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Li L, Yu J, Shen K, Chen X. The 21-Gene Recurrence Score Assay Improved Multidisciplinary Treatment Compliance in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Patients: An Analysis of 2,323 Patients. J Breast Cancer 2024; 27:163-175. [PMID: 38769684 PMCID: PMC11221206 DOI: 10.4048/jbc.2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE The 21-gene recurrence score (RS) can guide adjuvant chemotherapy decisions in the multidisciplinary treatment (MDT) of patients with early breast cancer. This study aimed to evaluate the influence of the 21-gene RS assay on patient' compliance with MDT and its association with disease outcomes. METHODS Patients diagnosed with pN0-1, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer between January 2013 and June 2019 were enrolled. A logistic regression model was used to identify parameters associated with treatment adherence. Prognostic indicators were evaluated using the Cox proportional hazard models. RESULTS After the assay, patients were less likely to violate the treatment plan (14.9% vs. 23.1%, p < 0.001), and higher compliance rates were observed for chemotherapy (p = 0.042), radiotherapy (p = 0.012), and endocrine therapy (p < 0.001). Multivariable analysis demonstrated that the 21-gene RS assay (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.09-1.88; p = 0.009) was independently associated with MDT compliance. Moreover, compliance with MDT was independently associated with better disease-free survival (hazard ratio, 0.43; 95% CI, 0.29-0.64; p < 0.001), regardless of the 21-gene RS assay (interaction p = 0.842). CONCLUSION The 21-gene RS assay improved the MDT compliance rate in patients with early breast cancer. Adherence to MDT is associated with a better prognosis.
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Affiliation(s)
- Liangqiang Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Breast Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Jing Yu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Turner BM, Finkelman BS, Hicks DG, Numbereye N, Moisini I, Dhakal A, Skinner K, Sanders MAG, Wang X, Shayne M, Schiffhauer L, Katerji H, Zhang H. The Rochester Modified Magee Algorithm (RoMMa): An Outcomes Based Strategy for Clinical Risk-Assessment and Risk-Stratification in ER Positive, HER2 Negative Breast Cancer Patients Being Considered for Oncotype DX ® Testing. Cancers (Basel) 2023; 15:cancers15030903. [PMID: 36765860 PMCID: PMC9913115 DOI: 10.3390/cancers15030903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Multigene genomic profiling has become the standard of care in the clinical risk-assessment and risk-stratification of ER+, HER2- breast cancer (BC) patients, with Oncotype DX® (ODX) emerging as the genomic profile test with the most support from the international community. The current state of the health care economy demands that cost-efficiency and access to testing must be considered when evaluating the clinical utility of multigene profile tests such as ODX. Several studies have suggested that certain lower risk patients can be identified more cost-efficiently than simply reflexing all ER+, HER2- BC patients to ODX testing. The Magee equationsTM use standard histopathologic data in a set of multivariable models to estimate the ODX recurrence score. Our group published the first outcome data in 2019 on the Magee equationsTM, using a modification of the Magee equationsTM combined with an algorithmic approach-the Rochester Modified Magee algorithm (RoMMa). There has since been limited published outcome data on the Magee equationsTM. We present additional outcome data, with considerations of the TAILORx risk-stratification recommendations. METHODS 355 patients with an ODX recurrence score, and at least five years of follow-up or a BC recurrence were included in the study. All patients received either Tamoxifen or an aromatase inhibitor. None of the patients received adjuvant systemic chemotherapy. RESULTS There was no significant difference in the risk of recurrence in similar risk categories (very low risk, low risk, and high risk) between the average Modified Magee score and ODX recurrence score with the chi-square test of independence (p > 0.05) or log-rank test (p > 0.05). Using the RoMMa, we estimate that at least 17% of individuals can safely avoid ODX testing. CONCLUSION Our study further reinforces that BC patients can be confidently stratified into lower and higher-risk recurrence groups using the Magee equationsTM. The RoMMa can be helpful in the initial clinical risk-assessment and risk-stratification of BC patients, providing increased opportunities for cost savings in the health care system, and for clinical risk-assessment and risk-stratification in less-developed geographies where multigene testing might not be available.
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Affiliation(s)
- Bradley M. Turner
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
- Correspondence: ; Tel.: +1-(585)-275-2228; Fax: +1-(585)-341-6725
| | - Brian S. Finkelman
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - David G. Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Numbere Numbereye
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Ioana Moisini
- M. Health Fairview Ridges, Burnsville, MN 55337, USA
| | - Ajay Dhakal
- Department of Medical Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Kristin Skinner
- Department of Surgical Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Mary Ann G. Sanders
- Norton Healthcare, University of Louisville Department of Pathology, Louisville, KY 40292, USA
| | - Xi Wang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Michelle Shayne
- Department of Medical Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Linda Schiffhauer
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Hani Katerji
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Huina Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
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Malam Y, Rabie M, Geropantas K, Alexander S, Pain S, Youssef M. The impact of Oncotype DX testing on adjuvant chemotherapy decision making in 1-3 node positive breast cancer. Cancer Rep (Hoboken) 2021; 5:e1546. [PMID: 34664429 PMCID: PMC9351646 DOI: 10.1002/cnr2.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Oncotype DX testing has reduced the use of adjuvant chemotherapy in node-negative early breast cancer but less is known about its impact in node positive patients. AIM This study aimed to investigate the impact of Oncotype DX gene assay testing on the decision to offer adjuvant chemotherapy in oestrogen positive, human epidermal growth factor receptor 2 negative, 1-3 lymph node positive patients. METHODS Retrospective review of all node positive patients who underwent Oncotype DX testing at a single centre. Clinicopathological data, as well as estimated survival benefit data (from the PREDICT tool), was evaluated by a multidisciplinary group of surgeons and oncologists. Treatment decisions based on clinicopathological data were compared to recurrence scores (RS). A cut off RS > 30 was used to offer adjuvant chemotherapy. RESULTS The 69 patients were identified, of which 9 (13%) had an RS > 30 and assigned a high-genomic risk of recurrence. The 32 patients (46.4%) were offered adjuvant chemotherapy. Overall based on the use of the RS, the decision to offer adjuvant chemotherapy changed in 36% of patients, and ultimately 24 patients (34.7%) would have been spared chemotherapy. CONCLUSION Using clinicopathological data alone to make decisions regarding adjuvant chemotherapy in node positive breast cancer leads to overtreatment. Additional information on tumour biology as assessed by the Oncotype DX RS helps to select those patients who will benefit from adjuvant chemotherapy and spare patients from unnecessary chemotherapy.
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Affiliation(s)
- Yogeshkumar Malam
- Department of Breast Surgery, Norfolk and Norwich University Hospital Trust, Norwich, UK
| | - Mohamed Rabie
- Department of Breast Surgery, Norfolk and Norwich University Hospital Trust, Norwich, UK.,Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Susanna Alexander
- Department of Oncology, Norfolk and Norwich University Hospital Trust, Norwich, UK
| | - Simon Pain
- Department of Breast Surgery, Norfolk and Norwich University Hospital Trust, Norwich, UK
| | - Mina Youssef
- Department of Breast Surgery, Norfolk and Norwich University Hospital Trust, Norwich, UK.,Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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AlSaleh K, Al Zahwahry H, Bounedjar A, Oukkal M, Saadeddine A, Mahfouf H, Bouzid K, Bensalem A, Filali T, Abdel-Razeq H, Larbaoui B, Kandil A, Abulkhair O, Al Foheidi M, Errihani H, Ghosn M, Abdel-Aziz N, Arafah M, Boussen H, Dabouz F, Rasool H, Bahadoor M, Ayari J, Kullab S, Nabholtz JM. Response to Induction Neoadjuvant Hormonal Therapy Using Upfront 21-Gene Breast Recurrence Score Assay-Results From the SAFIA Phase III Trial. JCO Glob Oncol 2021; 7:811-819. [PMID: 34086481 PMCID: PMC8457874 DOI: 10.1200/go.20.00575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Luminal, human epidermal growth factor receptor 2–negative breast cancer represents the most common subtype of breast malignancies. Neoadjuvant strategies of operable breast cancer are mostly based on chemotherapy, whereas it is not completely understood which patients might benefit from neoadjuvant hormone therapy (NAHT).
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Affiliation(s)
- Khalid AlSaleh
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Mohammed Oukkal
- Medical Oncology Department, Beni-Messous University Hospital, Algiers, Algeria
| | - Ahmed Saadeddine
- Oncology Center, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia
| | | | - Kamel Bouzid
- Oncology Center of Pierre et Marie Curie, Algiers, Algeria
| | - Assia Bensalem
- Oncology Department, Dr Benbadis University Hospital, Constantine, Algeria
| | - Taha Filali
- Oncology Department, Constantine University Hospital, Constantine, Algeria
| | | | | | | | | | - Meteb Al Foheidi
- Oncology Center of Princess Noorah, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Hassan Errihani
- Medical Oncology, National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Marwan Ghosn
- Hematology-Oncology Department, Hotel Dieu de France, University Saint Joseph, Beirut, Lebanon
| | - Nashwa Abdel-Aziz
- Oncology Center, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Maria Arafah
- Department of Pathology, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Hamouda Boussen
- Faculty of Medicine Tunis, University Tunis El Manar, Abderrahmen Mami Hospital, Ariana, Tunisia
| | - Farida Dabouz
- International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Haleem Rasool
- King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia
| | - Mohun Bahadoor
- International Cancer Research Group (ICRG), Sharjah, United Arab Emirates
| | - Jihen Ayari
- Faculty of Medicine Tunis, Oncology Department, University Tunis El Manar, Military Hospital of Tunis, Tunis, Tunisia
| | - Sharif Kullab
- Oncology Center, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
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Boland MR, Al-Maksoud A, Ryan ÉJ, Balasubramanian I, Geraghty J, Evoy D, McCartan D, Prichard RS, McDermott EW. Value of a 21-gene expression assay on core biopsy to predict neoadjuvant chemotherapy response in breast cancer: systematic review and meta-analysis. Br J Surg 2021; 108:24-31. [PMID: 33640948 DOI: 10.1093/bjs/znaa048] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 09/19/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND A recurrence score based on a 21-gene expression assay predicts the benefit of adjuvant chemotherapy in oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. This systematic review aimed to determine whether the 21-gene expression assay performed on core biopsy at diagnosis predicted pathological complete response (pCR) to neoadjuvant chemotherapy. METHODS The study was performed according to PRISMA guidelines. Relevant databases were searched to identify studies assessing the value of the 21-gene expression assay recurrence score in predicting response to neoadjuvant chemotherapy in patients with breast cancer. The Newcastle-Ottawa Scale was used to assess the quality of the studies. Results are reported as risk ratio (RR) with 95 per cent confidence interval using the Cochrane-Mantel-Haenszel method for meta-analysis. Sensitivity analyses were carried out where appropriate. RESULTS Seven studies involving 1744 patients reported the correlation between pretreatment recurrence score and pCR. Of these, 777 patients (44.6 per cent) had a high recurrence score and 967 (55.4 per cent) a low-intermediate score. A pCR was achieved in 94 patients (5.4 per cent). The pCR rate was significantly higher in the group with a high recurrence score than in the group with a low-intermediate score (10.9 versus 1.1 per cent; RR 4.47, 95 per cent c.i. 2.76 to 7.21; P < 0.001). A significant risk difference was observed between the two groups (risk difference 0.10, 0.04 to 0.15; P = 0.001). CONCLUSION A high recurrence score is associated with higher pCR rates and a low-intermediate recurrence score may indicate chemoresistance. Routine assessment of recurrence score by the 21-gene expression assay on core biopsy might be of value when considering neoadjuvant chemotherapy in patients with ER-positive, HER2-negative breast cancer.
