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Parker G, Hunter S, Ghazi S, Hayeems RZ, Rousseau F, Miller FA. Decision impact studies, evidence of clinical utility for genomic assays in cancer: A scoping review. PLoS One 2023; 18:e0280582. [PMID: 36897859 PMCID: PMC10004522 DOI: 10.1371/journal.pone.0280582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/03/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Decision impact studies have become increasingly prevalent in cancer prognostic research in recent years. These studies aim to evaluate the impact of a genomic test on decision-making and appear to be a new form of evidence of clinical utility. The objectives of this review were to identify and characterize decision impact studies in genomic medicine in cancer care and categorize the types of clinical utility outcomes reported. METHODS We conducted a search of four databases, Medline, Embase, Scopus and Web of Science, from inception to June 2022. Empirical studies that reported a "decision impact" assessment of a genomic assay on treatment decisions or recommendations for cancer patients were included. We followed scoping review methodology and adapted the Fryback and Thornbury Model to collect and analyze data on clinical utility. The database searches identified 1803 unique articles for title/abstract screening; 269 articles moved to full-text review. RESULTS 87 studies met inclusion criteria. All studies were published in the last 12 years with the majority for breast cancer (72%); followed by other cancers (28%) (lung, prostate, colon). Studies reported on the impact of 19 different proprietary (18) and generic (1) assays. Across all four levels of clinical utility, outcomes were reported for 22 discrete measures, including the impact on provider/team decision-making (100%), provider confidence (31%); change in treatment received (46%); patient psychological impacts (17%); and costing or savings impacts (21%). Based on the data synthesis, we created a comprehensive table of outcomes reported for clinical utility. CONCLUSIONS This scoping review is a first step in understanding the evolution and uses of decision impact studies and their influence on the integration of emerging genomic technologies in cancer care. The results imply that DIS are positioned to provide evidence of clinical utility and impact clinical practice and reimbursement decision-making in cancer care. Systematic review registration: Open Science Framework osf.io/hm3jr.
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Affiliation(s)
- Gillian Parker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hunter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Samer Ghazi
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Robin Z. Hayeems
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francois Rousseau
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Fiona A. Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Fallowfield L, Solis-Trapala I, Starkings R, May S, Matthews L, Eccles D, Evans DG, Turnbull C, Crawford G, Jenkins V. Talking about Risk, UncertaintieS of Testing IN Genetics (TRUSTING): development and evaluation of an educational programme for healthcare professionals about BRCA1 & BRCA2 testing. Br J Cancer 2022; 127:1116-1122. [PMID: 35715636 PMCID: PMC9470577 DOI: 10.1038/s41416-022-01871-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Mainstreaming of germline testing demands that all healthcare professionals have good communication skills, but few have genetic testing and counselling experience. We developed and evaluated educational workshops-Talking about Risk & UncertaintieS of Testing IN Genetics (TRUSTING). Contents included: presentations and exercises, an interview with a geneticist about BRCA testing, screening and prevention implications, filmed interactions between surgeons, a genetic counsellor and geneticists with a fictitious family (proband had a BRCA2 pathogenic variant with triple-negative breast cancer, her older sister-BRCA2 heterozygous, and cousin-negative for BRCA2 variant). METHODS Twenty-one surgeons, 5 oncologists, 18 nurses and 9 genetic counsellors participated. Knowledge (18 item MCQ), communication skills (responses to 6 questions from proband and relatives) and self-confidence (discussing 9 genetic testing issues) were assessed pre- and post workshop. RESULTS Knowledge scores improved significantly post workshop (mean change = 7.06; 95% confidence interval (CI) 6.37-7.74; P < 0.001), as did communication (mean change = 5.38; 95% CI 4.37-6.38; P < 0.001) and self-confidence (P < 0.001). DISCUSSION Healthcare professionals' knowledge and self-confidence when discussing the risks and uncertainties in genetics are often poor. TRUSTING workshops significantly enhanced attendees' navigation of communication difficulties encountered and will be rolled out more widely.
