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Westphal T, Gampenrieder SP, Rinnerthaler G, Balic M, Posch F, Dandachi N, Hauser-Kronberger C, Reitsamer R, Sotlar K, Radl B, Suppan C, Stöger H, Greil R. Transferring MINDACT to Daily Routine: Implementation of the 70-Gene Signature in Luminal Early Breast Cancer - Results from a Prospective Registry of the Austrian Group Medical Tumor Therapy (AGMT). Breast Care (Basel) 2022; 17:1-9. [PMID: 35355702 PMCID: PMC8914232 DOI: 10.1159/000512467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023] Open
Abstract
Background For hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (EBC), adjuvant chemotherapy (ACT) is recommended in the case of high-risk features only. The MINDACT trial showed that patients with high clinical risk (CR) but low genomic risk (GR) defined by the 70-gene signature (MammaPrint®; 70-GS) did not benefit from ACT. In this registry, we investigated the frequency and feasibility of 70-GS and concurrent 80-gene subtyping (BluePrint®) use in HR-positive, HER2-negative EBC. Furthermore, we recorded the frequency of ACT recommendation and the adherence to it when the "MINDACT strategy" was used. Methods This prospective registry included patients from 2 Austrian cancer centers. Similar to MINDACT, a modified version of Adjuvant!Online was used to determine CR, and 70-GC was used to determine GR in high-CR patients. ACT was recommended to patients with high CR and high GR. Results Of 224 enrolled patients, 76 (33.9%) had high CR and 67 (88.2%) received genomic testing. Of those, 43 (64.2%) were classified as low and 24 (35.8%) as high GR, respectively. All 24 patients with high CR and GR (10.7% of all patients) received the recommendation for ACT, but ACT was started in only 15 patients (62.5%). The median time from surgery to the start of ACT was 45 days (range 32-68), and the median time from test decision to the test result was 15 days (range 9-56). Conclusion We showed that the results of the MINDACT trial are reproducible in an Austrian population. Incorporating 70-GS into the daily clinical routine is feasible and mostly accepted by physicians for the guidance of treatment recommendations.
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Affiliation(s)
- Theresa Westphal
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Simon P. Gampenrieder
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria,Cancer Cluster Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria,Cancer Cluster Salzburg, Salzburg, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nadia Dandachi
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Cornelia Hauser-Kronberger
- Pathologic Institute of the University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Roland Reitsamer
- University Clinic for Special Gynecology of the University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Karl Sotlar
- Pathologic Institute of the University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bianca Radl
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Christoph Suppan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria,Cancer Cluster Salzburg, Salzburg, Austria,*Richard Greil IIIrd Medical Department Paracelsus Medical University Salzburg Müllner Hauptstrasse 48, AT-5020 Salzburg (Austria)
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Harnan S, Tappenden P, Cooper K, Stevens J, Bessey A, Rafia R, Ward S, Wong R, Stein RC, Brown J. Tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer: a systematic review and economic analysis. Health Technol Assess 2020; 23:1-328. [PMID: 31264581 DOI: 10.3310/hta23300] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breast cancer and its treatment can have an impact on health-related quality of life and survival. Tumour profiling tests aim to identify whether or not women need chemotherapy owing to their risk of relapse. OBJECTIVES To conduct a systematic review of the effectiveness and cost-effectiveness of the tumour profiling tests oncotype DX® (Genomic Health, Inc., Redwood City, CA, USA), MammaPrint® (Agendia, Inc., Amsterdam, the Netherlands), Prosigna® (NanoString Technologies, Inc., Seattle, WA, USA), EndoPredict® (Myriad Genetics Ltd, London, UK) and immunohistochemistry 4 (IHC4). To develop a health economic model to assess the cost-effectiveness of these tests compared with clinical tools to guide the use of adjuvant chemotherapy in early-stage breast cancer from the perspective of the NHS and Personal Social Services. DESIGN A systematic review and health economic analysis were conducted. REVIEW METHODS The systematic review was partially an update of a 2013 review. Nine databases were searched in February 2017. The review included studies assessing clinical effectiveness in people with oestrogen receptor-positive, human epidermal growth factor receptor 2-negative, stage I or II cancer with zero to three positive lymph nodes. The economic analysis included a review of existing analyses and the development of a de novo model. RESULTS A total of 153 studies were identified. Only one completed randomised controlled trial (RCT) using a tumour profiling test in clinical practice was identified: Microarray In Node-negative Disease may Avoid ChemoTherapy (MINDACT) for MammaPrint. Other studies suggest that all the tests can provide information on the risk of