"Next to speak was Bent Ejlertsen, M.D., Ph.D., of the Department of Oncology,
Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark. The title of his presentation was “Prediction
of Responsiveness to Adjuvant Anthracyclines in High-Risk Breast Cancer
He reported on the extensive studies about the TOP2A marker that he
and his colleagues have conducted. Their goal was to learn how to use this
biomarker for both prognostic and predictive evaluations to identify which
breast cancer patients would benefit from therapy with adjuvant anthracyclines.
The TOP2A marker is scored in a similar fashion as the HER2 marker. Ejlertsen
stressed that improved patient safety would result as the pathology profession
achieved more standardized processing and diagnosis when working with the TOP2A
Third speaker at this special seminar on histopathology workflow
and patient safety was Professor Giuseppe Viale, M.D., of the University of
Milan School of Medicine and European Institute of Oncology in Milan, Italy.
Viale emphasized the importance of achieving improved standardization for
estrogen receptor (ER) and progesterone receptor (PgR) assays in breast cancer.
Of particular note, Viale is a member of the international committee working to
develop recommendations for standardizing the preparation and evaluation of
tests utilizing ER and PgR immunohistochemical probes.
He opened his
presentation by describing the importance of achieving improved standardization
in ER and PgR testing. Viale stated that assessment of hormone receptor status
is “the first and most important clue” in tailoring treatment of a breast cancer
patient. Additionally, he noted that the importance of avoiding false positive
results for this testing, because Tamoxifen is detrimental for patients with
The topoIIA story is still not settled. Most studies have not demonstrated the utility of this marker as a predictive or prognostic marker.
ER testing recommendations/standards are supposedly forthcoming from ASCO/CAP. Participation in CAP Proficiency Testing or some other external validation program is a minimum. As I've stated previously, attention to preanalytical variables that affect IHC staining as well as testing protocols, especially with respect to antigen retrieval, are crucial and yet, curiously, seem to be not taken seriously. Choosing a control that has been externally validated to show negative, weak, and positive staining increased my confidence in our process and really helped "dial-in" our results with CAP-PT surveys.