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Affiliation(s)
- Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK.
| | | | - Rachel Starkings
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - Shirley May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - Lucy Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - Diana Eccles
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D Gareth Evans
- Division of Evolution Infection and Genomic Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Gillian Crawford
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Valerie Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK
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Zhou X, Qian A, Hou P. Role of Curculigo Orchioides in the Proliferation and Apoptosis of Breast Cancer Michigan Cancer Foundation-7 (MCF-7) Cells Under Network Pharmacology. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Based on network pharmacology (NP), the effects of curculigo orchioides (CO) granules alone or CO granules along with tamoxifen on the proliferation and apoptosis (P&A) of human breast cancer (BC) cells were explored. A search database was constructed to obtain the active components
(ACs) of CO and related target genes to perform disease mapping, and a BC target map was constructed to perform related pathway enrichment analysis (PEA). The blank control group (CG), estrogen group (EG), and tamoxifen group (TG) were set as controls to observe the effects of CO granules
alone and CO granules along with tamoxifen. The PEA showed that the effect of CO on BC may be related to the cooperation of its ACs. The target of action may be related to cell cycle and proliferation, growth factors, metabolic pathways, etc. Different concentrations of CO had different effects,
CO granules of various concentrations had no obvious growth-promoting effect (P < 0.05), and so did CO combined with tamoxifen (P > 0.05); high-dose (H-D) CO combined with tamoxifen can induce cell apoptosis (P < 0.05). Through NP, the ACs of CO and related targets
of BC were predicted and analyzed. At the same time, it was proved that CO granules are safe in clinical use, and the combined effect of tamoxifen is better in the treatment of estrogen-positive patients, providing reference for the follow-up use of CO in the treatment of BC.
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Affiliation(s)
- Xiaoyong Zhou
- Center of Emergency and Intensive Care Unit, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - An Qian
- Department of Pharmaceutical Engineering, School of Chemistry and Chemical Engineering, Hefei Normal University, Hefei, 230000, China
| | - Panfei Hou
- Department of Clinical Laboratory, Lianshui County People’s Hospital, Lianshui, 223400, Jiangsu, China
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Pelliccia C, Caselli E, Mandarano M, Del Sordo R, Bellezza G, Sidoni A. The implementation of a commercially available multi-gene profile test for breast cancer characterization in a department of pathology: what have we learned from the first 100 cases? Virchows Arch 2021; 478:1079-1087. [PMID: 33404851 DOI: 10.1007/s00428-020-02994-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022]
Abstract
Analysis of breast cancer prognostic and predictive factors is still nowadays poorly accurate and standardized. The advent of multi-gene expression profiles (MGEPs) has improved the prediction of breast cancer outcome, particularly regarding early luminal breast cancers (LBCs). The availability in our Institute of EndoPredict® (EP), a last-generation prognostic gene signature assay, has prompted us to study a series of LBCs, firstly verifying its reproducibility on six routine representative cases, either presenting non-optimal preanalytical conditions or different tumor samples from the same patient; secondly, correlating EP results on 8 retrospectively recruited samples with patients' follow-up; thirdly, applying prospectively EP on 100 routinely diagnosed cases, assessing the oncologists' and pathologists' attitude toward it. The complete reproducibility of EP on all the samples investigated in the first phase allowed to state that EP overcomes the detrimental effects of an inaccurate pre-analytic phase, determining the most appropriate prognostic and predictive parameters of breast cancer. The second phase confirmed EP as a fundamental tool in guiding therapeutic decision, improving the classical bio-pathological characterization and recovering 38% patients' inadequately managed. Finally, the study disclosed how oncologists sometimes inadequately requested EP, but also how it allows a better stratification of breast cancer otherwise considered poorly aggressive and not requiring an EP test, such as G1 neoplasms or tubular histotype. In conclusion, the introduction of EP test in an Anatomic Pathology Department emerges as a useful tool in routine breast cancer diagnosis, both for the characterization of individual cases and, as a result, for more appropriate therapeutic choices.