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Affiliation(s)
- M R Boland
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - A Al-Maksoud
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - É J Ryan
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - I Balasubramanian
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - J Geraghty
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - D Evoy
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - D McCartan
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - R S Prichard
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - E W McDermott
- Department of Breast Surgery, St Vincent's University Hospital, Dublin, Ireland
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Association of 21-Gene Assay (OncotypeDX) Testing and Receipt of Chemotherapy in the Medicare Breast Cancer Patient Population Following Initial Adoption. Clin Breast Cancer 2020; 20:487-494.e1. [PMID: 32653473 DOI: 10.1016/j.clbc.2020.05.010] [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: 12/11/2019] [Revised: 04/16/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our objective was to investigate why early studies regarding adoption of the 21-gene recurrence score (RS) assay did not show an initial reduction in the number of patients with breast cancer receiving real-world chemotherapy. MATERIALS AND METHODS We addressed 2 sources of confounding suspected in previous studies: (1) the early time frame during the initial adoption phase of the RS assay, and (2) suspected selective, increased administration to patients more likely to have been chemotherapy candidates. To address selective use during initial adoption, we used updated SEER-Medicare data from 2004 and 2011. To address individual selection bias, we examined whether RS test utilization was negatively associated with rates of local chemotherapy use assessed at the hospital referral region level using conventional ordinary least squares and instrumental variable approaches to adjust for selection bias. RESULTS A total of 26,009 patients met inclusion criteria. Assay use was associated with a decrease in absolute percentage use of chemotherapy of 4.5% (95% confidence interval [CI], 3.2%-5.7%), which was even more pronounced in sensitivity analyses limited to later study years (2008-2011), with a decrease of 6.8% (95% CI, 5.3%-8.3%). Instrumental variable models yielded similar point estimates but were insufficiently powered to draw conclusions. CONCLUSION Receipt of the 21-gene assay was associated with decreased utilization of chemotherapy by 2008.
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Willemsma K, Yip W, LeVasseur N, Dobosz K, Illmann C, Baxter S, Lohrisch C, Simmons CE. Impact of Recurrence Score on type and duration of chemotherapy in breast cancer. ACTA ACUST UNITED AC 2020; 27:e86-e92. [PMID: 32489257 DOI: 10.3747/co.27.5635] [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] [Indexed: 01/22/2023]
Abstract
Background The use of Oncotype dx (Genomic Health, Redwood City, CA, U.S.A.) testing has been shown to change treatment decisions in approximately 30% of breast cancer (bca) cases, but research on how Recurrence Score testing has affected the type of chemotherapy offered is limited. We sought to determine if the availability of Oncotype dx testing resulted in a change to the type and duration of chemotherapy regimens used in the treatment of early-stage hormone receptor-positive bca. Methods In a population-based cohort study, patients treated in the 2 years before the availability of Oncotype dx testing were compared with patients treated in the 2 years after testing availability. Charts were audited and divided into 2 groups: pre-Oncotype dx and post-Oncotype dx. The groups were compared for differences in duration of chemotherapy (12 weeks vs. >12 weeks), types of agents used (anthracycline vs. non-anthracycline), and myelosuppressive potential of the chosen regimen. Results Of 834 patients who fulfilled the enrolment criteria, 360 fell into the pre-Oncotype dx era, and 474, into the post-Oncotype dx era. An increase of 11.2 percentage points, to 69.5% from 58.3%, was observed in the proportion of patients receiving short-course compared with long-course chemotherapy (p = 0.068). The proportion of patients prescribed anthracycline-containing regimens declined in the post-Oncotype dx era (47.7% pre vs. 32.2% post, p = 0.016). The selection of more-myelosuppressive chemotherapy protocols increased in the post-Oncotype dx era (67.4% pre vs. 78.8% post, p = 0.044). Conclusions In the present study, the availability of Oncotype dx testing was observed to influence the choice of chemotherapy type in the setting of early-stage bca.
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Affiliation(s)
- K Willemsma
- Applied Health Sciences, University of Waterloo, Waterloo, ON
| | - W Yip
- Science, University of Waterloo, Waterloo, ON
| | | | - K Dobosz
- Cancer Medicine, University of British Columbia, Vancouver, BC
| | - C Illmann
- Science, University of Waterloo, Waterloo, ON
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Curtit E, Vannetzel JM, Darmon JC, Roche S, Bourgeois H, Dewas S, Catala S, Mereb E, Fanget CF, Genet D, Forest AM, Bernier C, Pivot X. Results of PONDx, a prospective multicenter study of the Oncotype DX ® breast cancer assay: Real-life utilization and decision impact in French clinical practice. Breast 2019; 44:39-45. [PMID: 30634106 DOI: 10.1016/j.breast.2018.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/28/2018] [Accepted: 12/31/2018] [Indexed: 12/11/2022] Open
Abstract
Adjuvant chemotherapy shows clear benefits in HER2-positive and triple-negative breast cancer (BC). Its benefits are less universal in BCs expressing hormone receptors. The 21-gene Oncotype DX® Breast Recurrence Score test was designed for HR+, HER2- early-stage BC before decision on adjuvant chemotherapy. Its validity and utility was demonstrated prospectively across multiple studies. The observational study PONDx characterized the use of Oncotype DX® Breast in routine practice in France and evaluated its decision impact. Of 882 ER-positive BC patients (67% postmenopausal), most (79%) had N0/Nmic node involvement, grade 2 tumors (68%), tumor size 1-5 cm (88%), and ductal histology (78%). BCs with histopathologically elevated recurrence risk included grade 3: 18%; N1: 21%; Ki67 > 20%: 31%. Recurrence Score results by prognostic category were: <18: 54%, 18-30: 36%; >30: 10%. Compared to recommendations before individual availability of the score, results prompted net absolute reductions in chemotherapy recommendations of 36% (total population), and 29% (grade 3 and/or Ki67 > 20% histologies). Decisions reflected prognostic implications: in the Recurrence Score <18 category, 95% of patients received recommendations of hormonal therapy only, in the >30 category, 97.5% were recommended additional chemotherapy; 95% followed the final recommendations of their physicians. The Recurrence Score provides independent predictive and prognostic information in ER + N0/N1 early BC, including high-risk subgroups. PONDx further characterizes the population where the test is beneficial in real-life use and fits current clinical needs. Oncotype DX® Breast enables relevant net reductions in chemotherapy use, sparing patients from serious toxicities. Its therapeutic implications are highly accepted by physicians and patients.
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Affiliation(s)
- Elsa Curtit
- Institut Régional Fédératif du Cancer pour la Région Franche-Comté, Université de Bourgogne Franche-Comté, Pôle Cancero-Biologie, 2 Bd Fleming, 25000, Besançon, France.
| | | | - Jean-Claude Darmon
- ICA-Polyclinique Urbain V, 95 Chemin du Pont des Deux Eaux, 84000, Avignon, France.
| | - Sophie Roche
- Centre Jean Bernard, 9 Rue Beauverger, 72000, Le Mans, France.
| | | | - Sylvain Dewas
- Centre Bourgogne - Polyclinique du Bois, 44 Avenue Marx Dormoy, 59000, Lille, France.
| | - Stéphanie Catala
- Centre Catalan d'Oncologie, 80 Rue Pascal Marie Agasse, 66000, Perpignan, France.
| | - Emile Mereb
- Hôpital Manchester - Centre Hospitalier de Charleville-Mézières, 45 Avenue de Manchester, Charleville-Mézières, France.
| | - Charlotte Furtos Fanget
- Institut de Cancérologie Lucien Neuwirth, 108bis Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Dominique Genet
- Clinique François Chenieux, 18 Rue du Général Catroux, 87000, Limoges, France.
| | - Anne-Marie Forest
- Centre Hospitalier de Montluçon 18, Avenue du 8 Mai 1945, 03113, Montluçon, France.
| | - Céline Bernier
- 3C Sud Ile de France, Centre de Coordination en Cancérologie Inter-établissements, Centre Hospitalier de Bligny, 91640, Briis-sous-Forges, France.
| | - Xavier Pivot
- Institut Régional du Cancer, 3 Rue de la Porte de l'hôpital, 67065, Strasbourg, France.
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Makower D, Sparano JA. Breast Cancer Management in the TAILORx Era: Less is More. NAM Perspect 2018. [DOI: 10.31478/201812e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Discrepancy in risk assessment of hormone receptor positive early-stage breast cancer patients using breast cancer index and recurrence score. Breast Cancer Res Treat 2018; 173:375-383. [DOI: 10.1007/s10549-018-5013-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
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Colomer R, Aranda-López I, Albanell J, García-Caballero T, Ciruelos E, López-García MÁ, Cortés J, Rojo F, Martín M, Palacios-Calvo J. Biomarkers in breast cancer: A consensus statement by the Spanish Society of Medical Oncology and the Spanish Society of Pathology. Clin Transl Oncol 2018; 20:815-826. [PMID: 29273958 PMCID: PMC5996012 DOI: 10.1007/s12094-017-1800-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/05/2017] [Indexed: 11/05/2022]
Abstract
This consensus statement revises and updates the recommendations for biomarkers use in the diagnosis and treatment of breast cancer, and is a joint initiative of the Spanish Society of Medical Oncology and the Spanish Society of Pathology. This expert group recommends determining in all cases of breast cancer the histologic grade and the alpha-estrogen receptor (ER), progesterone receptor, Ki-67 and HER2 status, in order to assist prognosis and establish therapeutic options, including hormone therapy, chemotherapy and anti-HER2 therapy. One of the four available genetic prognostic platforms (MammaPrint®, Oncotype DX®, Prosigna® or EndoPredict®) may be used in node-negative ER-positive patients to establish a prognostic category and decide with the patient whether adjuvant treatment may be limited to hormonal therapy. Newer technologies including next-generation sequencing, liquid biopsy, tumour-infiltrating lymphocytes or PD-1 determination are at this point investigational.
