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Li GQ, Xie SJ, Wu SG, He ZY. Impact of the 21-gene expression assay on treatment decisions and clinical outcomes in breast cancer with one to three positive lymph nodes. Front Endocrinol (Lausanne) 2023; 14:1103949. [PMID: 36875478 PMCID: PMC9980792 DOI: 10.3389/fendo.2023.1103949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND To assess the practice patterns of the recurrence score (RS) based on the 21-gene expression assay on adjuvant chemotherapy recommendations and survival outcomes in estrogen receptor-positive (ER+)/HER2- breast cancer (BC) with one to three positive lymph nodes (N1). METHODS We included patients with T1-2N1M0 and ER+/HER2- BC diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results Oncotype DX Database. Breast cancer-specific survival (BCSS) and overall survival (OS) were assessed. RESULTS We included 35,137 patients in this study. There were 21.2% of patients who had RS testing in 2010, which was significantly increased to 36.8% in 2015 (P < 0.001). Performance of the 21-gene testing was associated with older age, lower tumor grade, T1 stage, lower number of positive lymph nodes, and progesterone receptor-positive disease (all P < 0.05). In those without 21-gene testing, age was the main factor significantly related to the receipt of chemotherapy, whereas RS was the main factor significantly related to chemotherapy receipt in those with 21-gene testing. The probability of chemotherapy receipt in those without 21-gene testing was 64.1% and was decreased to 30.8% in those with 21-gene testing. On multivariate prognostic analysis, the performance of 21-gene testing was associated with better BCSS (P < 0.001) and OS (P < 0.001) compared with those without 21-gene testing. Similar results were found after propensity score matching. CONCLUSIONS The 21-gene expression assay is frequently and increasingly used for chemotherapy decision-making in ER+/HER2- BC with N1 disease. Performance of the 21-gene testing is associated with improved survival outcomes. Our study supports the routine use of 21-gene testing in the clinical practice of this population.
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Affiliation(s)
- Guan-Qiao Li
- Department of Breast Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Shang-Jin Xie
- Department of General Surgery, Xiang’an Hospital of Xiamen University, Xiamen, China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: San-Gang Wu, ; Zhen-Yu He,
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- *Correspondence: San-Gang Wu, ; Zhen-Yu He,
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Han L, Wang N, Li Y, Jiang S, Gu Y. A rapid reduction in tumor size by cyclin-dependent kinase inhibition in hormone receptor-positive postpartum breast cancer: a case report of two patients and a review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1413. [PMID: 36660646 PMCID: PMC9843329 DOI: 10.21037/atm-22-5201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022]
Abstract
Background Postpartum breast cancer (PPBC) as an independent entity different from PABC. PPBC is defined as breast cancer (BC) diagnosed within 5 years after delivery in many relevant literatures and is associated with a poor prognosis and a decrease in overall survival. PPBC patients commonly present with inflammatory breast cancer (IBC) phenotype, multifocal lesions, and lymph node metastasis. Hormone receptor-positive (HR+) PPBC is an under-investigated subtype. In PPBC, the risk of death of HR+ subtype significantly increased two-fold, while that was only modestly increased for triple-negative breast cancer (TNBC) subtype, and was not significant in human epidermal growth factor receptor 2-positive (HER2+) subtype. HR+ PPBC is a subtype associating with enhanced signatures of cell cycle control, T-cell activation and exhaustion, decreased HR signaling, and altered P53 signaling. The recommended treatment for HR+ PPBC patients is still lacking. Cyclin-dependent kinase (CDK) 4/6 inhibitors are used as a novel treatment standard not only in pretreated patients but also in the first-line setting of HR+ metastatic breast cancer (MBC). However, there is no clinical case report on the application and efficacy of CDK4/6 inhibitors in HR+ PPBC patients. Case Description This article describes the clinical cases of two patients with advanced HR+ PPBC who were rapidly relieved after receiving leuprorelin combined with letrozole combined with dalpiciclib. We reviewed the related literature of PPBC, and found that HR+ PPBC has not been clinically classified as a BC subtype, and only some basic studies suggested that HR+ PPBC may be sensitive to CDK4/6 inhibitors. The purpose of this study is to provide the basis for the related research on the therapeutic effect of CDK4/6 inhibitors in HR+ PPBC through the report of clinical cases. Conclusions This article reports for the first time the good therapeutic effects of CDK4/6 inhibitors on HR+ PPBC patients. Based on our findings, we suggest that dalpiciclib combined with endocrine therapy can be considered as the first-line treatment for patients with advanced HR+ PPBC. Our case report provides new clinical evidence for the related research on the role of CDK4/6 inhibitors in HR+ PPBC therapy.
