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

Sep 22, 2026

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Background: Breast cancers expressing low (1–9%) estrogen and progesterone receptor levels remain an uncertain category, variably considered as triple-negative or hormone-receptor positive across guidelines. Methods: Using ESME, a national real-world cohort of consecutive French patients starting first-line metastatic breast cancer treatment from 2008 onward, baseline characteristics and outcomes were analyzed in HER2-negative MBC with known hormone receptor expression. Overall survival was compared across HR-low, triple-negative, and HR-positive groups. Results: HR-low patients showed similar overall survival to triple-negative, while progression-free survival was worse. Conclusions: In this large cohort, HR-low metastatic disease mirrors the poor overall survival of triple-negative disease.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

The Breast 88 (2026) 104815 Contents lists available at ScienceDirect The Breast journal [homepage:](homepage: www.journals.elsevier.com/the-breast)[ www.journals.elsevier.com/the-breast](homepage: www.journals.elsevier.com/the-breast) | Characteristics and outcomes of patients with HER2-negative metastatic breast cancers with low expression of estrogen and progesterone receptors in the multicenter ESME cohort
Marie Alexandre a,* , Eva Teruelb, Florence Dalencc, Thibaut de la Motte Rouged,
Etienne Braine , Vincent Massardf, Monica Arnedos g , Audrey Mailliezh, Jean-Marc Ferreroi, Thomas Bachelotj , Isabelle Desmoulins k, Marie-Ange Mouret-Reynierl, Christelle Levy m, Antony Gonçalves n, Anca Berghiano, Thierry Petit p , Jean-S´ebastien Frenel q ,
Anne-Laure Martin r, Thomas Grindas , William Jacota
a Department of Medical Oncology, Regional Cancer Institute, Montpellier, France b Biostatistics Unit, Regional Cancer Institute, Montpellier, France
c Department of Medical Oncology, Oncopole Claudius Regaud IUCT-O, Toulouse, France d Department of Medical Oncology, Centre Eug`ene Marquis, Rennes, France e Department of Medical Oncology, Institut Curie, Saint-Cloud, France
f Department of Medical Oncology, Institut de Canc´erologie de Lorraine, Vandœuvre-l`es-Nancy, France g Department of Medical Oncology, Institut Bergoni´e, Bordeaux, France
h Department of Medical Oncology, Centre Oscar Lambret, Lille, France
i Department of Medical Oncology, Centre Antoine Lacassagne Universit´e Cˆote d’Azur, Nice, France j Department of Medical Oncology, Centre L´eon B´erard, Lyon, France
k Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France l Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand, France m Department of Medical Oncology, Centre François Baclesse, Caen, France n Department of Medical Oncology, Institut Paoli-Calmette, Marseille, France
o Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
p Department of Medical Oncology, Centre Paul Strauss ICANS, Strasbourg, France q Department of Medical Oncology, Institut de Canc´erologie de l’Ouest, Saint-Herblain, France r Health Data and Partnership department, Unicancer, Paris, France
s Breast Cancer Unit, Gustave Roussy, Villejuif, France | | | --- | --- | A R T I C L E I N F O Keywords: Metastatic breast cancer Hormone receptor low Real-world data Overall survival A B S T R A C T Background: 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- * Corresponding author. Institut regional du cancer de, Montpellier, 34090, France. E-mail [address:](address: Marie.Alexandre@icm.unicancer.fr)[ Marie.Alexandre@icm.unicancer.fr](a

FAQs

What defines HER2-negative metastatic breast cancer with low hormone receptor expression in this study?

The study focuses on HR-low disease defined by low estrogen and progesterone receptor expression levels (1–9%) measured by immunohistochemistry. Patients had HER2-negative metastatic breast cancer and known HR expression levels.

How was overall survival analyzed across HR-low, triple-negative, and HR-positive groups?

Researchers used the ESME national real-world cohort and evaluated overall survival as the primary objective. Survival outcomes were compared between HR-low patients and those with triple-negative and HR-positive disease using multivariable analysis.

What were the key outcome findings for HR-low versus triple-negative metastatic breast cancer?

Median overall survival was similar between HR-low and triple-negative groups, and multivariable analysis showed no difference in overall survival between these groups. However, progression-free survival was statistically poorer for HR-low compared with triple-negative.

Sep 22, 2026

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