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Affiliation(s)
- R Colomer
- Departamento de Oncología Médica, Hospital Universitario La Princesa, C/Diego de León, 62, 28006, Madrid, Spain.
| | - I Aranda-López
- Pathology Department, General University Hospital of Alicante, Alicante, Spain
| | - J Albanell
- Medical Oncology Department, Mar University Hospital, Hospital del Mar Medical Research Institute (IMIM), Pompeu Fabra University, CIBERONC, Barcelona, Spain
| | - T García-Caballero
- Pathology Department, University Hospital Complex of Santiago, Santiago de Compostela, Spain
| | - E Ciruelos
- Medical Oncology Department, Doce de Octubre University Hospital, Madrid, Spain
| | - M Á López-García
- Pathology Department, Virgen del Rocio University Hospital, CIBERONC, Seville, Spain
| | - J Cortés
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Baselga Institute of Oncology (IOB), Madrid, Barcelona, Spain
| | - F Rojo
- Pathology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - M Martín
- Medical Oncology Department, Gregorio Marañón University Hospital, CIBERONC, GEICAM, Madrid, Spain
| | - J Palacios-Calvo
- Pathology Department, Ramón y Cajal University Hospital, CIBERONC, IRYCIS and University of Alcalá, Madrid, Spain.
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Palacios Calvo J, Albanell J, Rojo F, Ciruelos E, Aranda-López I, Cortés J, García-Caballero T, Martín M, López-García MÁ, Colomer R. [Consensus statement on biomarkers in breast cancer by the Spanish Society of Pathology and the Spanish Society of Medical Oncology]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 51:97-109. [PMID: 29602380 DOI: 10.1016/j.patol.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/22/2017] [Indexed: 11/30/2022]
Abstract
This consensus statement is a joint initiative of the Spanish Society of Pathology (SEAP) and the Spanish Society of Medical Oncology (SEOM). It revises and updates the recommendations for the use of biomarkers in the diagnosis and treatment of breast cancer. The group of experts recommends that, in all cases of breast cancer, the histologic grade and the alpha-estrogen receptor (ER), progesterone receptor, Ki-67 and HER2 status should be determined, in order to assist prognosis and establish therapeutic options, including hormone therapy, chemotherapy and anti-HER2 therapy. One of the four available genetic prognostic platforms (MammaPrint®, Oncotype DX®, Prosigna® or EndoPredict®) may be used in node-negative ER-positive patients to establish a prognostic category and decide, together with the patient, whether adjuvant treatment be limited to hormonal therapy. Newer technologies, including next generation sequencing, liquid biopsy, tumour infiltrating lymphocytes or PD-1 determination, are still investigational.
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Affiliation(s)
- José Palacios Calvo
- Departamento de Anatomía Patológica, Hospital Universitario Ramón y Cajal, CIBERONC, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - Joan Albanell
- Departamento de Oncología Médica, Hospital del Mar, Instituto de Investigación Médica del Hospital del Mar (IMIM), Universidad Pompeu Fabra, CIBERONC, Barcelona, España
| | - Federico Rojo
- Departamento de Anatomía Patológica, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - Eva Ciruelos
- Departamento de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Ignacio Aranda-López
- Departamento de Anatomía Patológica, Hospital General Universitario de Alicante, Alicante, España
| | - Javier Cortés
- Departamento de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto de Oncología Vall d'Hebron (VHIO), Instituto de Oncología Baselga (IOB), Barcelona, España
| | - Tomás García-Caballero
- Departamento de Anatomía Patológica, Complexo Hospitalario de Santiago, Santiago de Compostela, La Coruña, España
| | - Miguel Martín
- Departamento de Oncología Médica, Hospital Universitario Gregorio Marañón, CIBERONC, GEICAM, Madrid, España
| | | | - Ramon Colomer
- Departamento de Oncología Médica, Hospital Universitario de la Princesa, Madrid, España
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Siow ZR, De Boer RH, Lindeman GJ, Mann GB. Spotlight on the utility of the Oncotype DX ® breast cancer assay. Int J Womens Health 2018; 10:89-100. [PMID: 29503586 PMCID: PMC5827461 DOI: 10.2147/ijwh.s124520] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The Oncotype DX® assay was developed to address the need for optimizing the selection of adjuvant systemic therapy for patients with estrogen receptor (ER)-positive, lymph node-negative breast cancer. It has ushered in the era of genomic-based personalized cancer care for ER-positive primary breast cancer and is now widely utilized in various parts of the world. Together with several other genomic assays, Oncotype DX has been incorporated into clinical practice guidelines on biomarker use to guide treatment decisions. The Oncotype DX result is presented as the recurrence score which is a continuous score that predicts the risk of distant disease recurrence. The assay, which provides information on clinicopathological factors, has been validated for use in the prognostication and prediction of degree of adjuvant chemotherapy benefit in both lymph node-positive and lymph node-negative early breast cancers. Clinical studies have consistently shown that the Oncotype DX has a significant impact on decision making in adjuvant therapy recommendations and appears to be cost-effective in diverse health care settings. In this article, we provide an overview of the validation and clinical impact studies for the Oncotype DX assay. We also discuss its potential use in the neoadjuvant setting, as well as the more recent prospective validation trials, and the economic and utility implications of studies that use a lower cutoff score to define low-risk disease.
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Affiliation(s)
- Zhen Rong Siow
- ACRF Stem Cells and Cancer Division, Walter and Eliza Hall Institute of Medical Research.,Department of Medical Oncology, Peter MacCallum Cancer Centre.,Familial Cancer Centre, The Royal Melbourne Hospital
| | - Richard H De Boer
- Department of Medical Oncology, Peter MacCallum Cancer Centre.,Familial Cancer Centre, The Royal Melbourne Hospital
| | - Geoffrey J Lindeman
- ACRF Stem Cells and Cancer Division, Walter and Eliza Hall Institute of Medical Research.,Department of Medical Oncology, Peter MacCallum Cancer Centre.,Familial Cancer Centre, The Royal Melbourne Hospital.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - G Bruce Mann
- Department of Medical Oncology, Peter MacCallum Cancer Centre.,Familial Cancer Centre, The Royal Melbourne Hospital.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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14
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Blok EJ, Bastiaannet E, van den Hout WB, Liefers GJ, Smit VTHBM, Kroep JR, van de Velde CJH. Systematic review of the clinical and economic value of gene expression profiles for invasive early breast cancer available in Europe. Cancer Treat Rev 2017; 62:74-90. [PMID: 29175678 DOI: 10.1016/j.ctrv.2017.10.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/29/2017] [Indexed: 01/12/2023]
Abstract
Gene expression profiles with prognostic capacities have shown good performance in multiple clinical trials. However, with multiple assays available and numerous types of validation studies performed, the added value for daily clinical practice is still unclear. In Europe, the MammaPrint, OncotypeDX, PAM50/Prosigna and Endopredict assays are commercially available. In this systematic review, we aim to assess these assays on four important criteria: Assay development and methodology, clinical validation, clinical utility and economic value. We performed a literature search covering PubMed, Embase, Web of Science and Cochrane, for studies related to one or more of the four selected assays. We identified 147 papers for inclusion in this review. MammaPrint and OncotypeDX both have evidence available, including level IA clinical trial results for both assays. Both assays provide prognostic information. Predictive value has only been shown for OncotypeDX. In the clinical utility studies, a higher reduction in chemotherapy was achieved by OncotypeDX, although the number of available studies differ considerably between tests. On average, economic evaluations estimate that genomic testing results in a moderate increase in total costs, but that these costs are acceptable in relation to the expected improved patient outcome. PAM50/prosigna and EndoPredict showed comparable prognostic capacities, but with less economical and clinical utility studies. Furthermore, for these assays no level IA trial data are available yet. In summary, all assays have shown excellent prognostic capacities. The differences in the quantity and quality of evidence are discussed. Future studies shall focus on the selection of appropriate subgroups for testing and long-term outcome of validation trials, in order to determine the place of these assays in daily clinical practice.
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Affiliation(s)
- E J Blok
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - W B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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15
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Comparison of Oncotype DX® Recurrence Score® with other risk assessment tools including the Nottingham Prognostic Index in the identification of patients with low-risk invasive breast cancer. Virchows Arch 2017; 471:321-328. [DOI: 10.1007/s00428-017-2184-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/11/2017] [Accepted: 06/25/2017] [Indexed: 12/12/2022]
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GENE EXPRESSION PROFILING AND EXPANDED IMMUNOHISTOCHEMISTRY TESTS TO GUIDE SELECTION OF CHEMOTHERAPY REGIMENS IN BREAST CANCER MANAGEMENT: A SYSTEMATIC REVIEW. Int J Technol Assess Health Care 2017; 33:32-45. [PMID: 28486999 DOI: 10.1017/s0266462317000034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this report was to assess the clinical effectiveness of two Gene expression profiling (GEP) and two expanded immunohistochemistry (IHC) tests compared with current prognostic tools in guiding the use of adjuvant chemotherapy in patients with early breast cancer. METHODS A systematic review of the evidence on clinical effectiveness of OncotypeDX, IHC4, MammaPrint, and Mammostrat, compared with current clinical practice using clinicopathological parameters, in women with early breast cancer was conducted. Ten databases were searched to include citations to May 2016. RESULTS Searches identified 7,064 citations, of which forty-one citations satisfied the criteria for the review. A narrative synthesis was performed. Evidence for OncotypeDX demonstrated the impact of the test on decision making and there was some support for OncotypeDX predicting chemotherapy benefit. There were relatively lower levels of evidence for the other three tests included in the analysis. MammaPrint, Mammostrat, and IHC4 tests were limited to a small number of studies. Limitations in relation to study design were identified for all tests. CONCLUSIONS The evidence base for OncotypeDX is considered to be the most robust. Methodological weaknesses relating to heterogeneity of patient cohorts and issues arising from the retrospective nature of the evidence were identified. Further evidence is required for all of the tests using prospective randomized controlled trial data.