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Affiliation(s)
- Luhong Han
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nan Wang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Li
- Department of Reproductive Medicine, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shan Jiang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanting Gu
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Yordanova M, Hassan S. The Role of the 21-Gene Recurrence Score ® Assay in Hormone Receptor-Positive, Node-Positive Breast Cancer: The Canadian Experience. Curr Oncol 2022; 29:2008-2020. [PMID: 35323363 PMCID: PMC8947241 DOI: 10.3390/curroncol29030163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 01/02/2023] Open
Abstract
The management of patients with hormone receptor-positive breast cancer has changed dramatically with use of the 21-gene Recurrence Score® (RS) Assay. While the utility of the assay was initially demonstrated among node-negative patients, recent studies have also demonstrated the assay's prognostic and predictive value in node-positive patients. In Canada, the RS assay is reimbursed by provincial health insurance plans, but not all provinces have approved the use of the assay for patients with node-positive disease. Here, we provide an overview of the clinical factors that influence physician recommendation of the RS assay and, alternatively, the impact of the RS assay on patient treatment decisions in Canada. We performed a comprehensive review of the impact of the assay upon physician treatment decisions and cost in node-positive breast cancer patients within Canada and other countries. Furthermore, we evaluated biomarkers that can predict the RS result, in addition to other genomic assays that predict recurrence risk among node-positive patients. Overall, the 21-gene RS assay was shown to be a cost-effective tool that significantly reduced the use of chemotherapy in node-positive breast cancer patients in Canada.
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Affiliation(s)
- Mariya Yordanova
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada;
| | - Saima Hassan
- Faculty of Medicine, Université de Montréal, Montréal, QC H3C 3T5, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), l’Institut de Cancer de Montréal, Montréal, QC H2X 0A9, Canada
- Division of Surgical Oncology, Department of Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC H2X 0C1, Canada
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Li H, Liu RB, Long CM, Teng Y, Cheng L, Liu Y. Development and Validation of a New Multiparametric Random Survival Forest Predictive Model for Breast Cancer Recurrence with a Potential Benefit to Individual Outcomes. Cancer Manag Res 2022; 14:909-923. [PMID: 35256862 PMCID: PMC8898179 DOI: 10.2147/cmar.s346871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Breast cancer (BC) is a multi-factorial disease. Its individual prognosis varies; thus, individualized patient profiling is instrumental to improving BC management and individual outcomes. An economical, multiparametric, and practical model to predict BC recurrence is needed. Patients and Methods We retrospectively investigated the clinical data of BC patients treated at the Third Affiliated Hospital of Sun Yat-sen University and Liuzhou Women and Children’s Medical Center from January 2013 to December 2020. Random forest-recursive feature elimination (run by R caret package) was used to determine the best variable set, and the random survival forest method was used to develop a predictive model for BC recurrence. Results The training and validations sets included 623 and 151 patients, respectively. We selected 14 variables, the pathological (TNM) stage, gamma-glutamyl transpeptidase, total cholesterol, Ki-67, lymphocyte count, low-density lipoprotein, age, apolipoprotein B, high-density lipoprotein, globulin, neutrophil count to lymphocyte count ratio, alanine aminotransferase, triglyceride, and albumin to globulin ratio, using random survival forest (RSF)-recursive feature elimination. We developed a recurrence prediction model using RSF. Using area under the receiver operating characteristic curve and Kaplan–Meier survival analyses, the model performance was determined to be accurate. C-indexes were 0.997 and 0.936 for the training and validation sets, respectively. Conclusion The model could accurately predict BC recurrence. It aids clinicians in identifying high-risk patients and making treatment decisions for Breast cancer patients in China. This new multiparametric RSF model is instrumental for breast cancer recurrence prediction and potentially improves individual outcomes.