relapse; however, results were more varied in lymph node-positive (LN+) patients than in lymph node-negative (LN0) patients. There is limited and varying evidence that oncotype DX and MammaPrint can predict benefit from chemotherapy. The net change in the percentage of patients with a chemotherapy recommendation or decision pre/post test ranged from an increase of 1% to a decrease of 23% among UK studies and a decrease of 0% to 64% across European studies. The health economic analysis suggests that the incremental cost-effectiveness ratios for the tests versus current practice are broadly favourable for the following scenarios: (1) oncotype DX, for the LN0 subgroup with a Nottingham Prognostic Index (NPI) of > 3.4 and the one to three positive lymph nodes (LN1-3) subgroup (if a predictive benefit is assumed); (2) IHC4 plus clinical factors (IHC4+C), for all patient subgroups; (3) Prosigna, for the LN0 subgroup with a NPI of > 3.4 and the LN1-3 subgroup; (4) EndoPredict Clinical, for the LN1-3 subgroup only; and (5) MammaPrint, for no subgroups. LIMITATIONS There was only one completed RCT using a tumour profiling test in clinical practice. Except for oncotype DX in the LN0 group with a NPI score of > 3.4 (clinical intermediate risk), evidence surrounding pre- and post-test chemotherapy probabilities is subject to considerable uncertainty. There is uncertainty regarding whether or not oncotype DX and MammaPrint are predictive of chemotherapy benefit. The MammaPrint analysis uses a different data source to the other four tests. The Translational substudy of the Arimidex, Tamoxifen, Alone or in Combination (TransATAC) study (used in the economic modelling) has a number of limitations. CONCLUSIONS The review suggests that all the tests can provide prognostic information on the risk of relapse; results were more varied in LN+ patients than in LN0 patients. There is limited and varying evidence that oncotype DX and MammaPrint are predictive of chemotherapy benefit. Health economic analyses indicate that some tests may have a favourable cost-effectiveness profile for certain patient subgroups; all estimates are subject to uncertainty. More evidence is needed on the prediction of chemotherapy benefit, long-term impacts and changes in UK pre-/post-chemotherapy decisions. STUDY REGISTRATION This study is registered as PROSPERO CRD42017059561. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Sue Harnan
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katy Cooper
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alice Bessey
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rachid Rafia
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sue Ward
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ruth Wong
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert C Stein
- University College London Hospitals Biomedical Research Centre, London, UK.,Research Department of Oncology, University College London, London, UK
| | - Janet Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Kuijer A, Straver M, den Dekker B, van Bommel AC, Elias SG, Smorenburg CH, Wesseling J, Linn SC, Rutgers EJ, Siesling S, van Dalen T. Impact of 70-Gene Signature Use on Adjuvant Chemotherapy Decisions in Patients With Estrogen Receptor–Positive Early Breast Cancer: Results of a Prospective Cohort Study. J Clin Oncol 2017; 35:2814-2819. [DOI: 10.1200/jco.2016.70.3959] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Gene-expression profiles increasingly are used in addition to conventional prognostic factors to guide adjuvant chemotherapy (CT) decisions. The Dutch guideline suggests use of validated gene-expression profiles in patients with estrogen receptor (ER) –positive, early-stage breast cancer without overt lymph node metastases. We aimed to assess the impact of a 70-gene signature (70-GS) test on CT decisions in patients with ER-positive, early-stage breast cancer. Patients and Methods In a prospective, observational, multicenter study in patients younger than 70 years old who had undergone surgery for ER-positive, early-stage breast cancer, physicians were asked whether they intended to administer adjuvant CT before deployment of the 70-GS test and after the test result was available. Results Between October 1, 2013, and December 31, 2015, 660 patients, treated in 33 hospitals, were enrolled. Fifty-one percent of patients had pT1cN0, BRII, HER2-Neu-negative breast cancer. On the basis of conventional clinicopathological characteristics, physicians recommended CT in 270 (41%) of the 660 patients and recommended withholding CT in 107 (16%) of the 660 patients. For the remaining 43% of patients, the physicians were unsure and unable to give advice before 70-GS testing. In patients for whom CT was initially recommended or not recommended, 56% and 59%, respectively, were assigned to a low-risk profile by the 70-GS (κ, 0.02; 95% CI, -0.08 to 0.11). After disclosure of the 70-GS test result, the preliminary advice was changed in 51% of patients who received a recommendation before testing; the definitive CT recommendation of the physician was in line with the 70-GS result in 96% of patients. Conclusion In this prospective, multicenter study in a selection of patients with ER-positive, early-stage breast cancer, 70-GS use changed the physician-intended recommendation to administer CT in half of the patients.
