{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:29:12Z","timestamp":1789468152892,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Receptor conversion following neoadjuvant therapy may alter eligibility for adjuvant systemic therapy in breast cancer. However, current guidelines provide limited recommendations for biomarker-guided treatment adaptation after receptor change. We aimed to characterize clinical decision-making after receptor conversion and identify a framework describing treatment adaptation across clinically relevant receptor conversion scenarios. Methods: A nationwide cross-sectional survey was conducted between August and September 2025 among Polish medical oncologists involved in breast cancer care. The questionnaire assessed receptor reassessment practices and treatment recommendations across five receptor conversion scenarios. Treatment decisions were classified into three predefined strategies\u2014baseline-driven, residual disease-driven, and combined\u2014according to whether they relied on pretreatment biomarkers, residual disease biomarkers, or both. Results: A total of 104 medical oncologists completed the survey. Routine receptor reassessment in residual disease was reported by 52.9% of respondents, while 73.1% incorporated residual disease biomarkers into treatment planning either routinely or selectively. Overall, baseline-driven strategies accounted for only 26.3% of treatment decisions, compared with 40.2% for combined strategies and 33.5% for residual disease-driven strategies. Combined strategies predominated following hormone receptor conversion (52.9% for luminal HER2-negative to TNBC and 55.8% for TNBC to luminal HER2-negative). Baseline-driven approaches were most frequently selected following HER2 loss (42.3%), whereas HER2 gain favored residual disease-driven strategies in TNBC-to-HER2-positive conversion (46.2%) and combined strategies in luminal HER2-negative-to-HER2-positive conversion (48.1%). Conclusions: A three-strategy framework of clinical decision-making emerged after receptor conversion, with most treatment decisions incorporating residual disease biology despite limited guideline direction. This framework highlights an important evidence gap and provides a practical foundation for future studies evaluating treatment adaptation after receptor conversion.<\/jats:p>","DOI":"10.3390\/jcm15187141","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:16:48Z","timestamp":1789460208000},"page":"7141","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Decision-Making After Receptor Conversion Following Neoadjuvant Therapy in Breast Cancer: A Three-Strategy Framework"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9902-711X","authenticated-orcid":false,"given":"Katarzyna","family":"Pogoda","sequence":"first","affiliation":[{"name":"Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Magdalena","family":"Czopowicz","sequence":"additional","affiliation":[{"name":"National Cancer Strategy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Wojciech","family":"Olszewski","sequence":"additional","affiliation":[{"name":"Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Monika","family":"Durzynska","sequence":"additional","affiliation":[{"name":"Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4003-5278","authenticated-orcid":false,"given":"Piotr Jan","family":"Wysocki","sequence":"additional","affiliation":[{"name":"Department of Oncology, Jagiellonian University Medical College, Kopernika 50, 31-501 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1016\/j.annonc.2025.09.007","article-title":"Tailoring treatment to cancer risk and patient preference: The 2025 St Gallen International Breast Cancer Consensus Statement on individualizing therapy for patients with early breast cancer","volume":"36","author":"Burstein","year":"2025","journal-title":"Ann. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2838","DOI":"10.1158\/1078-0432.CCR-19-3492","article-title":"Pathologic Complete Response after Neoadjuvant Chemotherapy and Impact on Breast Cancer Recurrence and Survival: A Comprehensive Meta-analysis","volume":"26","author":"Spring","year":"2020","journal-title":"Clin. Cancer Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1159\/000521880","article-title":"Receptor Status after Neoadjuvant Therapy of Breast Cancer: Significance and Implications","volume":"89","author":"Shaaban","year":"2022","journal-title":"Pathobiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1038\/s41416-024-02777-6","article-title":"A population-based study on trajectories of HER2 status during neoadjuvant chemotherapy for early breast cancer and metastatic progression","volume":"131","author":"Boman","year":"2024","journal-title":"Br. J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.humpath.2023.11.003","article-title":"HER2 categorical changes after neoadjuvant chemotherapy: A study of 192 matched breast cancers with the inclusion of HER2-Low category","volume":"142","author":"Karakas","year":"2023","journal-title":"Hum. Pathol."},{"key":"ref_6","unstructured":"(2026, July 28). NCCN Clinical Practice Guidelines in Oncology. Breast Cancer (NCCN Guidelines). Version 4. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/breast.