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Affiliation(s)
- Cristina Pelliccia
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, P.le Menghini 1, Perugia, 06129, Italy
| | - Emanuele Caselli
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, P.le Menghini 1, Perugia, 06129, Italy
| | - Martina Mandarano
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, P.le Menghini 1, Perugia, 06129, Italy.
| | - Rachele Del Sordo
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, P.le Menghini 1, Perugia, 06129, Italy
| | - Guido Bellezza
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, P.le Menghini 1, Perugia, 06129, Italy
| | - Angelo Sidoni
- Department of Experimental Medicine, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, P.le Menghini 1, Perugia, 06129, Italy
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van Steenhoven JEC, den Dekker BM, Kuijer A, van Diest PJ, Nieboer P, Zuetenhorst JM, Imholz ALT, Siesling S, van Dalen T. Patients' perceptions of 70-gene signature testing: commonly changing the initial inclination to undergo or forego chemotherapy and reducing decisional conflict. Breast Cancer Res Treat 2020; 182:107-115. [PMID: 32430679 PMCID: PMC7275022 DOI: 10.1007/s10549-020-05683-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Little is known about the impact of 70-gene signature (70-GS) use on patients' chemotherapy decision-making. The primary aim of this study was to evaluate the impact of 70-GS use on patients' decisions to undergo chemotherapy. The perceived decision conflict during decision-making was a secondary objective of the study. METHODS Patients operated for estrogen receptor positive early breast cancer were asked to fill out a questionnaire probing their inclination to undergo chemotherapy before deployment of the 70-GS test. After disclosure of the 70-GS result patients were asked about their decision regarding chemotherapy. Patients' decisional conflict was measured using the 16-item decisional conflict scale (DCS); scores < 25 are associated with a persuaded decision while a score > 37.5 implies that one feels unsure about a choice. RESULTS Between January 1th 2017 and December 31th 2018, 106 patients completed both questionnaires. Before deployment of the 70-GS, 58% of patients (n = 62) formulated a clear treatment preference, of whom 21 patients (34%) changed their opinion on treatment with chemotherapy following the 70-GS. The final decision regarding chemotherapy was in line with the 70-GS result in 90% of patients. The percentage of patients who felt unsure about their preference to be treated with chemotherapy decreased from 42 to 5% after disclosure of the 70-GS. The mean total DCS significantly decreased from pre-test to post-test from 35 to 23, irrespective of the risk estimate (p < 0.001). CONCLUSION Deployment of the 70-GS changed patients' inclination to undergo adjuvant chemotherapy in one third of patients and decreased patients' decisional conflict.
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Affiliation(s)
- Julia E C van Steenhoven
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Bianca M den Dekker
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne Kuijer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter Nieboer
- Department of Medical Oncology, Wilhelmina Hospital Assen, Assen, The Netherlands
| | - Johanna M Zuetenhorst
- Department of Medical Oncology, Franciscus Gasthuis Hospital, Rotterdam, The Netherlands
| | - Alex L Th Imholz
- Department of Medical Oncology, Deventer Hospital, Deventer, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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Villarreal-Garza C, Lopez-Martinez EA, Deneken-Hernandez Z, Maffuz-Aziz A, Muñoz-Lozano JF, Barragan-Carrillo R, Ramos-Elias P, Moreno B, Diaz-Perez H, Peña-Curiel O, Curiel-Valdez JDJ, Bautista-Piña V. Change in therapeutic management after the EndoPredict assay in a prospective decision impact study of Mexican premenopausal breast cancer patients. PLoS One 2020; 15:e0228884. [PMID: 32160201 PMCID: PMC7065749 DOI: 10.1371/journal.pone.0228884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the change in adjuvant therapeutic decision in a cohort of young women with breast cancer discussed by a multidisciplinary team, before and after EndoPredict testing. Patients and methods 99 