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Bear HD, Wan W, Robidoux A, Rubin P, Limentani S, White RL, Granfortuna J, Hopkins JO, Oldham D, Rodriguez A, Sing AP. Using the 21-gene assay from core needle biopsies to choose neoadjuvant therapy for breast cancer: A multicenter trial. J Surg Oncol 2017; 115:917-923. [PMID: 28407247 DOI: 10.1002/jso.24610] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/19/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We hypothesized that the Oncotype Dx® 21-gene Recurrence Score (RS) could guide neoadjuvant systemic therapy (NST) to facilitate breast conserving surgery (BCS) for hormone receptor positive (HR+) breast cancers. METHODS This study enrolled patients with HR+, HER2-negative, invasive breast cancers not suitable for BCS (size ≥ 2 cm). Core needle biopsy blocks were tested. For tumors with RS < 11, patients received hormonal therapy (NHT); patients with RS > 25 tumors received chemotherapy (NCT); patients with RS 11-25 were randomized to NHT or NCT. Primary endpoint was whether 1/3 or more of randomized patients refused assigned treatment. RESULTS Sixty-four patients were enrolled. Of 33 patients with RS 11-25, 5 (15%) refused assignment to NCT. This was significantly lower than the 33% target (binomial test, P = 0.0292). Results for clinical outcomes (according to treatment received for 55 subjects) included successful BCS for 75% of tumors with RS < 11 receiving NHT, 72% for RS 11-25 receiving NHT, 64% for RS 11-25 receiving NCT, and 57% for RS > 25 receiving NCT. CONCLUSIONS Using the RS to guide NST is feasible. These results suggest that for patients with RS < 25 NHT is a potentially effective strategy.
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Affiliation(s)
- Harry D Bear
- Virginia Commonwealth University and Massey Cancer Center, Richmond, Virginia
| | - Wen Wan
- Virginia Commonwealth University and Massey Cancer Center, Richmond, Virginia
| | - André Robidoux
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Peter Rubin
- Cone Health Cancer Center, Greensboro, North Carolina
| | | | | | | | | | - Dwight Oldham
- Lynchburg Hematology Oncology Clinic, Lynchburg, Virginia
| | | | - Amy P Sing
- Genomic Health, Inc., Redwood City, California
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18
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21-Gene recurrence score decreases receipt of chemotherapy in ER+ early-stage breast cancer: an analysis of the NCDB 2010-2013. Breast Cancer Res Treat 2016; 159:315-26. [PMID: 27507245 PMCID: PMC5012154 DOI: 10.1007/s10549-016-3926-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/20/2016] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to determine if receipt of chemotherapy was associated with utilization of the 21-gene recurrence score assay (RS assay) or with recurrence score (RS) in eligible patients. Using the National Cancer Data Base (NCDB), we identified female patients eligible for RS assay based on National Comprehensive Cancer Network (NCCN) guidelines: age 18–70, ER-positive and HER2-negative early-stage breast cancer diagnosed during 2010–2013. We excluded patients not meeting testing guidelines. Inclusion required result of RS in patients who underwent RS assay and status for receipt of chemotherapy. Multivariable logistic regression models and propensity matched analysis were used to determine associations between RS assay and RS with receipt of chemotherapy. Among 129,765 patients who were eligible, 74,778 underwent RS assay and had results available. Of these, 59.5 % (44,505) had low-risk, 32.0 % (23,920) had intermediate-risk, and 8.5 % (6353) had high-risk RS. Patients with intermediate- and high-risk RS were more likely to receive chemotherapy [OR 12.9 (CI 12.2–13.6), p <0.001 and OR 87.2 (CI 79.6–95.6), p <0.0001], respectively. In both low- and intermediate-risk groups, increasing RS score was significantly associated with increasing odds of receiving chemotherapy [OR 1.10 (CI 1.09–1.12), p <0.0001 and OR 1.26 (CI 1.25–1.27), p <0.0001, respectively, for each point increase in RS]. Receipt of chemotherapy was more likely in patients who did not undergo RS assay compared to those who did, OR 1.21 (CI 1.175–1.249) p <0.0001. The utilization of RS assay and the RS were both strongly associated with chemotherapy receipt. Patients eligible for chemotherapy, based on NCCN criteria, were more likely to receive chemotherapy if they did not undergo RS assay or they had a high RS.
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19
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Schmidt KT, Chau CH, Price DK, Figg WD. Precision Oncology Medicine: The Clinical Relevance of Patient-Specific Biomarkers Used to Optimize Cancer Treatment. J Clin Pharmacol 2016; 56:1484-1499. [PMID: 27197880 DOI: 10.1002/jcph.765] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 12/22/2022]
Abstract
Precision medicine in oncology is the result of an increasing awareness of patient-specific clinical features coupled with the development of genomic-based diagnostics and targeted therapeutics. Companion diagnostics designed for specific drug-target pairs were the first to widely utilize clinically applicable tumor biomarkers (eg, HER2, EGFR), directing treatment for patients whose tumors exhibit a mutation susceptible to an FDA-approved targeted therapy (eg, trastuzumab, erlotinib). Clinically relevant germline mutations in drug-metabolizing enzymes and transporters (eg, TPMT, DPYD) have been shown to impact drug response, providing a rationale for individualized dosing to optimize treatment. The use of multigene expression-based assays to analyze an array of prognostic biomarkers has been shown to help direct treatment decisions, especially in breast cancer (eg, Oncotype DX). More recently, the use of next-generation sequencing to detect many potential "actionable" cancer molecular alterations is further shifting the 1 gene-1 drug paradigm toward a more comprehensive, multigene approach. Currently, many clinical trials (eg, NCI-MATCH, NCI-MPACT) are assessing novel diagnostic tools with a combination of different targeted therapeutics while also examining tumor biomarkers that were previously unexplored in a variety of cancer histologies. Results from ongoing trials such as the NCI-MATCH will help determine the clinical utility and future development of the precision-medicine approach.
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Affiliation(s)
- Keith T Schmidt
- Clinical Pharmacology Program, Office of the Clinical Director, NIH, Bethesda, MD, USA
| | - Cindy H Chau
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Douglas K Price
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - William D Figg
- Clinical Pharmacology Program, Office of the Clinical Director, NIH, Bethesda, MD, USA
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
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Petkov VI, Miller DP, Howlader N, Gliner N, Howe W, Schussler N, Cronin K, Baehner FL, Cress R, Deapen D, Glaser SL, Hernandez BY, Lynch CF, Mueller L, Schwartz AG, Schwartz SM, Stroup A, Sweeney C, Tucker TC, Ward KC, Wiggins C, Wu XC, Penberthy L, Shak S. Breast-cancer-specific mortality in patients treated based on the 21-gene assay: a SEER population-based study. NPJ Breast Cancer 2016; 2:16017. [PMID: 28721379 PMCID: PMC5515329 DOI: 10.1038/npjbcancer.2016.17] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/02/2016] [Accepted: 05/13/2016] [Indexed: 01/07/2023] Open
Abstract
The 21-gene Recurrence Score assay is validated to predict recurrence risk and chemotherapy benefit in hormone-receptor-positive (HR+) invasive breast cancer. To determine prospective breast-cancer-specific mortality (BCSM) outcomes by baseline Recurrence Score results and clinical covariates, the National Cancer Institute collaborated with Genomic Health and 14 population-based registries in the the Surveillance, Epidemiology, and End Results (SEER) Program to electronically supplement cancer surveillance data with Recurrence Score results. The prespecified primary analysis cohort was 40-84 years of age, and had node-negative, HR+, HER2-negative, nonmetastatic disease diagnosed between January 2004 and December 2011 in the entire SEER population, and Recurrence Score results (N=38,568). Unadjusted 5-year BCSM were 0.4% (n=21,023; 95% confidence interval (CI), 0.3-0.6%), 1.4% (n=14,494; 95% CI, 1.1-1.7%), and 4.4% (n=3,051; 95% CI, 3.4-5.6%) for Recurrence Score <18, 18-30, and ⩾31 groups, respectively (P<0.001). In multivariable analysis adjusted for age, tumor size, grade, and race, the Recurrence Score result predicted BCSM (P<0.001). Among patients with node-positive disease (micrometastases and up to three positive nodes; N=4,691), 5-year BCSM (unadjusted) was 1.0% (n=2,694; 95% CI, 0.5-2.0%), 2.3% (n=1,669; 95% CI, 1.3-4.1%), and 14.3% (n=328; 95% CI, 8.4-23.8%) for Recurrence Score <18, 18-30, ⩾31 groups, respectively (P<0.001). Five-year BCSM by Recurrence Score group are reported for important patient subgroups, including age, race, tumor size, grade, and socioeconomic status. This SEER study represents the largest report of prospective BCSM outcomes based on Recurrence Score results for patients with HR+, HER2-negative, node-negative, or node-positive breast cancer, including subgroups often under-represented in clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | - Frederick L Baehner
- Genomic Health, Inc., Redwood City, CA, USA
- University of California, San Francisco, CA, USA
| | - Rosemary Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA, USA
| | - Dennis Deapen
- University of Southern California, Los Angeles, CA, USA
| | - Sally L Glaser
- Cancer Prevention Institute of California, Fremont, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | | | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Lloyd Mueller
- Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT, USA
| | - Ann G Schwartz
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Stephen M Schwartz
- Cancer Surveillance System, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Antoinette Stroup
- Rutgers School of Public Health, Piscataway, NJ, USA
- Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Carol Sweeney
- Utah Cancer Registry, Department of Internal Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Thomas C Tucker
- University of Kentucky, Markey Cancer Center, Lexington, KY, USA
| | | | - Charles Wiggins
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Xiao-Cheng Wu
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Marshall DA, Deal K, Bombard Y, Leighl N, MacDonald KV, Trudeau M. How do women trade-off benefits and risks in chemotherapy treatment decisions based on gene expression profiling for early-stage breast cancer? A discrete choice experiment. BMJ Open 2016; 6:e010981. [PMID: 27256091 PMCID: PMC4893875 DOI: 10.1136/bmjopen-2015-010981] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/01/2016] [Accepted: 03/30/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Gene expression profiling (GEP) of tumours informs baseline risk prediction, potentially affecting adjuvant chemotherapy decisions for women with early-stage breast cancer. Since only 15% will experience a recurrence, concerns have been raised about potential harms from overtreatment and high GEP costs in publicly funded healthcare systems. We aimed to estimate preferences and personal utility of GEP testing information and benefit-risk trade-offs in chemotherapy treatment decisions. DESIGN, SETTING AND INTERVENTION Based on literature review and findings from our qualitative research (focus groups, interviews with patients with breast cancer and medical oncologists), we developed a discrete choice experiment (DCE) survey and administered it via an internet panel. The DCE included 12 choice tasks with 5 attributes and 3 alternatives considering orthogonality, D-efficiency and level balance. PARTICIPANTS The DCE survey was administered to 1004 Canadian women from the general population. MAIN OUTCOME MEASURES Preferences were analysed using conditional logit and hierarchical Bayes and evaluated for goodness of fit. We conducted simulation analyses for alternative scenarios. RESULTS GEP test score indicating likely benefit from chemotherapy was the most important attribute. Doctor's clinical estimate of the risk of cancer returning, trust in your cancer doctor and side effects of chemotherapy (temporary and permanent) were relatively less important but showed significant differences among levels. In the scenario analyses, 78% were likely to choose chemotherapy in a high-risk scenario, 55% in a moderate-risk scenario and 33% in a low-risk scenario, with the other attributes held constant. A high GEP score was more important in influencing the choice of chemotherapy for those at intermediate clinical risk. CONCLUSIONS GEP testing information influences chemotherapy treatment decisions in early-stage breast cancer and varies depending on clinical risk. Clinicians should be aware of these differences and tailor the use of GEP testing accordingly.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ken Deal
