConceptsHost anti-tumor immunityAnti-tumor immunityHomologous recombination deficiencyBreast cancerPurposeTriple-negative breast cancerAnti-tumor immune cellsRecombination deficiencyTriple-negative breast cancerCare systemic therapyImmune-directed therapiesImmune cell subsetsHomologous recombination DNA repair deficiencyBRCA2 mutation carriersBiomarker-driven approachBreast cancer subtypesPARP inhibitor olaparibHR-deficient tumorsDNA repair capacityMetastatic diseaseSystemic therapyImmune infiltratesImproved prognosisCell subsetsImmune cellsWorse outcomesCharacterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program
Cardoso F, Bartlett J, Slaets L, van Deurzen C, van Leeuwen-Stok E, Porter P, Linderholm B, Hedenfalk I, Schröder C, Martens J, Bayani J, van Asperen C, Murray M, Hudis C, Middleton L, Vermeij J, Punie K, Fraser J, Nowaczyk M, Rubio I, Aebi S, Kelly C, Ruddy K, Winer E, Nilsson C, Dal Lago L, Korde L, Benstead K, Bogler O, Goulioti T, Peric A, Litière S, Aalders K, Poncet C, Tryfonidis K, Giordano S. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Annals Of Oncology 2018, 29: 405-417. PMID: 29092024, PMCID: PMC5834077, DOI: 10.1093/annonc/mdx651.Peer-Reviewed Original ResearchConceptsRecurrence-free survivalMale breast cancerAdjuvant endocrine therapyBreast cancerEndocrine therapySentinel lymph node biopsyLymph node biopsyBreast cancer programFemale breast cancerDuctal invasive carcinomaBC mortalityIHC subtypesIHC surrogatesAdjuvant radiotherapyM1 patientsMetastatic diseaseMedian ageCentral pathologyM0 tumorsM0 casesProgesterone receptorCancer programsInvasive carcinomaKi67 expressionAndrogen receptor
2017
Phase 2 study of pembrolizumab (pembro) monotherapy for previously treated metastatic triple-negative breast cancer (mTNBC): KEYNOTE-086 cohort A.
Adams S, Schmid P, Rugo H, Winer E, Loirat D, Awada A, Cescon D, Iwata H, Campone M, Nanda R, Hui R, Curigliano G, Toppmeyer D, O'Shaughnessy J, Loi S, Paluch-Shimon S, Card D, Zhao J, Karantza V, Cortes J. Phase 2 study of pembrolizumab (pembro) monotherapy for previously treated metastatic triple-negative breast cancer (mTNBC): KEYNOTE-086 cohort A. Journal Of Clinical Oncology 2017, 35: 1008-1008. DOI: 10.1200/jco.2017.35.15_suppl.1008.Peer-Reviewed Original ResearchMetastatic triple-negative breast cancerTreatment-related AEsPD-L1 expressionPD-L1Manageable safetyTriple-negative breast cancerECOG PS 0Subset of ptsDisease control ratePhase 2 studyPoor prognostic factorEfficacy/safetyBest overall responseCohort A.Evaluable ptsKEYNOTE-012Median DoRMedian PFSPrior chemotherapyData cutoffPembrolizumab monotherapyDurable responsesMetastatic diseasePrior linesPS 0
2016
Randomized trial of a physical activity intervention in women with metastatic breast cancer
Ligibel JA, Giobbie-Hurder A, Shockro L, Campbell N, Partridge AH, Tolaney SM, Lin NU, Winer EP. Randomized trial of a physical activity intervention in women with metastatic breast cancer. Cancer 2016, 122: 1169-1177. PMID: 26872302, DOI: 10.1002/cncr.29899.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedBreast NeoplasmsChemotherapy, AdjuvantChi-Square DistributionCombined Modality TherapyDisease-Free SurvivalExercise TherapyFemaleFollow-Up StudiesHumansMastectomy, SegmentalMiddle AgedNeoplasm InvasivenessNeoplasm StagingPhysical FitnessQuality of LifeRadiotherapy, AdjuvantReference ValuesSurvival AnalysisTreatment OutcomeUnited StatesConceptsMetastatic breast cancerEarly-stage breast cancerExercise interventionBreast cancerPhysical functioningLife Questionnaire-Core 30 questionnaireModerate-intensity aerobic exercisePhysical Activity Recall interviewModerate-intensity exercise interventionAdvanced breast cancerPhysical activity interventionsTime of enrollmentWait-list control groupQuality of lifeMetastatic diseaseCancer QualityMedian ageIntervention armMedian timeActivity interventionsAerobic exerciseWeekly exerciseTreadmill testFunctional capacityNonsignificant increase
2013
Prospective clinical experience with research biopsies in breast cancer patients
Vaz-Luis I, Zeghibe CA, Frank ES, Sohl J, Washington KE, Silverman SG, Fonte JM, Mayer EL, Overmoyer BA, Richardson AL, Krop IE, Winer EP, Lin NU. Prospective clinical experience with research biopsies in breast cancer patients. Breast Cancer Research And Treatment 2013, 142: 203-209. PMID: 24113744, PMCID: PMC3825285, DOI: 10.1007/s10549-013-2717-5.Peer-Reviewed Original ResearchConceptsResearch biopsiesAdverse eventsDisease courseMetastatic samplesDana-Farber Cancer InstituteGrade 2 painGrade 3 painProspective clinical experiencePatient's disease courseSingle institution experienceBreast cancer patientsPerformance of biopsyHigh rateAnalytic cohortFirst recurrenceMetastatic diseaseMost patientsPerformance statusReceptor statusPrimary cancerProspective studyCancer patientsBreast cancerPatientsBiopsyProspective clinical experience with research biopsies in breast cancer patients.