premenopausal women with hormone receptor-positive, HER2-negative, T1-T2, and N0-N1 breast cancer were included. Clinicopathological characteristics were recorded and cases were presented in a multidisciplinary tumor board. Consensual therapeutic decisions before and after EndoPredict results were registered. Medical records were reviewed at six-month follow-up to determine physicians’ adherence to therapeutic recommendations. Pearson chi-square and McNemar’s tests were used to analyze differences between groups and changes in treatment recommendations, respectively. Results Median age at diagnosis was 43 years. The most frequent tumor size was pT2 (53.5%) and 27% of patients had 1–3 positive lymph nodes. 46% of patients had a low-risk EPclin result. Nodal status and tumor grade were significantly associated with EPclin result (p < .00001 and p = .0110, respectively), while Ki67 levels and age ≤40 years were not. A change in chemotherapy decision was registered in 19.2% of patients (p = .066), with the greatest impact in de-escalation (9% net reduction). A change in chemotherapy or endocrine therapy regimen was suggested in 19% and 20% of cases, respectively, after EPclin results were available. A significant difference was found in the median EPclin score between patients with a low- vs. high-intensity chemotherapy and endocrine therapy regimen recommendation (p = 0.049 and p = 0.0001, respectively). Tumor board treatment recommendation adherence with the EndoPredict result was 95% and final treatment adherence to EPclin result was 93%. Conclusions The EndoPredict test successfully assisted the clinical decision-making process in premenopausal patients, with a clinically significant change in overall decision-making, with the greatest impact seen in chemotherapy reduction, and a high rate of therapeutic adherence.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
- Research and Breast Cancer Department, Instituto Nacional de Cancerologia, Mexico City, Mexico
- * E-mail:
| | | | | | | | | | | | - Pier Ramos-Elias
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
| | - Brizio Moreno
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
| | - Hector Diaz-Perez
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
| | - Omar Peña-Curiel
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico
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Zekri J, Al-Foheidi M, Alata M, Zabani R, Rasmy A. Adjuvant Chemotherapy for Patients with Breast Cancer Based on Clinical and Evolving Oncotype DX Criteria. Breast Care (Basel) 2020; 15:642-647. [PMID: 33447239 DOI: 10.1159/000506389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Oncotype DX assay recurrence score (ODX-RS) cut-off values have recently changed after the publication of the TAILOR-X trial results. We aim to explore decisions for adjuvant chemotherapy (ACT) based on physicians' clinical assessment and the evolving ODX-RS. Methodology Patients who underwent ODX testing after curative surgical resection of estrogen receptor positive (ER+), Her2 non-overexpressed (Her2-) and lymph node-negative (LN-) breast cancer (BC) were eligible. Management of these patients was guided by the results of the old ODX-RS-1 (<18, 18-30, and ≥31) risk grouping. For the purpose of this study, treatment decisions were also assumed according to TAILOR-X results (ODX-RS-2). Decisions of 3 medical oncologists on ACT were solicited by blinding them to the RS to investigate concordance with ODXA RS-1 and 2 recommendations. Results Sixty-six consecutive patients were included. Median age was 50.5 (range: 21-73) years. There was 1 male patient, and 37/65 females (56.9%) were premenopausal. Among the 3 oncologists, recommendations for ACT based on clinical assessment were discrepant in 29 (43.9%) patients. Based on majority consensus (≥2 oncologists), ACT would have been recommended to 22/41 (53.7%) and 22/46 (47.82%) patients with low-risk tumors according to ODX-RS-1 and ODX-RS-2, respectively. Compared to ODX-RS-1, ODX-RS-2 identifies 12% (46 vs. 41) more low-risk patients and 66% (20 vs. 12 patients) more high-risk patients. Conclusion Overtreatment and discrepancies in the management of patients with ER+/Her2-/LN- early BC can be minimized by the implementation of ODX genomic assay. Some differences in ACT recommendations exist between ODX-RS-1 and ODX-RS-2.