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Leighl
- Department of Medicine, University of Toronto,Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Trudeau
- University of Toronto,Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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22
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MacDonald KV, Bombard Y, Deal K, Trudeau M, Leighl N, Marshall DA. The influence of gene expression profiling on decisional conflict in decision making for early-stage breast cancer chemotherapy. Eur J Cancer 2016; 61:85-93. [PMID: 27155447 DOI: 10.1016/j.ejca.2016.03.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/04/2016] [Accepted: 03/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Women with early-stage breast cancer, of whom only 15% will experience a recurrence, are often conflicted or uncertain about taking chemotherapy. Gene expression profiling (GEP) of tumours informs risk prediction, potentially affecting treatment decisions. We examined whether receiving a GEP test score reduces decisional conflict in chemotherapy treatment decision making. METHODS A general population sample of 200 women completed the decisional conflict scale (DCS) at baseline (no GEP test score scenario) and after (scenario with GEP test score added) completing a discrete choice experiment survey for early-stage breast cancer chemotherapy. We scaled the 16-item DCS total scores and subscores from 0 to 100 and calculated means, standard deviations and change in scores, with significance (p < 0.05) based on matched pairs t-tests. RESULTS We identified five respondent subgroups based on preferred treatment option; almost 40% did not change their chemotherapy decision after receiving GEP testing information. Total score and all subscores (uncertainty, informed, values clarity, support, and effective decision) decreased significantly in the respondent subgroup who were unsure about taking chemotherapy initially but changed to no chemotherapy (n =33). In the subgroup of respondents (n = 25) who chose chemotherapy initially but changed to unsure, effective decision subscore increased significantly. In the overall sample, changes in total and all subscores were non-significant. CONCLUSIONS GEP testing adds value for women initially unsure about chemotherapy treatment with a decrease in decisional conflict. However, for women who are confident about their treatment decisions, GEP testing may not add value. Decisions to request GEP testing should be personalised based on patient preferences.
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Affiliation(s)
- Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Room 3C62, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Room 312, Toronto, Ontario M5B 1T8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 209 Victoria Street, Room 312, Toronto, Ontario M5B 1T8, Canada
| | - Ken Deal
- DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Maureen Trudeau
- University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Natasha Leighl
- Department of Medicine, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, McMaster University, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
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Jasem J, Amini A, Rabinovitch R, Borges VF, Elias A, Fisher CM, Kabos P. 21-Gene Recurrence Score Assay As a Predictor of Adjuvant Chemotherapy Administration for Early-Stage Breast Cancer: An Analysis of Use, Therapeutic Implications, and Disparity Profile. J Clin Oncol 2016; 34:1995-2002. [PMID: 27001563 DOI: 10.1200/jco.2015.65.0887] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The 21-gene Recurrence Score (RS) assay is used to predict disease recurrence and benefit of chemotherapy in estrogen receptor-positive, lymph node-negative early-stage breast cancer (EBC). Our study is the first analysis of trends and differences in the use of the RS assay and its impact on recommending chemotherapy in a population-based data set. METHODS Patients with EBC diagnosed from 2004 to 2012 and included in the National Cancer Data Base were analyzed. Multivariate logistic regression analysis was used to estimate the covariates associated with use of the test and its impact on chemotherapy decisions. RESULTS The RS assay was ordered for 54.0% of the 143,032 identified patients. Of all the variables, RS assay had the strongest association with recommendation for chemotherapy, with an adjusted odds ratio (AOR) of 83 for high assay scores. When indicated, test use was significantly associated with younger age, white race, academic centers, private insurance, and pT2/pN0(i+) grade 2 to 3 disease. Black patients (AOR, 1.31; 95% CI, 1.20 to 1.43) and those treated in community facilities (AOR, 1.49; 95% CI, 1.35 to 1.63) were more likely to be tested outside the National Comprehensive Cancer Network guidelines. Black patients (AOR, 1.51; 95% CI, 1.31 to 1.69) and those with high tumor grade (AOR, 30.76; 95% CI, 26.48 to 35.73) had significantly higher assay scores. Younger black patients (AOR, 1.33; 95% CI, 1.16 to 1.54) were more likely to receive chemotherapy despite low assay scores. CONCLUSION The RS assay significantly influences clinicians' recommendations for chemotherapy in patients with EBC. Black patients tended to have higher assay scores, which may reflect use patterns or less favorable tumor biology for estrogen receptor-positive disease. There are significant differences in use and clinical implications of the test on the basis of race, insurance, and type of facility.
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Affiliation(s)
- Jagar Jasem
- All authors: University of Colorado, Aurora, CO
| | - Arya Amini
- All authors: University of Colorado, Aurora, CO
| | | | | | | | | | - Peter Kabos
- All authors: University of Colorado, Aurora, CO
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Jahn B, Rochau U, Kurzthaler C, Hubalek M, Miksad R, Sroczynski G, Paulden M, Kluibenschädl M, Krahn M, Siebert U. Cost effectiveness of personalized treatment in women with early breast cancer: the application of OncotypeDX and Adjuvant! Online to guide adjuvant chemotherapy in Austria. SPRINGERPLUS 2015; 4:752. [PMID: 26693110 PMCID: PMC4666888 DOI: 10.1186/s40064-015-1440-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022]
Abstract
A Breast Cancer Outcomes model was developed at the ONCOTYROL research center to evaluate personalized test-treatment strategies in Austria. The goal was to evaluate the cost-effectiveness of a new 21-gene assay (ODX) when used in conjunction with the Adjuvant! Online (AO) decision aid to support personalized decisions about use of adjuvant chemotherapy in early-stage breast cancer patients in Austria. We applied a validated discrete-event-simulation model to a hypothetical cohort of 50 years old women over a lifetime horizon. The test-treatment strategies of interest were defined using three-letter acronyms. The first (second, third) letter indicates whether patients with a low (intermediate, high) risk according to AO were tested using ODX (Y yes, N no). The main outcomes were life-years gained, quality-adjusted life-years (QALYs), costs and cost effectiveness. Robustness of the results was tested in sensitivity analyses. Results were compared to a Canadian analysis conducted by the Toronto Health Economics and Technology Assessment Collaborative (THETA). Five of eight strategies were dominated (i.e., more costly and less effective: NNY, NYN, YNN, YNY, YYN). The base-case analysis shows that YYY (ODX provided to all patients) is the most effective strategy and is cost effective with an incremental cost-effectiveness ratio of 15,700 EUR per QALY gained. These results are sensitive to changes in the probabilities of distant recurrence, age and costs of chemotherapy. The results of the base-case analysis were comparable to the THETA results. Based on our analyses, using ODX in addition to AO is effective and cost effective in all women in Austria. The development of future genetic tests may require alternative or additional test-treatment strategies to be evaluated.
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Affiliation(s)
- B Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center 1, A-6060 Hall i.T, Austria ; Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - U Rochau
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center 1, A-6060 Hall i.T, Austria ; Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - C Kurzthaler
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center 1, A-6060 Hall i.T, Austria ; Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - M Hubalek
- Department of Obstetrics and Gynaecology, Medical University Innsbruck, Innsbruck, Austria
| | - R Miksad
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - G Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center 1, A-6060 Hall i.T, Austria ; Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - M Paulden
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON Canada ; Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - M Kluibenschädl
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center 1, A-6060 Hall i.T, Austria ; Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - M Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON Canada
| | - U Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center 1, A-6060 Hall i.T, Austria ; Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria ; Center for Health Decision Science, Department of Health Policy and Management, T.H.Chan Harvard School of Public Health, Boston, MA USA ; Institute for Technology Assessment and Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA USA
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Levine MN, Julian JA, Bedard PL, Eisen A, Trudeau ME, Higgins B, Bordeleau L, Pritchard KI. Prospective Evaluation of the 21-Gene Recurrence Score Assay for Breast Cancer Decision-Making in Ontario. J Clin Oncol 2015; 34:1065-71. [PMID: 26598746 DOI: 10.1200/jco.2015.62.8503] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate the 21-gene recurrence score (RS) on decision-making in a population-based cohort. PATIENTS AND METHODS Patients with axillary node-negative or nodal micrometastases, estrogen receptor-positive, and human epidermal growth factor receptor 2-negative breast cancer being considered for chemotherapy were eligible. All cancer treatment centers in Ontario, Canada, participated. Oncologists made a preliminary recommendation for endocrine therapy with or without chemotherapy on the basis of Adjuvant! Online (AOL) risk estimation. Patients were asked for their preference regarding chemotherapy. After RSs were available, patients returned for final decision-making. Patient satisfaction was measured by using the decisional conflict scale. RESULTS Between January 2012 and July 2013, 1,000 patients were recruited. RSs were available for 979 patients. In 58% of patients, risk was categorized as low (RS, 0 to 18); in 33%, intermediate (RS, 19 to 30); and in 9%, high (RS, ≥ 31). Oncologists' recommendations pretest and post-test remained the same in 464 patients (48%), changed from unsure or chemotherapy to no chemotherapy in 365 (38%), and changed from unsure or no chemotherapy to chemotherapy in 143 (15%). After the test, oncologists recommended chemotherapy for 236 patients, 81% of whom received chemotherapy. Of 151 patients in whom risk was classified as intermediate by means of AOL, 41% were a low risk and 44% intermediate risk with RS. Of 298 patients at high risk with AOL, 16% had a high risk RS. None of 236 patients with grade I tumors had a high-risk RS. Mean total decisional conflict scale score significantly improved from pretest to post-test from 34 to 19 (P < .001). CONCLUSION The RS substantially influenced both oncologists' recommendations and patients' preferences for chemotherapy. The major effect was avoidance of chemotherapy when AOL indicated high or intermediate risk.