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Affiliation(s)
- Anne Kuijer
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Marieke Straver
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Bianca den Dekker
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Annelotte C.M. van Bommel
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Sjoerd G. Elias
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Carolien H. Smorenburg
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Jelle Wesseling
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Sabine C. Linn
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Emiel J.Th. Rutgers
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Sabine Siesling
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
| | - Thijs van Dalen
- Anne Kuijer, Marieke Straver, Bianca den Dekker, Annelotte C.M. van Bommel, and Thijs van Dalen, Diakonessenhuis; Anne Kuijer, Sjoerd G. Elias, Sabine C. Linn, and Thijs van Dalen, University Medical Centre Utrecht; Sabine Siesling, Netherlands Comprehensive Cancer Organization, Utrecht; Carolien H. Smorenburg and Jelle Wesseling, Antoni van Leeuwenhoek Hospital; Carolien H. Smorenburg, Jelle Wesseling, Sabine C. Linn, and Emiel J.Th. Rutgers, Netherlands Cancer Institute, Amsterdam; and Sabine Siesling,
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Jensen K, Krusenstjerna-Hafstrøm R, Lohse J, Petersen KH, Derand H. A novel quantitative immunohistochemistry method for precise protein measurements directly in formalin-fixed, paraffin-embedded specimens: analytical performance measuring HER2. Mod Pathol 2017; 30:180-193. [PMID: 27767098 DOI: 10.1038/modpathol.2016.176] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/18/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022]
Abstract
In clinical routine pathology today, detection of protein in intact formalin-fixed, paraffin-embedded tissue is limited to immunohistochemistry, which is semi-quantitative. This study presents a new and reliable quantitative immunohistochemistry method, qIHC, based on a novel amplification system that enables quantification of protein directly in formalin-fixed, paraffin-embedded tissue by counting of dots. The qIHC technology can be combined with standard immunohistochemistry, and assessed using standard bright-field microscopy or image analysis. The objective was to study analytical performance of the qIHC method. qIHC was tested under requirements for an analytical quantitative test, and compared with ELISA and flow cytometry for quantitative protein measurements. Human epidermal growth factor receptor 2 (HER2) protein expression was measured in five different cell lines with HER2 expression from undetectable with immunohistochemistry to strong positive staining (IHC 3+). Repeatability, reproducibility, robustness, linearity, dynamic range, sensitivity, and quantification limits were evaluated. Reproducibility and robustness were assessed in a setup to resemble daily work in a laboratory using a commercial immunohistochemistry platform. In addition, qIHC was correlated to standard HER2 immunohistochemistry in 44 breast cancer specimens. For all evaluated parameters, qIHC performance was either comparable or better than the reference methods. Furthermore, qIHC has a lower limit of detection than both immunohistochemistry and the ELISA reference method, and demonstrated ability to measure HER2 accurately and precise within a large dynamic range. In conclusion, the results show that qIHC provides a sensitive, quantitative, accurate, and robust assay for measurement of protein expression in formalin-fixed, paraffin-embedded cell lines, and tissue.
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Affiliation(s)
- Kristian Jensen
- Dako Denmark A/S, an Agilent Technologies Company, Produktionsvej 42, Glostrup, Denmark
| | | | - Jesper Lohse
- Dako Denmark A/S, an Agilent Technologies Company, Produktionsvej 42, Glostrup, Denmark
| | - Kenneth H Petersen
- Dako Denmark A/S, an Agilent Technologies Company, Produktionsvej 42, Glostrup, Denmark
| | - Helene Derand
- Dako Denmark A/S, an Agilent Technologies Company, Produktionsvej 42, Glostrup, Denmark
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Birnbaum JK, Ademuyiwa FO, Carlson JJ, Mallinger L, Mason MW, Etzioni R. Comparative Effectiveness of Biomarkers to Target Cancer Treatment: Modeling Implications for Survival and Costs. Med Decis Making 2016; 36:594-603. [PMID: 26304062 PMCID: PMC4766067 DOI: 10.1177/0272989x15601998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/23/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Biomarkers used at the time of diagnosis to tailor treatment decisions may diffuse into clinical practice before data become available on whether biomarker testing reduces cancer mortality. In the interim, quantitative estimates of the mortality impact of testing are needed to assess the value of these diagnostic biomarkers. These estimates are typically generated by customized models that are resource intensive to build and apply. METHODS We developed a user-friendly system of models for Cancer Translation of Comparative Effectiveness Research (CANTRANce) to model the mortality impact of cancer interventions. The Diagnostic Biomarker module of this system projects the mortality impact of testing for a diagnostic biomarker, given data on how testing affects treatment recommendations. Costs and quality-of-life outcomes may also be modeled. We applied the Diagnostic Biomarker module to 2 case studies to demonstrate its capabilities. RESULTS The user interface (http://www.fhcrc.org/cantrance) allows comparative effectiveness researchers to use the Diagnostic Biomarker module of CANTRANce. Our case studies indicate that the model produces estimates on par with those generated by customized models and is a strong tool for quickly generating novel projections. LIMITATIONS The simple structure that makes CANTRANce user-friendly also constrains the complexity with which cancer progression can be modeled. The quality of the results rests on the quality of the input data, which may pertain to small or dissimilar populations or suffer from informative censoring. CONCLUSIONS The Diagnostic Biomarker module of CANTRANce is a novel public resource that can provide timely insights into the expected mortality impact of testing for diagnostic biomarkers. The model projections should be useful for understanding the long-term potential of emerging diagnostic biomarkers.