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Affiliation(s)
- Huan Li
- Department of Thyroid and Breast Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ren-Bin Liu
- Department of Thyroid and Breast Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Chen-Meng Long
- Department of Breast Surgery, Liuzhou Women and Children’s Medical Center, Liuzhou, Guangxi, People’s Republic Of China
| | - Yuan Teng
- Department of Breast Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, People’s Republic of China
| | - Lin Cheng
- Department of Thyroid and Breast Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Yu Liu
- Department of Thyroid and Breast Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Yu Liu, Tel +8613560170809, Fax +86 20 85252154, Email
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5
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Fan M, Cui Y, You C, Liu L, Gu Y, Peng W, Bai Q, Gao X, Li L. Radiogenomic Signatures of Oncotype DX Recurrence Score Enable Prediction of Survival in Estrogen Receptor-Positive Breast Cancer: A Multicohort Study. Radiology 2021; 302:516-524. [PMID: 34846204 DOI: 10.1148/radiol.2021210738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Radiogenomics explores the association between imaging features and genomic assays to uncover relevant prognostic features; however, the prognostic implications of the derived signatures remain unclear. Purpose To identify preoperative radiogenomic signatures of estrogen receptor-positive breast cancer associated with the Oncotype DX recurrence score (RS) and to evaluate whether they are biomarkers for survival and responses to neoadjuvant chemotherapy (NACT). Materials and Methods In this retrospective multicohort study, three data sets were analyzed. The radiogenomic development data set, with preoperative dynamic contrast-enhanced MRI and RS data obtained between January 2016 and October 2019 was used to identify radiogenomic signatures. Prognostic implications of the imaging signatures were assessed by measuring overall survival and recurrence-free survival in the prognostic assessment data set using a multivariable Cox proportional hazards model. The therapeutic implication of the radiogenomic signatures was evaluated by determining their ability to predict the response to NACT using the treatment assessment data set obtained between August 2015 and March 2019. Prediction performance was estimated by using the area under the receiver operating characteristic curve (AUC). Results The final cohorts included a radiogenomic development data set with 130 women (mean age, 52 years ± 10 [standard deviation]), a prognostic assessment data set with 116 women (mean age, 48 years ± 9), and a treatment assessment data set with 135 women (mean age, 50 years ± 11). Radiogenomic signatures (n = 11) of texture and morphologic and statistical features were identified to generate the predicted RS (R2 = 0.33, P < .001). A predicted RS greater than 29.9 was associated with poor overall and recurrence-free survival (P = .001 and P = .007, respectively); predicted RS was greater in women with a good NACT response (30.51 ± 6.92 vs 27.35 ± 4.04 [responders vs nonresponders], P = .001). By combining the predicted RS and complementary features, the model achieved improved performance in prediction of the NACT response (AUC, 0.85; P < .001). Conclusion Radiogenomic signatures associated with genomic assays provide markers of prognosis and treatment in estrogen receptor-positive breast cancer. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Ming Fan
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
| | - Yajing Cui
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
| | - Chao You
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
| | - Li Liu
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
| | - Yajia Gu
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
| | - Weijun Peng
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
| | - Qianming Bai
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
| | - Xin Gao
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
| | - Lihua Li
- From the Institute of Biomedical Engineering and Instrumentation, Hangzhou Dianzi University, High Education Zone, Hangzhou 310018, Zhejiang, China (M.F., Y.C., L. Li); Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China (C.Y., L. Liu, Y.G., W.P., Q.B.); and Computational Bioscience Research Center, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia (X.G.)