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Affiliation(s)
- Mark N Levine
- Mark N. Levine, Jim A. Julian, and Louise Bordeleau, McMaster University, Hamilton; Mark N. Levine and Louise Bordeleau, Hamilton Health Sciences Juravinski Cancer Centre, Hamilton; Mark N. Levine and Jim A. Julian, Ontario Clinical Oncology Group and Escarpment Cancer Research Institute, Hamilton; Philippe L. Bedard, Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, University of Toronto, Toronto; Phillipe L. Bedard, Princess Margaret Hospital, Toronto; Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, Odette Sunnybrook Regional Cancer Centre; Toronto; and Brian Higgins, Peel Regional Cancer Centre, Mississauga, Ontario, Canada.
| | - Jim A Julian
- Mark N. Levine, Jim A. Julian, and Louise Bordeleau, McMaster University, Hamilton; Mark N. Levine and Louise Bordeleau, Hamilton Health Sciences Juravinski Cancer Centre, Hamilton; Mark N. Levine and Jim A. Julian, Ontario Clinical Oncology Group and Escarpment Cancer Research Institute, Hamilton; Philippe L. Bedard, Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, University of Toronto, Toronto; Phillipe L. Bedard, Princess Margaret Hospital, Toronto; Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, Odette Sunnybrook Regional Cancer Centre; Toronto; and Brian Higgins, Peel Regional Cancer Centre, Mississauga, Ontario, Canada
| | - Philippe L Bedard
- Mark N. Levine, Jim A. Julian, and Louise Bordeleau, McMaster University, Hamilton; Mark N. Levine and Louise Bordeleau, Hamilton Health Sciences Juravinski Cancer Centre, Hamilton; Mark N. Levine and Jim A. Julian, Ontario Clinical Oncology Group and Escarpment Cancer Research Institute, Hamilton; Philippe L. Bedard, Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, University of Toronto, Toronto; Phillipe L. Bedard, Princess Margaret Hospital, Toronto; Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, Odette Sunnybrook Regional Cancer Centre; Toronto; and Brian Higgins, Peel Regional Cancer Centre, Mississauga, Ontario, Canada
| | - Andrea Eisen
- Mark N. Levine, Jim A. Julian, and Louise Bordeleau, McMaster University, Hamilton; Mark N. Levine and Louise Bordeleau, Hamilton Health Sciences Juravinski Cancer Centre, Hamilton; Mark N. Levine and Jim A. Julian, Ontario Clinical Oncology Group and Escarpment Cancer Research Institute, Hamilton; Philippe L. Bedard, Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, University of Toronto, Toronto; Phillipe L. Bedard, Princess Margaret Hospital, Toronto; Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, Odette Sunnybrook Regional Cancer Centre; Toronto; and Brian Higgins, Peel Regional Cancer Centre, Mississauga, Ontario, Canada
| | - Maureen E Trudeau
- Mark N. Levine, Jim A. Julian, and Louise Bordeleau, McMaster University, Hamilton; Mark N. Levine and Louise Bordeleau, Hamilton Health Sciences Juravinski Cancer Centre, Hamilton; Mark N. Levine and Jim A. Julian, Ontario Clinical Oncology Group and Escarpment Cancer Research Institute, Hamilton; Philippe L. Bedard, Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, University of Toronto, Toronto; Phillipe L. Bedard, Princess Margaret Hospital, Toronto; Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, Odette Sunnybrook Regional Cancer Centre; Toronto; and Brian Higgins, Peel Regional Cancer Centre, Mississauga, Ontario, Canada
| | - Brian Higgins
- Mark N. Levine, Jim A. Julian, and Louise Bordeleau, McMaster University, Hamilton; Mark N. Levine and Louise Bordeleau, Hamilton Health Sciences Juravinski Cancer Centre, Hamilton; Mark N. Levine and Jim A. Julian, Ontario Clinical Oncology Group and Escarpment Cancer Research Institute, Hamilton; Philippe L. Bedard, Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, University of Toronto, Toronto; Phillipe L. Bedard, Princess Margaret Hospital, Toronto; Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, Odette Sunnybrook Regional Cancer Centre; Toronto; and Brian Higgins, Peel Regional Cancer Centre, Mississauga, Ontario, Canada
| | - Louise Bordeleau
- Mark N. Levine, Jim A. Julian, and Louise Bordeleau, McMaster University, Hamilton; Mark N. Levine and Louise Bordeleau, Hamilton Health Sciences Juravinski Cancer Centre, Hamilton; Mark N. Levine and Jim A. Julian, Ontario Clinical Oncology Group and Escarpment Cancer Research Institute, Hamilton; Philippe L. Bedard, Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, University of Toronto, Toronto; Phillipe L. Bedard, Princess Margaret Hospital, Toronto; Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, Odette Sunnybrook Regional Cancer Centre; Toronto; and Brian Higgins, Peel Regional Cancer Centre, Mississauga, Ontario, Canada
| | - Kathleen I Pritchard
- Mark N. Levine, Jim A. Julian, and Louise Bordeleau, McMaster University, Hamilton; Mark N. Levine and Louise Bordeleau, Hamilton Health Sciences Juravinski Cancer Centre, Hamilton; Mark N. Levine and Jim A. Julian, Ontario Clinical Oncology Group and Escarpment Cancer Research Institute, Hamilton; Philippe L. Bedard, Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, University of Toronto, Toronto; Phillipe L. Bedard, Princess Margaret Hospital, Toronto; Andrea Eisen, Maureen E. Trudeau, and Kathleen I. Pritchard, Odette Sunnybrook Regional Cancer Centre; Toronto; and Brian Higgins, Peel Regional Cancer Centre, Mississauga, Ontario, Canada
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Dreyfus C, Ballester M, Gligorov J, Agranat P, Antoine M, Tengher I, Bricou A. [Impact of the 21-gene assay in decision-making during multidisciplinary breast meeting: A French experience]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:780-5. [PMID: 26584893 DOI: 10.1016/j.gyobfe.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 09/29/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The 21-gene assay (Oncotype DX(®)) test is used to estimate the risk of recurrence and to predict the benefit of adjuvant chemotherapy at an early stage of endocrine responsive breast cancers, without HER2 overexpression or amplification. This test corresponds to a recurrence score (RS), classifying patients into three groups (low, intermediate or high risk). The objective of this two-center prospective study is to define the impact of Oncotype DX(®) in clinical practice. METHODS Between August 2013 and May 2015, an Oncotype DX(®) test was decided in multidisciplinary meeting, to certain patients with an indication of adjuvant chemotherapy for HR+ and HER2 negative cancers. The therapeutic changes after knowledge of RS were collected. An estimate of the economic impact was performed and a correlation between the RS and usual breast cancer prognostic markers was investigated. RESULTS Thirty-nine patients had a test, twenty-six (66.7%) of them have finally been no indication retaining chemotherapy. The economy obtained through the use of the test was estimated around 173,000euros. It has not been demonstrated correlation between the RS, the usual decisional and prognostic factors for breast cancer or with adjuvant! Online. CONCLUSIONS The RS has an additional decision value compared to other common decision criteria. Use of Oncotype DX(®) reduced in our experience the indications of adjuvant chemotherapy. The medical and economic impact could be significant.
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Affiliation(s)
- C Dreyfus
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, AP-HP, Jean-Verdier, avenue du 14-Juillet, 93143 Bondy cedex, France
| | - M Ballester
- Service de gynécologie-obstétrique, Sorbonne université, AP-HP, Tenon, IUC-UPMC, Paris, France
| | - J Gligorov
- Service d'oncologie médicale, Sorbonne université, AP-HP, Tenon, IUC-UPMC, Paris, France
| | - P Agranat
- Service d'oncologie médicale, université Paris XIII-Bobigny, AP-HP, Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - M Antoine
- Laboratoire d'anatomopathologie, Sorbonne université, AP-HP, Tenon, IUC-UPMC, Paris, France
| | - I Tengher
- Laboratoire d'anatomopathologie, université Paris XIII-Bobigny, AP-HP, Jean-Verdier, avenue du 14-Juillet, 93143 Bondy cedex, France
| | - A Bricou
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, AP-HP, Jean-Verdier, avenue du 14-Juillet, 93143 Bondy cedex, France.
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Iwamoto T, Kelly C, Mizoo T, Nogami T, Motoki T, Shien T, Taira N, Hayashi N, Niikura N, Fujiwara T, Doihara H, Matsuoka J. Relative Prognostic and Predictive Value of Gene Signature and Histologic Grade in Estrogen Receptor-Positive, HER2-Negative Breast Cancer. Clin Breast Cancer 2015; 16:95-100.e1. [PMID: 26631838 DOI: 10.1016/j.clbc.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/28/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND In estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer, first-generation genomic signatures serve predominately as prognostic biomarkers and secondarily as predictors of response to chemotherapy. We compared both the prognostic and predictive value of histologic grades and genomic markers. METHODS We retrieved publicly available cDNA microarray data from 1373 primary ER(+)/HER2(-) breast cancers and developed a genomic signature simulated from Recurrence Online (http://www.recurrenceonline.com/) to calculate the recurrence score and risk using predefined sets of genes in the cDNA microarray. We then compared the prognostic and predictive information provided by histologic grade and genomic signature. RESULTS Based on genomic signatures, 55%, 28%, and 17% of breast cancers were classified as low, intermediate, and high risk, respectively, whereas the histologic grades were I, II, and III in 22%, 59%, and 19% of breast cancers, respectively. Univariate analysis in the untreated cohort revealed that both histologic grade (overall P = .007) and genomic signature (P < .001) could predict prognosis. Results were similar using the genomic signature, with pathologic complete response rates of 4.6%, 5.7%, and 16.5% for low-, intermediate-, and high-risk cancers, respectively. Neither biomarker was statistically significant in multivariate analysis for predictive response to neoadjuvant chemotherapy (NAC). CONCLUSION Genomic signature was better at identifying low-risk cases compared to histologic grade alone, but both markers had similar predictive values for NAC response. Better predictive biomarkers for NAC response are still needed.
