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6 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Luminal androgen receptor cancers are triple-negative breast cancers that behave like hormone-driven tumours run by the male hormone receptor instead of oestrogen. They are less proliferative, respond less well to chemotherapy, and have shown modest benefit from prostate cancer drugs that block the androgen receptor in phase 2 trials; none is approved for breast cancer.
The luminal androgen receptor (LAR) subtype was characterised by androgen receptor signalling and luminal gene expression despite ER negativity, included patients with decreased relapse-free survival, and its cell lines were uniquely sensitive to bicalutamide (Lehmann 2011); it survived the 2016 refinement as one of four tumour-intrinsic subtypes, with a pathological complete response rate of 29 percent across five neoadjuvant datasets against 41 percent for BL1 (Lehmann 2016) and 10 percent in the MD Anderson series (Masuda 2013). Burstein's LAR subtype carries the androgen receptor and the mucin MUC1 as candidate targets and separates from the other three subtypes on DNA copy number (Burstein 2015). The molecular apocrine tumours described in France are the same entity approached from ER-negative disease: ESR1-negative, AR- and FOXA1-positive by transcript, with 67 percent HER2 3+ and 57 percent GCDFP15-positive by immunohistochemistry and a clinically aggressive course (Lehmann-Che 2013); the histological apocrine carcinoma, ER and PR negative and androgen receptor positive, is on its own page. Androgen blockade has been tested in two phase 2 trials: bicalutamide 150 mg daily gave a six-month clinical benefit rate of 19 percent and median progression-free survival of 12 weeks in 26 AR-positive, ER- and PR-negative patients (Gucalp 2013); enzalutamide 160 mg daily gave a 16-week clinical benefit rate of 25 percent in all 118 enrolled and 33 percent in the 78 with 10 percent or more nuclear AR, median progression-free survival 2.9 and 3.3 months and median overall survival 12.7 and 17.6 months, with fatigue the only grade 3 or higher treatment-related event above 2 percent (Traina 2018). Neither drug is approved for breast cancer; PIK3CA mutations are enriched in this subtype, the basis for trials combining androgen blockade with PI3K-pathway inhibitors.
A research classification by gene expression (Lehmann 2011, refined 2016), not a test the NHS runs; treatment follows the triple-negative rows on the parent page.
| Setting | Approach | Guideline |
|---|---|---|
| Stage II to III | As for triple-negative disease; the subtype's lower pathological complete response rate is a research observation. | not mapped |
| Metastatic, androgen receptor-positive (trials only) | Bicalutamide or enzalutamide showed clinical benefit rates of 19 to 33 percent in phase 2; not approved for breast cancer, so within a trial or after the approved options. | not mapped |