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Affiliation(s)
- Jeanette K Birnbaum
- Department of Health Services, University of Washington, Seattle, WA, USA (JKB, RE)
| | - Foluso O Ademuyiwa
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA (FOA)
| | - Josh J Carlson
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle WA, USA (JJC)
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA, USA (JJC, MWM, RE)
| | - Leslie Mallinger
- Department of Health Administration, University of Washington, Seattle, WA, USA (LM)
| | - Mark W Mason
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA, USA (JJC, MWM, RE)
| | - Ruth Etzioni
- Department of Health Services, University of Washington, Seattle, WA, USA (JKB, RE)
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA, USA (JJC, MWM, RE)
- Department of Biostatistics, University of Washington, Seattle WA, USA (RE)
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Prognostic risk factors for treatment decision in pT1a,b N0M0 HER2-positive breast cancers. Cancer Treat Rev 2016; 43:1-7. [DOI: 10.1016/j.ctrv.2015.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 12/26/2022]
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Using a gene expression signature when controversy exists regarding the indication for adjuvant systemic treatment reduces the proportion of patients receiving adjuvant chemotherapy: a nationwide study. Genet Med 2015; 18:720-6. [PMID: 26583684 DOI: 10.1038/gim.2015.152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/14/2015] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The Dutch national guideline advises use of gene-expression signatures, such as the 70-gene signature (70-GS), in case of ambivalence regarding the benefit of adjuvant chemotherapy (CT). In this nationwide study, the impact of 70-GS use on the administration of CT in early breast cancer patients with a dubious indication for CT is assessed. METHODS Patients within a national guideline directed indication area for 70-GS use who were surgically treated between November 2011 and April 2013 were selected from the Netherlands Cancer Registry database. The effect of 70-GS use on the administration of CT was evaluated in guideline- and age-delineated subgroups addressing potential effect of bias by linear mixed-effect modeling and instrumental variable (IV) analyses. RESULTS A total of 2,043 patients within the indicated area for 70-GS use were included, of whom 298 received a 70-GS. Without use of the 70-GS, 45% of patients received CT. The 70-GS use was associated with a 9.5% decrease in CT administration (95% confidence interval (CI): -15.7 to -3.3%) in linear mixed-effect model analyses and IV analyses showed similar results (-9.9%; 95% CI: -19.3 to -0.4). CONCLUSION In patients in whom the Dutch national guidelines suggest the use of a gene-expression profile, 70-GS use is associated with a 10% decrease in the administration of adjuvant CT.Genet Med 18 7, 720-726.Genetics in Medicine (2016); 18 7, 720-726. doi:10.1038/gim.2015.152.
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Modelska A, Quattrone A, Re A. Molecular portraits: the evolution of the concept of transcriptome-based cancer signatures. Brief Bioinform 2015; 16:1000-7. [PMID: 25832647 PMCID: PMC4652618 DOI: 10.1093/bib/bbv013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Indexed: 12/13/2022] Open
Abstract
Cancer results from dysregulation of multiple steps of gene expression programs. We review how transcriptome profiling has been widely explored for cancer classification and biomarker discovery but resulted in limited clinical impact. Therefore, we discuss alternative and complementary omics approaches.
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Paplomata E, Nahta R, O'Regan RM. Systemic therapy for early-stage HER2-positive breast cancers: time for a less-is-more approach? Cancer 2014; 121:517-26. [PMID: 25346473 DOI: 10.1002/cncr.29060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/11/2022]
Abstract
Trastuzumab-based chemotherapy has dramatically improved outcomes for patients with all stages of human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Additional HER2-directed agents that have recently been approved are also expected to improve outcomes. Patients with small, lymph node-negative, HER2-positive breast cancers who are treated with trastuzumab-based chemotherapy demonstrate especially favorable responses, with 5-year recurrence rates of <5%. In this review, recent data regarding response rates among patients with early-stage HER2-positive breast cancer treated with trastuzumab-based chemotherapy are discussed. This review supports future studies of the possible omission of chemotherapy in a subset of patients with HER2-positive cancers, specifically those that coexpress hormone receptors.
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Affiliation(s)
- Elisavet Paplomata
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia; Department of Hematology and Medical Oncology, Emory University, Georgia Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia
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10
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Prognostic relevance of biological subtype overrides that of TNM staging in breast cancer: discordance between stage and biology. Tumour Biol 2014; 36:1073-9. [DOI: 10.1007/s13277-014-2730-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/09/2014] [Indexed: 11/27/2022] Open
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