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Affiliation(s)
- Jamal Zekri
- College of Medicine, Al-Faisal University, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Meteb Al-Foheidi
- Princess Noorah Oncology Center, King Saud bin Abdulaziz University, Jeddah, Saudi Arabia
| | - Maaz Alata
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Reem Zabani
- Ibn Sina National Medical College, Jeddah, Saudi Arabia
| | - Ayman Rasmy
- Medical Oncology Department, King Saud Medical City, Riyadh, Saudi Arabia.,Medical Oncology, Zagazig University Hospitals, Zagazig, Egypt
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Penault-Llorca F, Kwiatkowski F, Arnaud A, Levy C, Leheurteur M, Uwer L, Derbel O, Le Rol A, Jacquin JP, Jouannaud C, Quenel-Tueux N, Girre V, Foa C, Guardiola E, Lortholary A, Catala S, Guiu S, Valent A, Boinon D, Lemonnier J, Delaloge S. Decision of adjuvant chemotherapy in intermediate risk luminal breast cancer patients: A prospective multicenter trial assessing the clinical and psychological impact of EndoPredict® (EpClin) use (UCBG 2-14). Breast 2020; 49:132-140. [PMID: 31790959 PMCID: PMC7375561 DOI: 10.1016/j.breast.2019.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/13/2019] [Accepted: 10/25/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Genomic tests can identify ER-positive HER2-negative localized breast cancer patients who may not benefit from adjuvant chemotherapy. Such tests seem especially interesting in "intermediate" clinico-pathological risk categories. The psychological impact of the decision uncertainty in these women remains largely unexplored. We assessed the clinical and psychological impact of EndoPredict® (EpClin), a clinico-genomic test, in these patients. METHODS This multicenter, single arm prospective study (NCT02773004) enrolled patients for which adjuvant chemotherapy was uncertain, based on predefined criteria. The primary endpoint was the proportion of change between initial adjuvant decision and final administration of chemotherapy. Secondary endpoints included post-test (Day 17) and 1-year patient reported outcomes. RESULTS One third of 200 evaluable patients had a high EpClin score (≥3.32867; 10 years cumulative risk of distance failure ≥10%). The overall change rate of chemotherapy decision was 72/200 (35.8%, 95% CI 29.2-42.4). Chemotherapy was withdrawn in 57 cases (28.4% [22.2-34.8]) and added in 15 (7.5% [3.8-11.2]. 6 changes (8%) were based on patients' decisions. Anxiety and distress levels increased at Day 17 when adding chemotherapy after the test result (p < 10-7 and 0.00022 respectively), while stable in other situations. At 1-year, all patients had returned to the baseline anxiety and distress levels (mean anxiety 51.5, +/- SD = 2.5 [max. 80], mean distress 3±1 [max. 10]). CONCLUSIONS EndoPredict ® (EpClin) is clinically useful in deciding whether or not to administer adjuvant chemotherapy in patients with intermediate risk. A single-step decision is preferable since adding chemotherapy at a later stage increases anxiety and distress.
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Affiliation(s)
- Frédérique Penault-Llorca
- Université Clermont Auvergne, Centre Jean Perrin, Department of Biology and Pathology, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Fabrice Kwiatkowski
- Université Clermont Auvergne, Centre Jean Perrin, Department of Biostatistics, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - Antoine Arnaud
- Department of Medical Oncology, Institut Sainte Catherine, Avignon, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | - Olfa Derbel
- Department of Medical Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Annick Le Rol
- Department of Medical Oncology, Centre Hospitalier Intercommunal, Quimper, France
| | - Jean-Philippe Jacquin
- Department of Medical Oncology, Institut de Cancérologie Lucien Newirth, Saint Priest en Jarez, France
| | | | | | - Véronique Girre
- Department of Medical Oncology, Centre Hospitalier Départemental de Vendée, La Roche sur Yon, France
| | - Cyril Foa
- Department of Medical Oncology, Hôpital Saint Joseph, Marseille, France
| | - Emmanuel Guardiola
- Department of Medical Oncology, Centre Hospitalier de La Dracénie, Draguignan, France
| | - Alain Lortholary
- Department of Medical Oncology, Centre Catherine de Sienne, Nantes, France
| | - Stéphanie Catala
- Department of Medical Oncology, Centre Catalan D'oncologie, Perpignan, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut Régional Du Cancer Montpellier (ICM), Val D'Aurelle, Montpellier, France
| | | | - Diane Boinon
- Department of Supportive Care, Psycho-oncology Unit, Gustave Roussy, Villejuif, France
| | | | - Suzette Delaloge
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.