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Piltin MA, Hoskin TL, Day CN, Shumway DA, Habermann EB, Davis J, Boughey JC. Use of the Twelve-Gene Recurrence Score for Ductal Carcinoma in Situ and Its Influence on Receipt of Adjuvant Radiation and Hormonal Therapy. Ann Surg Oncol 2021; 28:4294-4303. [PMID: 33462716 DOI: 10.1245/s10434-020-09517-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tumor genomic prognostic assays estimate 10-year local recurrence risk in ductal carcinoma in situ (DCIS) and can guide treatment decisions. This study aimed to evaluate which DCIS patients treated with breast-conserving surgery (BCS) underwent DCIS score genomic testing and the influence of the results on adjuvant treatment recommendations. METHODS The study identified patients from the National Cancer Database (NCDB) who had DCIS treated with BCS from 2010 to 2016. RESULTS Of 141,047 patients, 4255 (3%) had a DCIS score assessed, 0.3% in 2010 increasing to 5.8% in 2016 (p < 0.001). The patients most likely to undergo DCIS score assessment had more favorable tumor features in the multivariable analysis. The DCIS score result was documented for 91.4% of the tested patients (n = 3888): 70.5% of the low-risk, 14.9% of the intermediate-risk, and 14.6% of the high-risk patients. The patients with low-risk scores were less likely to have radiation than those with intermediate- or high-risk scores among the patients with either ER + (35.0% vs 71.0% or 81.1%) or ER- disease (48.1% vs 77.0% or 85.5%) (each p ≤ 0.001). The patients who had ER + disease with high- and intermediate-risk scores were most commonly treated with both radiation and hormone therapy (HT) (57.1% and 52.2%), whereas the most common treatment for those with a low-risk DCIS score was HT alone without radiation (37.1%). Comparison of genomic testing with clinicopathologic features showed an independent influence of genomic testing on treatment. CONCLUSIONS Use of the DCIS score increased over time, predominantly for favorable DCIS. Patients with a low-risk score were significantly less likely to receive radiation, supporting an impact of the DCIS score on treatment de-escalation.
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Affiliation(s)
- Mara A Piltin
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tanya L Hoskin
- Department of Health Science Research and Clinical Statistics, Mayo Clinic, Rochester, MN, USA
| | - Courtney N Day
- Department of Health Science Research and Clinical Statistics, Mayo Clinic, Rochester, MN, USA
| | - Dean A Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Habermann
- Department of Health Science Research and Clinical Statistics, Mayo Clinic, Rochester, MN, USA
| | - John Davis
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Weiser R, Haque W, Polychronopoulou E, Hatch SS, Kuo YF, Gradishar WJ, Klimberg VS. The 21-gene recurrence score in node-positive, hormone receptor-positive, HER2-negative breast cancer: a cautionary tale from an NCDB analysis. Breast Cancer Res Treat 2020; 185:667-676. [PMID: 33070279 DOI: 10.1007/s10549-020-05971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The 21-gene recurrence score assay (RS) has not been prospectively validated to predict adjuvant chemotherapy benefit in hormone receptor-positive (HR+), HER2-negative (HER2-), node-positive breast cancer patients. Nevertheless, de-escalation based on RS has been demonstrated and partially advocated by retrospective data. The purpose of this study was to identify subgroups of node-positive patients with low to intermediate RS who still benefit from adjuvant chemotherapy. METHODS The National Cancer Database was used to identify 28,591 women with stage I-III, T1-T3, N1, HR+, HER2- breast cancer and a RS ≤ 25 between 2010 and 2016. Univariate and multivariate analyses were used to identify variables correlating with chemotherapy use and 5-year survival. Subgroup analysis was performed to discern patients in whom the use of adjuvant chemotherapy correlated with better survival. RESULTS A 35% decline in chemotherapy use was observed from 2010 to 2016. Patients with younger age, higher RS, larger tumors and more positive lymph nodes, and those treated by mastectomy, axillary lymph node dissection and radiation, were more likely to receive chemotherapy. Chemotherapy use was associated with an improved 5-year survival (HR = 1.63, 95% CI 1.28-2.07). Upon subgroup analysis, this association was lost in patients > 70 years and those with a RS ≤ 11, while patients ≤ 70 with a RS of 12-25 treated with chemotherapy had an absolute 5-year survival advantage of 3.0% (HR = 1.91, 95% CI 1.42-2.57). CONCLUSION Clinicians should be cautious when considering omission of adjuvant chemotherapy in patients ≤ 70 years, with HR+, HER2-, N1 tumors and a RS 12-25, at least until the results of the anticipated RxPONDER trial become available.