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.annonc.2023.11.016","article-title":"Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"35","author":"Loibl","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3867","DOI":"10.1200\/JCO.22.02864","article-title":"Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: ASCO\u2013College of American Pathologists Guideline Update","volume":"41","author":"Wolff","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1200\/JCO.19.02309","article-title":"Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO\/CAP Guideline Update","volume":"38","author":"Allison","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Tarantino, P., Ajari, O., Graham, N., Vincuilla, J., Parker, T., Hughes, M.E., Tayob, N., Garrido-Castro, A.C., Morganti, S., and King, T.A. (2024). Evolution of HER2 expression between pre-treatment biopsy and residual disease after neoadjuvant therapy for breast cancer. Eur. J. Cancer, 201.","DOI":"10.1016\/j.ejca.2024.113920"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.clbc.2026.02.006","article-title":"Impact of Post-Neoadjuvant Chemotherapy Biomarker Changes on Long-Term Oncological Outcomes in Non-pCR Breast Cancer","volume":"26","author":"Lu","year":"2026","journal-title":"Clin. Breast Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1200\/JCO.24.00886","article-title":"For the Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer Guideline Expert Panel. Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer\u2014Cyclin-Dependent Kinase 4 and 6 Inhibitors: ASCO Guideline Rapid Recommendation Update","volume":"42","author":"Freedman","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1200\/OP.22.00284","article-title":"Use of Immune Checkpoint Inhibitors in the Treatment of High-Risk, Early-Stage Triple-Negative Breast Cancer: ASCO Guideline Rapid Recommendation Update Q and A","volume":"18","author":"Vikas","year":"2022","journal-title":"JCO Oncol. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2935","DOI":"10.1007\/s12094-024-03541-1","article-title":"Biomarkers in breast cancer 2024: An updated consensus statement by the Spanish Society of Medical Oncology and the Spanish Society of Pathology","volume":"26","author":"Colomer","year":"2024","journal-title":"Clin. Transl. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Liu, Y., Liang, Z., Bu, H., and Yang, W. (2025). Chinese guidelines for HER2 testing in breast cancer (2024 edition): Summary of key recommendations. J. Clin. Pathol.","DOI":"10.1136\/jcp-2025-210175"},{"key":"ref_16","unstructured":"Allison, K., and Krishnamurti, U. (2025). Template for Reporting Results of Biomarker Testing of Specimens From Patients with Carcinoma of the Breast, College of American Pathologists. Breast Biomarkers, version 1.6.1.0."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cardoso, F., Paluch-Shimon, S., Schumacher-Wulf, E., Matos, L., Gelmon, K., Aapro, M.S., Bajpai, J., Barrios, C.H., Bergh, J., and Bergsten-Nordstr\u00f6m, E. (2024). 6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7). Breast, 76.","DOI":"10.1016\/j.breast.2024.103756"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.annonc.2026.05.707","article-title":"Metastatic breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"37","author":"Barrios","year":"2026","journal-title":"Ann. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.clbc.2025.10.017","article-title":"Immunohistochemical Changes After Neoadjuvant Chemotherapy and Their Impact on Breast Cancer Survival: A Systematic Review and Meta-analysis","volume":"26","author":"Antonini","year":"2026","journal-title":"Clin. Breast Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Dowling, G.P., Daly, G.R., Hehir, C.M., AlRawasdeh, M.M., Calpin, G.G., Almasri, S., Toomey, S., Young, L.S., Hennessey, B.T., and Hill, A.D. (2025). Prognostic significance of receptor conversion following neoadjuvant therapy in breast cancer: A systematic review & meta-analysis. Breast, 82.","DOI":"10.1016\/j.breast.2025.104516"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1038\/s41379-019-0326-5","article-title":"Pathologic reporting practices for breast cancer specimens after neoadjuvant chemotherapy\u2014A survey of pathologists in academic institutions across the United States","volume":"33","author":"Lanjewar","year":"2020","journal-title":"Mod. Pathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.5858\/arpa.2019-0539-OA","article-title":"Lack of Standardization in the Processing and Reporting of Post-Neoadjuvant Breast Cancer Specimens","volume":"144","author":"Han","year":"2020","journal-title":"Arch. Pathol. Lab Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chen, H.-L., Huang, F.-B., Chen, Q., and Deng, Y.-C. (2023). Impact of estrogen receptor expression level on response to neoadjuvant chemotherapy and prognosis in HER2-negative breast cancers. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-11368-2"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kang, S., Lee, S.H., Lee, H.J., Jeong, H., Jeong, J.H., Kim, J.E., Ahn, J.-H., Jung, K.H., Gong, G., and Kim, H.H. (2023). Prognostic implications of HER2 changes after neoadjuvant chemotherapy in patients with HER2-zero and HER2-low breast cancer. Eur. J. Cancer, 191.","DOI":"10.1016\/j.ejca.2023.112956"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1056\/NEJMoa2406070","article-title":"Survival with Trastuzumab Emtansine in Residual HER2-Positive Breast Cancer","volume":"392","author":"Geyer","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Loibl, S., Huang, C.-S., Mano, M.S., Mamounas, E.P., Geyer, C.E., Untch, M., Thery, J.-C., Schwaner, I., Limentani, S., and Loman, N. (2022). Adjuvant trastuzumab emtansine in HER2-positive breast cancer patients with HER2-negative residual invasive disease in KATHERINE. npj Breast Cancer, 8.","DOI":"10.1038\/s41523-022-00477-z"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7141\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:55:44Z","timestamp":1789462544000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":26,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187141"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187141","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}