What does this research mean for the field?

Patients with HER2-negative metastatic breast cancer with low hormone receptor expression (1-9%) have similar overall survival outcomes to those with triple-negative breast cancer. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research assesses overall survival in HER2-negative metastatic breast cancer patients with low hormone receptor expression compared to triple negative and hormone receptor-positive cases.

May 20, 2026Open Access

Characteristics and outcomes of patients with HER2-negative metastatic breast cancers with low expression of estrogen and progesterone receptors in the multicenter ESME cohort.

Puntos clave

This research assesses overall survival in HER2-negative metastatic breast cancer patients with low hormone receptor expression compared to triple negative and hormone receptor-positive cases.
Analyzed data from ESME cohort of 30,459 patients initiating first-line treatment for metastatic breast cancer from 2008 to 2021.
Included 19,109 patients categorized as HR+, TN, and HR-low based on hormone receptor expression.
Conducted multivariable analyses for overall and progression-free survival comparisons.
Median overall survival for HR+ was 44.6 months, TN was 19.1 months, and HR-low was 15.7 months (p < 0.05).
No significant difference in overall survival between HR-low and TN groups (HR 0.93, 95% CI 0.77-1.11).
HR-low group demonstrated poorer progression-free survival than TN group (HR 1.24, 95% CI 1.04-1.49).

Resumen

AbstractBackground Breast cancers expressing low (1-9%) immunohistochemistry levels of estrogen and progesterone hormone receptors (HR), remain an uncertain category, being considered either as triple negative (TN) breast cancers or HR-positive (HR+) tumors across guidelines or approvals. Methods ESME is a National real-world cohort of all consecutive patients who initiated a first-line treatment for metastatic breast cancer (MBC) from year 2008 onwards in one of the 18 French Comprehensive Cancer Centers. We analyzed baseline data and outcomes from all patients with HER2-negative MBC and known HR expression levels. Our primary objective was to evaluate overall survival (OS) in HR-low MBC patients compared with those with TN and HR+ disease. Results Out of 30,459 patients in the ESME database who initiated an MBC treatment between 01/2008 and 01/2021, 19,109 were eligible for this analysis: 16768, 2113, 228 respectively with HR+, TN, and HR-low MBC. Median follow-up was 58.0 months (56.6-59.0). Median OS were 44.6 (43.8-45.5), 19.1 (15.5-22.4) and 15.7 (15.0-16.8) months in the HR+, TN, and HR-low groups, respectively. The multivariable analysis identified no difference in OS between HR-low and TN groups (Hazard Ratio 0.93, 95%CI 0.77-1.11). Median PFS under first line chemotherapy were 10.2 (9.9-10.6), 5.3 (5.1-5.6) and 5.1 (4.1-6.2) months for HR+, TN and HR-low groups, respectively. In the multivariable analysis, the HR-low group had a statistically poorer PFS compared to the TN group (Hazard Ratio 1.24, 95% CI 1.04-1.49). Conclusions In this large cohort, patients with HR-low MBC have the same dismal overall survival as those with TN MBC.

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