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Affiliation(s)
- Roi Weiser
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Efstathia Polychronopoulou
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Sandra S Hatch
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - William J Gradishar
- Department of Medicine & Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - V Suzanne Klimberg
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.
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Zhang L, Hsieh MC, Petkov V, Yu Q, Chiu YW, Wu XC. Trend and survival benefit of Oncotype DX use among female hormone receptor-positive breast cancer patients in 17 SEER registries, 2004-2015. Breast Cancer Res Treat 2020; 180:491-501. [PMID: 32060781 DOI: 10.1007/s10549-020-05557-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To examine (1) the trend and associated factors of Oncotype DX (ODX) use among hormone receptor-positive (HR+) breast cancer (BC) patients in 2004-2015; (2) the trend of reported chemotherapy by Recurrence Score (RS); and (3) the survival differences associated with ODX use. METHODS ODX data from Genomic Health Inc. were linked with 17 SEER registries data. HR + BC cases with lymph node negative (N0) or 1-3 positive LNs (N1) from 2004-2015 were analyzed. The Cochrane-Armitage trend test, logistic regression, Kaplan-Meier survival curve, and stratified Cox model were performed. Survival analysis was restricted to HR+/HER2- patients from 2010 to 2014, matched on propensity score. RESULTS ODX use increased substantially from 2004 to 2015 (N0: 2.0% to 42.7%; N1: 0.3% to 27.9%). Non-Hispanic black and Medicaid insured patients had lower odds of receiving ODX. N0 patients with moderately differentiated or 2.1-5.0 cm tumor and N1 patients with well-differentiated or < 2.0 cm tumor had higher odds of using ODX. The reported chemotherapy use decreased significantly with low and intermediate RS, and increased for high RS among N0 patients. ODX use was associated with better breast cancer-specific survival [hazard ratio (95% CI) N0 1.96 (1.60-2.41), N1 1.90 (1.42-2.54)] and overall survival [N0 2.06 (1.83-2.31), N1 1.72 (1.42-2.09)], especially in the first 36 months. CONCLUSION ODX use has increased significantly since 2004, nonetheless disparities remain, especially for racial/ethnic minorities and Medicaid insured patients. Administering chemotherapy based on ODX results has been improved among N0 patients. Patients receiving ODX had better survival than those not.
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Affiliation(s)
- Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry/Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St., 3rd floor, New Orleans, LA, 70112, USA
| | | | - Qingzhao Yu
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA
| | - Yu-Wen Chiu
- Health Policy & Systems Management Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry/Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St., 3rd floor, New Orleans, LA, 70112, USA.