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Hochheiser L, Hornberger J, Turner M, Lyman GH. Letter in reply. J Comp Eff Res 2019; 8:1261-1263. [PMID: 31739684 DOI: 10.2217/cer-2019-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Lou Hochheiser
- Professor Emeritus, Department of Family Practice, University of Vermont, Burlington, VT 05405, USA
| | | | | | - Gary H Lyman
- Fred Hutchinson Cancer Center & The University of Washington, Seattle, WA 98109, USA
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Sestak I. Risk stratification in early breast cancer in premenopausal and postmenopausal women: integrating genomic assays with clinicopathological features. Curr Opin Oncol 2019; 31:29-34. [PMID: 30299292 DOI: 10.1097/cco.0000000000000490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW There is growing consensus that genomic assays provide useful complementary information to clinicopathological features in oestrogen receptor-positive breast cancers. Here, ongoing research with multigene tests used for postmenopausal breast cancer and new emerging prognostic and predictive markers for pre and postmenopausal women are summarised. RECENT FINDINGS Results of the TAILORx trial have shown that women with an intermediate risk score do not benefit from adjuvant chemotherapy. Prosgina has been further investigated in a contemporary patient population in postmenopausal women and its use has been extended for premenopausal women. The EndoPredict was extensively used in decision-impact studies showing that its use can potentially reduce the need for adjuvant chemotherapy. Several new genomic assays have been developed, with some of them showing promising use for women with early oestrogen receptor-positive breast cancer. SUMMARY New areas of research for prediction of recurrence and risk stratification involve the development of immune gene signatures that carry modest but significant prognostic value. The recent expansion of high-throughput technology platforms including circulating tumour DNA/RNA and microRNA offer new opportunities to improve prediction models, particularly in women with oestrogen receptor-negative disease and premenopausal women. Genomic assays have clearly improved prognostication of early oestrogen receptor-positive breast cancer but it is clear that standard clinicopathological parameters are still very important when identifying patient for adjuvant chemotherapy.
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Affiliation(s)
- Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
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Ross E, Swallow J, Kerr A, Cunningham-Burley S. Online accounts of gene expression profiling in early-stage breast cancer: Interpreting genomic testing for chemotherapy decision making. Health Expect 2018; 22:74-82. [PMID: 30387238 PMCID: PMC6351409 DOI: 10.1111/hex.12832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Genomic techniques are being developed within oncology and beginning to be experienced within routine cancer care. Little is known about how these tools feature in patients’ experiences of treatment decision making. Objective This research explores the ways in which women interpret and discuss gene expression profiling for breast cancer treatment decision making, as articulated within online accounts. Design This study used a qualitative approach to analyse written exchanges focusing on gene expression profiling in the UK (Oncotype DX test). Accounts are taken from online forums hosted by two UK cancer charity websites, comprising 132 discussion threads from a total of seven forums. Authors qualitatively analysed the data and developed key themes drawing on existing literature from medical sociology. Findings Women used online spaces to share and discuss results of gene expression profiling. Women interpreted results in the context of indirect experience of cancer treatment, and sociocultural depictions of cancer and chemotherapy. Users largely represented the test positively, emphasizing its ability to “personalize” treatment pathways, though many also pointed to inherent uncertainties with regards the possibility of cancer recurrence. Discussion and Conclusions We highlight the complex contexts in which genomic techniques are experienced, with these shaped by personal biographies, online environments and pervasive cultural narratives of cancer and its treatment. We highlight tensions between the claims of genomic testing to aid treatment decision making and patient reflections on the capability of these techniques to resolve uncertainties surrounding treatment decisions.
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Affiliation(s)
- Emily Ross
- The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julia Swallow
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Anne Kerr
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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