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Affiliation(s)
| | | | | | | | | | | | | | - Naoki Hayashi
- Department of Breast Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Niikura
- Department of Breast and Endocrine Surgery, Tokai University Hospital, Kanagawa, Japan
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Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland. Breast Cancer Res Treat 2015; 153:573-82. [PMID: 26364296 DOI: 10.1007/s10549-015-3555-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/21/2015] [Indexed: 12/21/2022]
Abstract
The 21-gene test is a validated multi-gene diagnostic test that predicts chemotherapy (CT) benefit in oestrogen receptor positive (ER+), lymph node-negative (N0) breast cancer (BC) patients (pts). Ireland was the first public health care system to reimburse this test in Europe. Study objectives were to assess the impact of this test on decision-making and to analyse the economic impact of testing. Between October 2011 and February 2013, a national, retrospective, cross-sectional observational study of ER+, N0 BC pts tested with the 21-gene test was conducted. Surveyed breast medical oncologists, provided the assumption for the decision impact analysis that grade (G) 1 pts would not have received CT before testing and G2/3 pts would have received CT before testing. Descriptive statistical analyses were performed. 592 pts were identified; Low, intermediate and high recurrence score were identified in 53, 36 and 10 % pts, respectively. 384 (70 %) pts had G2, 129 (22 %) G3 and 76 (13 %) G1 tumours. Post testing, 345 pts (59 %) experienced a change in CT decision; 339 changed to hormone therapy alone and 6 advised to receive CT. 172 (30 %) pts received CT, 12 (3.9 %) of pts with low scores, 108 (50.9 %) of intermediate risk and 50 (90.9 %) of pts with high risk scores. Net reduction in CT use was 58 % and net savings achieved were €793,565. Since public reimbursement, the introduction of the 21-gene test has resulted in a significant reduction in chemotherapy administration and cost savings for the Irish public healthcare system.
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Potosky AL, O'Neill SC, Isaacs C, Tsai HT, Chao C, Liu C, Ekezue BF, Selvam N, Kessler LG, Zhou Y, Schwartz MD. Population-based study of the effect of gene expression profiling on adjuvant chemotherapy use in breast cancer patients under the age of 65 years. Cancer 2015; 121:4062-70. [PMID: 26291519 DOI: 10.1002/cncr.29621] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/23/2015] [Accepted: 07/10/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Gene expression profiling (GEP) testing can help to predict the risk of cancer recurrence and guide decisions about adjuvant chemotherapy for breast cancer (BC). However, no prior US studies have evaluated the relation between GEP testing and the use of adjuvant chemotherapy by women treated in a general oncology practice. METHODS Eligible patients were women under the age 65 of years who were newly diagnosed with their first stage I or II, hormone receptor-positive BC between 2006 and 2011 (n = 9405). This retrospective study was conducted with a data set consisting of registry data, health claims data, and GEP testing results. The distribution of GEP test results was reported in terms of the risk of recurrence predicted, and logistic regression was used to assess the association of test results with chemotherapy use, with adjustments made for multiple patient characteristics. RESULTS The proportions of tested women with low, intermediate, and high recurrence score results were 51%, 39%, and 10%, respectively. Among these women, 11%, 47%, and 88%, respectively, received adjuvant chemotherapy. There was a significant, positive linear relation of assay scores with chemotherapy use within the low and intermediate subgroups after adjustments for all other factors (adjusted odds ratios, 1.17 and 1.20, respectively). CONCLUSIONS Adjuvant chemotherapy use after GEP testing is generally consistent with the recommended test interpretation for women with a high or low predicted risk of recurrence. Chemotherapy use in the intermediate-risk group increased with Recurrence Score values, and evidence from ongoing randomized trials may help to clarify whether this finding reflects optimal interpretation of GEP test results. These results demonstrate the principle that genomic testing, on the basis of research establishing its utility, can be applied appropriately in general practice in accordance with guideline recommendations.
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Affiliation(s)
- Arnold L Potosky
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Huei-Ting Tsai
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Calvin Chao
- Genomic Health, Inc, Redwood City, California
| | | | | | | | - Larry G Kessler
- University of Washington School of Public Health, Seattle, Washington
| | - Yingjun Zhou
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Augustovski F, Soto N, Caporale J, Gonzalez L, Gibbons L, Ciapponi A. Decision-making impact on adjuvant chemotherapy allocation in early node-negative breast cancer with a 21-gene assay: systematic review and meta-analysis. Breast Cancer Res Treat 2015; 152:611-25. [PMID: 26126971 DOI: 10.1007/s10549-015-3483-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/18/2015] [Indexed: 01/10/2023]
Abstract
Risk stratification based on results provided by a 21-gene assay (Oncotype DX(®)) in early stage breast cancer can help optimize hormone therapy (HT) and/or chemotherapy (CT) decisions. We performed a systematic review and meta-analysis of decision impact (DI) and net change in CT use before and after assay results, both in the whole studies' population and by recurrence risk score (RS) strata. A systematic search of studies with prospective data collection reported physician's decision on treatment allocation in early stage node-negative breast cancer was performed. DI reflects the proportion of patients whose management was changed, and net change focuses on CT change. A random-effects model is reported. Fifteen studies (N = 2229) met our inclusion criteria: 50.09, 37.35, and 13.38 % of patients with low, intermediate, and high RS. Treatment decision changed in 29.5 % (95 % CI 26.29-32.86). Net reduction of CT use was 12 % (8-17 %). It was 16 % (12.00-19.00) in the low RS group, 0 % (-3.00 to 3.00) in the intermediate RS group, and increased by 2 % (-1.00 to 3.00) in the high RS group. Use of a 21-gene assay showed a significant impact on treatment decisions. From 100 women tested, 30 could have their treatment optimized, and 12 could avoid CT. Its main effects consist of sparing chemotherapy in low risk patients and slightly increasing it in the high risk category. DI could be higher in selected patient populations with greater uncertainty regarding initial treatment decisions.
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Affiliation(s)
- Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024 (1414), Ciudad Autónoma de Buenos Aires, Argentina,
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Alvarado M, Carter DL, Guenther JM, Hagans J, Lei RY, Leonard CE, Manders J, Sing AP, Broder MS, Cherepanov D, Chang E, Eagan M, Hsiao W, Schultz MJ. The impact of genomic testing on the recommendation for radiation therapy in patients with ductal carcinoma in situ: A prospective clinical utility assessment of the 12-gene DCIS score™ result. J Surg Oncol 2015; 111:935-40. [DOI: 10.1002/jso.23933] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/18/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - James Hagans
- The Surgical Center of Central Arkansas; Little Rock Arkansas
| | | | | | | | - Amy P. Sing
- Genomic Health, Inc.; Redwood City California
| | - Michael S. Broder
- Partnership for Health Analytic Research, LLC; Beverly Hills California
| | - Dasha Cherepanov
- Partnership for Health Analytic Research, LLC; Beverly Hills California
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC; Beverly Hills California
| | - Marianne Eagan
- Partnership for Health Analytic Research, LLC; Beverly Hills California
| | - Wendy Hsiao
- University of Southern California; Los Angeles California
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Bombard Y, Rozmovits L, Trudeau M, Leighl NB, Deal K, Marshall DA. The value of personalizing medicine: medical oncologists' views on gene expression profiling in breast cancer treatment. Oncologist 2015; 20:351-6. [PMID: 25746345 DOI: 10.1634/theoncologist.2014-0268] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/31/2014] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Guidelines recommend gene-expression profiling (GEP) tests to identify early-stage breast cancer patients who may benefit from chemotherapy. However, variation exists in oncologists' use of GEP. We explored medical oncologists' views of GEP tests and factors impacting its use in clinical practice. METHODS We used a qualitative design, comprising telephone interviews with medical oncologists (n = 14; 10 academic, 4 in the community) recruited through oncology clinics, professional advertisements, and referrals. Interviews were analyzed for anticipated and emergent themes using the constant comparative method including searches for disconfirming evidence. RESULTS Some oncologists considered GEP to be a tool that enhanced confidence in their established approach to risk assessments, whereas others described it as "critical" to resolving their uncertainty about whether to recommend chemotherapy. Some community oncologists also valued the test in interpreting what they considered variable practice and accuracy across pathology reports and testing facilities. However, concerns were also raised about GEP's cost, overuse, inappropriate use, and over-reliance on the results within the medical community. In addition, although many oncologists said it was simple to explain the test to patients, paradoxically, they remained uncertain about patients' understanding of the test results and their treatment implications. CONCLUSION Oncologists valued the test as a treatment-decision support tool despite their concerns about its cost, over-reliance, overuse, and inappropriate use by other oncologists, as well as patients' limited understanding of GEP. The results identify a need for decision aids to support patients' understanding and clinical practice guidelines to facilitate standardized use of the test.
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Affiliation(s)
- Yvonne Bombard
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Linda Rozmovits
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Trudeau
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Natasha B Leighl
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ken Deal
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Insititute of Health Policy, Management and Evaluation, Department of Medicine, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Independent Qualitative Researcher; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada; DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Issa AM, Chaudhari VS, Marchant GE. The value of multigene predictors of clinical outcome in breast cancer: an analysis of the evidence. Expert Rev Mol Diagn 2015; 15:277-86. [PMID: 25479414 PMCID: PMC4712951 DOI: 10.1586/14737159.2015.983476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Multigene predictors are being used increasingly in early-stage breast cancer patients for prediction and prognosis. However, one consequence of the increased use of multigene predictors, and the heightened efforts toward their incorporation into routine clinical practice, is the potential for future malpractice litigation. It is, therefore, important to ascertain the strength of the evidence for using the different commercially available multigene predictor assays clinically. We evaluated the literature for evidence of clinical validity of four currently available gene signatures and to assess the influence of the 21-gene-expression assay on changes in treatment recommendations. METHODS A systematic search of the peer-reviewed literature from January 2002 to March 2014 for multigene predictor assays was carried out, and a meta-analysis was conducted. RESULTS The adjusted Cox hazard ratio average for studies that met the eligibility criteria was 3.538 (95% CI: 1.513-8.469). The 21-gene signature showed the highest stability in the estimation of likelihood of distant risk of recurrence. Using the recurrence scores resulted in changes in treatment recommendations in 31.8% of all patients in the studies. CONCLUSION This study may provide insight about the use of multigene predictors in clinical practice for prediction and prognosis of breast cancer.