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Yadav S, Karam D, Riaz IB, Xie H, Durani U, Duma N, Giridhar KV, Hieken TJ, Boughey JC, Mutter RW, Hawse JR, Jimenez RE, Couch FJ, Ferre RAL, Ruddy KJ. Male breast cancer in the United States: Treatment patterns and prognostic factors in the 21st century. Cancer 2020; 126:26-36. [PMID: 31588557 PMCID: PMC7668385 DOI: 10.1002/cncr.32472] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/02/2019] [Accepted: 07/29/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease for which there is limited understanding of treatment patterns and prognostic factors. METHODS Men with TNM stage I to stage III breast cancer diagnosed between 2004 and 2014 in the National Cancer Data Base were included. Trends in treatment modalities were described using the average annual percentage change (AAPC) and estimated using Joinpoint software for the analysis of trends. Kaplan-Meier curves and the multivariate Cox proportional hazards regression model were used to compare survival between subgroups and to identify prognostic factors. RESULTS A total of 10,873 MBC cases were included, with a median age at diagnosis of 64 years. Breast-conserving surgery was performed in 24% of patients, and 70% of patients undergoing breast conservation received radiotherapy. Approximately 44% of patients received chemotherapy, and 62% of patients with estrogen receptor-positive disease received endocrine therapy. Oncotype DX was ordered in 35% of patients with lymph node-negative, estrogen receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative tumors. During the study period, there was a significant increase in the rates of total mastectomy, contralateral prophylactic mastectomy, radiotherapy after breast conservation, ordering of Oncotype DX, and the use of endocrine therapy (P < .05). On multivariate analysis, factors found to be associated with worse overall survival were older age, black race, higher Charlson Comorbidity Index, high tumor grade and stage of disease, and undergoing total mastectomy. Residing in a higher income area; having progesterone receptor-positive tumors; and receipt of chemotherapy, radiotherapy, and endocrine therapy were associated with better overall survival. CONCLUSIONS Despite the lack of prospective randomized trials in patients with MBC, the results of the current study demonstrated that the treatment of this disease has evolved over the years. These findings further the understanding of the modern treatment and prognosis of MBC, and identify several areas for further research.
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Affiliation(s)
- Siddhartha Yadav
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Dhauna Karam
- Department of Community Internal Medicine, Mayo Clinic Health System at Austin and Albert Lea, Albert Lea, MN 56007, USA
| | - Irbaz Bin Riaz
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hao Xie
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Urshila Durani
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Narjust Duma
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Karthik V. Giridhar
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Tina J. Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Judy C. Boughey
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - John R. Hawse
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rafael E. Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Roberto A. Leon Ferre
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kathryn J. Ruddy
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
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10
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Giridhar KV, Liu MC. Available and emerging molecular markers in the clinical management of breast cancer. Expert Rev Mol Diagn 2019; 19:919-928. [PMID: 31498011 DOI: 10.1080/14737159.2019.1664901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Biomarker assessment is fundamental to managing patients with invasive breast cancer. While the assessment of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 is mandatory for all invasive breast tumors, recent advances in our understanding of tumor biology have uncovered a growing list of clinically relevant biomarkers. Areas covered: In early-stage breast cancer, we focus on dynamic changes in Ki-67 during neoadjuvant endocrine therapy and multigene prognostic assays to guide adjuvant chemotherapy decisions. In advanced breast cancer, we discuss the techniques and clinical relevance of ESR1 and PIK3CA mutations in cell-free DNA and describe therapeutically targetable germline or somatic alterations, with specific focus on BRCA mutations, microsatellite instability, and NTRK fusions. Expert opinion: Biomarkers influence breast cancer management at every stage of disease. This review summarizes recently identified tissue and blood-based biomarkers, implications on clinical management, current limitations and future developments in both early- and advanced-stage breast cancer.
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Affiliation(s)
| | - Minetta C Liu
- Department of Oncology, Mayo Clinic , Rochester , MN , USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester , MN , USA
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11
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Abstract
Male breast cancer is rare, accounting for 1% of all breast cancer diagnoses in the USA. Because of its rarity, most major breast cancer trials have included only female patients. This has resulted in limited prospective data to guide the clinical management of men with breast cancer. As a result, treatment decisions are typically extrapolated from data generated in female patients. This approach may be suboptimal, particularly considering the differing hormonal milieus between men and women with respect to both breast cancer development and treatment. Herein, we summarize current knowledge of the biology and clinicopathology of male breast cancer and review current approaches to locoregional and systemic management of this rare disease.