Zeghibe C, Luis I, Frank E, Sohl J, Washington K, Silverman S, Fonte J, Mayer E, Overmoyer B, Richardson A, Krop I, Winer E, Lin N. Prospective clinical experience with research biopsies in breast cancer patients. Journal Of Clinical Oncology 2013, 31: e17574-e17574. DOI: 10.1200/jco.2013.31.15_suppl.e17574.Peer-Reviewed Original ResearchResearch biopsiesAdverse eventsBreast cancerCohort 1Cohort 2Grade 2Dana-Farber Cancer InstituteGrade 2 painGrade 3 painProspective clinical experienceSingle institution experienceTime of diagnosisBreast cancer patientsOngoing prospective studyMajority of ptsAcademic medical centerWithdrew consentAnalytic cohortChart reviewFirst recurrenceMetastatic diseasePerformance statusSevere painInstitution experienceProspective studyClinical and translational results of CALGB 40601: A neoadjuvant phase III trial of weekly paclitaxel and trastuzumab with or without lapatinib for HER2-positive breast cancer.
Carey L, Berry D, Ollila D, Harris L, Krop I, Weckstein D, Henry N, Anders C, Cirrincione C, Winer E, Perou C, Hudis C. Clinical and translational results of CALGB 40601: A neoadjuvant phase III trial of weekly paclitaxel and trastuzumab with or without lapatinib for HER2-positive breast cancer. Journal Of Clinical Oncology 2013, 31: 500-500. DOI: 10.1200/jco.2013.31.15_suppl.500.Peer-Reviewed Original ResearchHER2-positive breast cancerBreast pCR ratePathological complete responsePCR rateCALGB 40601Weekly paclitaxelResidual diseaseBreast cancerStage IIClinical stage IIDose-dense ACPhase III trialsProgression-free survivalHER2-targeted agentsBiomarkers of sensitivityGene copy number abnormalitiesTissue-based studiesEligible patientsNeoadjuvant settingNeoadjuvant studiesTH armPrimary endpointIII trialsMetastatic diseaseComplete responseInternational guidelines for management of metastatic breast cancer (MBC) from the European School of Oncology (ESO)–MBC Task Force: Surveillance, staging, and evaluation of patients with early-stage and metastatic breast cancer
Lin NU, Thomssen C, Cardoso F, Cameron D, Cufer T, Fallowfield L, Francis PA, Kyriakides S, Pagani O, Senkus E, Costa A, Winer EP, Force E. International guidelines for management of metastatic breast cancer (MBC) from the European School of Oncology (ESO)–MBC Task Force: Surveillance, staging, and evaluation of patients with early-stage and metastatic breast cancer. The Breast 2013, 22: 203-210. PMID: 23601761, DOI: 10.1016/j.breast.2013.03.006.Peer-Reviewed Original ResearchConceptsMetastatic breast cancerEarly-stage breast cancerBreast cancerTumor markersRisk/benefit ratioEuropean Breast Cancer ConferenceEarly-stage patientsEvaluation of patientsInitiation of treatmentProgression of diseaseSpecific BC subtypesTask ForceQuality of lifeType of treatmentEndocrine therapyMetastatic diseaseMetastatic involvementSystemic therapyBC subtypesPhysical examinationClinical trialsCancer ConferencePatientsClinical practiceInternational guidelinesA phase II study of ixabepilone and trastuzumab for metastatic HER2-positive breast cancer
Tolaney SM, Najita J, Sperinde J, Huang W, Chen WY, Savoie J, Fornier M, Winer EP, Bunnell C, Krop IE. A phase II study of ixabepilone and trastuzumab for metastatic HER2-positive breast cancer. Annals Of Oncology 2013, 24: 1841-1847. PMID: 23559151, PMCID: PMC3690910, DOI: 10.1093/annonc/mdt121.Peer-Reviewed Original ResearchConceptsMetastatic HER2-positive breast cancerHER2-positive breast cancerCombination of ixabepilonePhase II studyBreast cancerII studyMetastatic diseaseCohort 2Cohort 1Treatment-related toxic effectsClinical benefit rateSubsequent-line therapyTrastuzumab-containing regimensMetastatic breast cancerPrior chemotherapyLine therapyBenefit rateOverall RRDay 1PatientsTrastuzumabIxabepiloneCancerTumor biomarkersCohort
2012
Human epidermal growth factor receptor-2-positive breast cancer: does estrogen receptor status define two distinct subtypes?
Vaz-Luis I, Winer EP, Lin NU. Human epidermal growth factor receptor-2-positive breast cancer: does estrogen receptor status define two distinct subtypes? Annals Of Oncology 2012, 24: 283-291. PMID: 23022997, PMCID: PMC3551479, DOI: 10.1093/annonc/mds286.Peer-Reviewed Original ResearchConceptsHER2-positive breast cancerHER2-positive diseaseEstrogen receptor statusBreast cancerReceptor statusClinical outcomesEpidermal growth factor receptor 2 overexpressionHuman epidermal growth factor receptor 2 (HER2) overexpressionDistinct subtypesFuture clinical trialsEfficacy of therapyMetastatic settingNeoadjuvant therapyMetastatic diseaseER statusSurvival outcomesClinical trialsPatterns of disseminationTherapyCancerDiseaseSubstantial minorityOutcomesSubtypesHeterogeneous entity