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12
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Chen WR, Deng JP, Wang J, Sun JY, He ZY, Wu SG. Impact of 21-Gene Recurrence Score on Chemotherapy Decision in Invasive Ductal Carcinoma of Breast with Nodal Micrometastases. Cancer Res Treat 2019; 51:1437-1448. [PMID: 30913871 PMCID: PMC6790862 DOI: 10.4143/crt.2018.611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/01/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of this study was to investigate the effect of 21-gene recurrence score (RS) on predicting prognosis and chemotherapy decision in node micrometastases (N1mi) breast invasive ductal carcinoma (IDC). Methods Patients with stage T1-2N1mi and estrogen receptor-positive IDC diagnosed between 2004 and 2015 were included. The associations of 21-gene RS with breast cancer-specific survival (BCSS), chemotherapy decision, and benefit of chemotherapy were analyzed. Results We identified 4,758 patients including 1,403 patients (29.5%) treated with adjuvant chemotherapy. In the traditional RS cutoffs, 2,831 (59.5%), 1,634 (34.3%), and 293 (6.2%) patients were in the low-, intermediate-, and high-risk RS groups, respectively. In 3,853 patients with human epidermal growth factor receptor-2 (HER2) status available, most patients were HER2-negative disease (98.3%). A higher RS was independently related to chemotherapy receipt, and 14.0%, 47.7%, and 77.8% of patients in the low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. The multivariate analysis indicated that a higher RS was related to worse BCSS (p < 0.001). The 5-year BCSS rates were 99.3%, 97.4%, and 91.9% in patients with low-, intermediate-, and high-risk RS groups, respectively (p < 0.001). However, chemotherapy receipt did not correlate with better BCSS in low-, intermediate-, or high-risk RS groups. There were similar trends using Trial Assigning Individualized Options for Treatment RS cutoffs. Conclusion The 21-gene RS does predict outcome and impact on chemotherapy decision of N1mi breast IDC. Large cohort and long-term outcomes studies are needed to identify the effects of chemotherapy in N1mi patients by different 21-gene RS groups.
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Affiliation(s)
- Wei-Rong Chen
- Department of Breast Surgery, Zhuhai Maternity and Child Health Hospital, Zhuhai, China
| | - Jia-Peng Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jun Wang
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - San-Gang Wu
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
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13
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Altman AM, Marmor S, Tuttle TM, Hui JYC. 21-Gene Recurrence Score Testing in HER2-positive Patients. Clin Breast Cancer 2019; 19:126-130. [PMID: 30595493 DOI: 10.1016/j.clbc.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The 21-gene recurrence score (RS) has been extensively studied and validated in patients with estrogen receptor-positive (ER+), human epidermal growth factor 2 (HER2)-negative breast cancer; however, RS testing is not routinely performed in patients with HER2-positive (HER2+) disease. We sought to determine patterns of RS testing, to characterize RS distributions, and to determine the impact of RS results on clinical decision-making for patients with ER+, HER2+ breast cancer. MATERIALS AND METHODS Using the Surveillance and Epidemiology End Results program database, we identified women with ER+, HER2+ breast cancer. We stratified patients using TAILORx RS cutoffs and evaluated treatment characteristics across patients. Multivariable logistic regression was performed to determine factors associated with RS testing and receipt of a high-risk RS. RESULTS Overall, 5% of patients with ER+, HER2+, early stage breast cancer underwent RS testing. The distribution of RS testing by TAILORx cutoffs were: high-risk, 17%; intermediate-risk, 49%; and low-risk, 34%. Chemotherapy utilization among those not tested was 66%. Among those tested, utilization was significantly associated with RS results: 67% of high-risk, 30% of intermediate-risk, and 19% of low-risk patients received chemotherapy. Progesterone receptor-negative status, larger tumor size, and high tumor grade were significantly associated with high-risk RS. CONCLUSIONS RS testing is used sparingly among patients with HER2+ early-stage breast cancer; however, test results appear to impact clinician's decision-making on chemotherapy use.
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Affiliation(s)
- Ariella M Altman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN
| | - Jane Yuet Ching Hui
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN.
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14
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Use of Multigene Prognostic Indices to Guide Clinical Decision-Making Regarding Adjuvant Systemic Therapy. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0297-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Turashvili G, Gonzalez-Loperena M, Brogi E, Dickler M, Norton L, Morrow M, Wen HY. The 21-Gene Recurrence Score in Male Breast Cancer. Ann Surg Oncol 2018. [PMID: 29520654 DOI: 10.1245/s10434-018-6411-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Given the limited data, systemic treatment of male breast cancer has been extrapolated from female patients. The 21-gene recurrence score (RS) assay estimates the risk of distant recurrence and chemotherapy benefit in early-stage, ER+/HER2- female breast cancer. We assessed the association between RS and type of treatment in male breast cancer. METHODS We identified male patients with ER+/HER2- breast cancer and available RS results treated at our institution in 2006-2016. We collected data on clinicopathologic features, treatment, and outcome. The Institutional Review Board approved the study. RESULTS The study cohort consists of 38 male breast cancer patients with a median age of 70 years. Median tumor size was 1.6 cm, and 81.6% (31) were node-negative. RS was low (≤ 17) in 26 (68.4%) cases, intermediate (18-30) in 9 (23.7%) cases, and high (≥ 31) in 3 (7.9%) cases, comparable to that in female patients at our institution. All patients underwent total mastectomy, and one received radiotherapy. Thirty-four (89.5%) patients received adjuvant endocrine therapy, mostly tamoxifen (81.6%; 31). Five (13.2%) patients with intermediate or high RS were treated with adjuvant chemotherapy. No locoregional recurrence was observed, and one patient developed distant recurrence (median follow-up 34 months). CONCLUSIONS The RS distribution in male breast cancers was similar to that in females treated at our institution. With limited follow-up, patients with low RS were spared chemotherapy and did not develop recurrence. Our results suggest that the RS may have a clinical utility in male breast cancer patients.
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Affiliation(s)
- Gulisa Turashvili
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maura Dickler
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larry Norton
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hannah Y Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Tumor Biology and Response to Chemotherapy Impact Breast Cancer-specific Survival in Node-positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: Long-term Follow-up From ACOSOG Z1071 (Alliance). Ann Surg 2017; 266:667-676. [PMID: 28657941 DOI: 10.1097/sla.0000000000002373] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Women with node-positive breast cancer are at high risk for recurrence. We evaluate the impact of approximated tumor subtype and response to chemotherapy on long-term outcomes in a node-positive cohort receiving neoadjuvant chemotherapy. METHODS ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with neoadjuvant chemotherapy from 2009 to 2011. Factors impacting breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed. RESULTS Median follow-up of 701 eligible patients was 4.1 years (0.4-6.5). Ninety patients (12.8%) died from breast cancer. Approximated subtype and chemotherapy response were significantly associated with BCSS and OS (P < 0.0001). BCSS and OS were highest in patients who achieved pathologic complete response (pCR) (P < 0.0001 and P < 0.0001, respectively).Five-year BCSS was highest in human epidermal growth factor receptor 2 (HER2)-positive disease [95.8%; 95% confidence interval (CI): 87.7-98.6], followed by hormone receptor-positive/HER2-negative (80.4%; 95% CI: 73.2-85.9) and lowest in triple-negative (TNBC) (74.8%; 95% CI: 66.6-81.2; P < 0.0001). Similar patterns were seen in OS.In TNBC (n = 174), 5-year BCSS was higher in patients with pCR versus residual disease (89.8%; 95% CI: 78.8-95.3 vs 65.8%; 95% CI: 54.5-74.9; P = 0.0013). In hormone receptor-positive/HER2-negative (n = 318) disease, BCSS was 100% in patients with pCR and 78.3% (95% CI: 70.4-84.3) in those with residual disease (P = 0.018). In HER2-positive disease (n = 204) there was no difference between pCR and residual disease (96.0%; 95% CI: 83.6-99.1 vs 95.8%; 95% CI: 81.4-99.1; P = 0.77). CONCLUSIONS In node-positive breast cancer patients treated with neoadjuvant chemotherapy, BCSS and OS were associated with approximated subtype and chemotherapy response and were lowest in TNBC patients with residual disease. Five-year BCSS was > 95% in HER2-positive disease independent of chemotherapy response.
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