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Affiliation(s)
- Amalia M Issa
- Program in Personalized Medicine and Targeted Therapeutics, University of the Sciences, 600 South 43rd Street, Philadelphia, PA 19104, USA
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Patil D, Issa AM. Factors affecting the adoption and use of gene expression profiling by oncologists in clinical practice. Per Med 2015; 12:33-42. [PMID: 29767541 DOI: 10.2217/pme.14.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM In this study, we evaluated the association between oncologists' perceptions of and attitudes toward one frequently used gene expression profiling assays, the Oncotype DX® and oncologists' intention to use this assay in making treatment recommendations for breast cancer patients. METHODS A nationally representative sample of breast cancer oncologists was surveyed using an adapted technology acceptance model. RESULTS The survey response rate was 44.1%. The test characteristics `validity of the test' (p = 0.006) and 'use of Oncotype DX by fellow oncologists' (p = 0.0068) were significantly associated with use of the assay by oncologists. Oncologists' intention to use Oncotype DX increased consistently with their perceptions about its usefulness (β = 0.222). Insurance status of the patients was also significantly associated with physicians' use of Oncotype DX (p = 0.008). CONCLUSION We report a novel application of an adapted technology acceptance model to understand the adoption of gene expression profiling by oncologists who treat breast cancer patients in making treatment recommendations.
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Affiliation(s)
- Dhaval Patil
- Program in Personalized Medicine & Targeted Therapeutics, University of the Sciences, Philadelphia, PA 19104, USA
| | - Amalia M Issa
- Program in Personalized Medicine & Targeted Therapeutics, University of the Sciences, Philadelphia, PA 19104, USA.,Department of Health Policy & Public Health, University of the Sciences, Philadelphia, PA 19104, USA
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Marrone M, Stewart A, Dotson WD. Clinical utility of gene-expression profiling in women with early breast cancer: an overview of systematic reviews. Genet Med 2014; 17:519-32. [PMID: 25474343 DOI: 10.1038/gim.2014.140] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/02/2014] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This overview systematically evaluates the clinical utility of using Oncotype DX and MammaPrint gene-expression profiling tests to direct treatment decisions in women with breast cancer. The findings are intended to inform an updated recommendation from the Evaluation of Genomic Applications in Practice and Prevention Working Group. METHODS Evidence reported in systematic reviews evaluating the clinical utility of Oncotype DX and MammaPrint, as well as the ability to predict treatment outcomes, change in treatment decisions, and cost-effectiveness, was qualitatively synthesized. RESULTS Five systematic reviews found no direct evidence of clinical utility for either test. Indirect evidence showed Oncotype DX was able to predict treatment effects of adjuvant chemotherapy, whereas no evidence of predictive value was found for MammaPrint. Both tests influenced a change in treatment recommendations in 21 to 74% of participants. The cost-effectiveness of Oncotype DX varied with the alternative compared. For MammaPrint, lack of evidence of the predictive value led to uncertainty in the cost-effectiveness. CONCLUSION No studies were identified that provided direct evidence that using gene-expression profiling tests to direct treatment decisions improved outcomes in women with breast cancer. Three ongoing studies may provide direct evidence for determining the clinical utility of gene-expression profiling testing.
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Affiliation(s)
- Michael Marrone
- 1] McKing Consulting Corporation, Atlanta, Georgia, USA [2] Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Stewart
- 1] McKing Consulting Corporation, Atlanta, Georgia, USA [2] Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W David Dotson
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Sheppard VB, O'Neill SC, Dilawari A, Horton S, Hirpa FA, Isaacs C. Patterns of 21-gene assay testing and chemotherapy use in black and white breast cancer patients. Clin Breast Cancer 2014; 15:e83-92. [PMID: 25555816 DOI: 10.1016/j.clbc.2014.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/20/2014] [Accepted: 11/25/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND In women with early stage, hormone receptor (HR)-positive (HR(+)) breast cancer, the 21-gene recurrence score (RS) assay quantifies recurrence risk and predicts chemotherapy responsiveness. Recent data suggest that not all women with early-stage, HR(+) disease receive this testing. We examined sociodemographic, clinical, and attitudinal factors associated with RS testing receipt and the RS testing effect on chemotherapy use in black and white patients. PATIENTS AND METHODS Women with newly diagnosed invasive, nonmetastatic breast cancer were recruited and interviewed to collect sociocultural and health care process data; clinical data were collected from charts. Of the sample (n = 359), 270 had HR(+) disease. Primary analysis focused on those with HR(+) node-negative disease (n = 143); secondary analyses included node-positive women. Logistic regression models evaluated factors associated with receipt of RS testing and chemotherapy. RESULTS Among women eligible for the 21-gene assay, 62 patients [43%] received RS testing. In multivariable analysis, older age (odds ratio, 1.04 per 1 year increase; 95% confidence interval, 1.01-1.08) was associated with RS testing after adjustment for covariates. Chemotherapy use was 23%. In multivariable analysis, positive attitudes about chemotherapy and greater risk of recurrence were associated with chemotherapy use (P < .05). CONCLUSION Patterns of genomic testing might vary according to age. Efforts to understand factors associated with low testing rates will be important.
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Affiliation(s)
- Vanessa B Sheppard
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC.
| | - Suzanne C O'Neill
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Asma Dilawari
- Medstar Georgetown University Hospital, Washington, DC
| | - Sara Horton
- Department of Oncology, Howard University Hospital, Washington, DC
| | - Fikru A Hirpa
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Claudine Isaacs
- Breast Cancer Program, Lombardi Comprehensive Cancer Center and Departments of Oncology and Medicine, Georgetown University School of Medicine, Medstar Georgetown University Hospital, Washington, DC
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Bargallo JE, Lara F, Shaw‐Dulin R, Perez‐Sánchez V, Villarreal‐Garza C, Maldonado‐Martinez H, Mohar‐Betancourt A, Yoshizawa C, Burke E, Decker T, Chao C. A study of the impact of the 21‐gene breast cancer assay on the use of adjuvant chemotherapy in women with breast cancer in a Mexican public hospital. J Surg Oncol 2014; 111:203-7. [DOI: 10.1002/jso.23794] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 08/28/2014] [Indexed: 11/07/2022]
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Zanotti L, Bottini A, Rossi C, Generali D, Cappelletti MR. Diagnostic tests based on gene expression profile in breast cancer: from background to clinical use. Tumour Biol 2014; 35:8461-70. [DOI: 10.1007/s13277-014-2366-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/15/2014] [Indexed: 12/17/2022] Open
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Jain S, Gradishar WJ. The application of Oncotype DX in early-stage lymph-node-positive disease. Curr Oncol Rep 2014; 16:360. [PMID: 24442572 DOI: 10.1007/s11912-013-0360-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The recurrence score derived from the 21-gene Oncotype DX assay is both prognostic and predictive of adjuvant chemotherapy benefit in node-negative, estrogen-receptor-positive breast cancer patients treated with tamoxifen. This has led to a remarkable shift in the treatment paradigm, with a sizeable number of patients being able to avoid adjuvant chemotherapy. The recurrence score was then analyzed in a large retrospective study with node-positive, estrogen-receptor-positive patients, in which it demonstrated both prognostic and predictive abilities. This review introduces the clinical trials that validated the Oncotype DX assay in the node-negative population, highlights the studies evaluating the utility of the assay in node-positive patients, examines the impact of the assay results on treatment decisions, and discusses the health outcomes and health care expenditures associated with this assay.
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Affiliation(s)
- Sarika Jain
- Division of Hematology/Oncology, Department of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 676 N. St Clair, Suite 850, Chicago, IL, 60611, USA
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Abu-Khalf M, Pusztai L. Influence of genomics on adjuvant treatments for pre-invasive and invasive breast cancer. Breast 2014; 22 Suppl 2:S83-7. [PMID: 24074799 DOI: 10.1016/j.breast.2013.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION AND AIM Tribute to the improved quality of tumor marker studies all major national and international practice guidelines now recognized the potential clinical value of multivariate genomic prognostic tests. There are several diagnostic companies that offer these products for clinical use. This paper reviews recent trends in genomic prognostic testing in the clinic and briefly discusses future trends. METHODS AND RESULTS Published manuscripts on breast cancer biomarkers, genomic prognostic and predictive tests were reviewed along with abstracts and proceedings of major conferences to extract information on the clinical utility, cost-effectiveness and usage of molecular tests in the management of early stage breast cancers. Genomic test use has steadily increased over the past 5 years, approximately 30%, 13% and 1% of stage I, II and III ER-positive breast cancer breast cancers are tested. Among those who are tested, approximately, 25-30% of the time treatment recommendations change due to test results. Testing is associated with decreased use of chemotherapy overall, however in clinically low risk patients who are tested tend to receive chemotherapy more frequently than low risk patients who are untested. Almost all cost-effectiveness studies concluded that genomic testing is cost effective under a broad range of assumptions when used within current guidelines. Simple immunohistochemistry based assays when performed following a standard operating procedure and combined into a multivariate prognostic model, have the potential to substitute for genomic tests in the future. DISCUSSION AND CONCLUSIONS Genomic testing, when available, is widely used to assist in adjuvant chemotherapy treatment recommendations for clinically intermediate risk (e.g. grade 2, stage I-II) ER-positive breast cancers.
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Affiliation(s)
- Maysa Abu-Khalf
- Yale University School of Medicine, Yale Cancer Center, Section of Breast Medical Oncology, 333 Cedar St, PO Box 208032, New Haven, CT 06520-8032, USA.
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Miller FA, Hayeems RZ, Bytautas JP, Bedard PL, Ernst S, Hirte H, Hotte S, Oza A, Razak A, Welch S, Winquist E, Dancey J, Siu LL. Testing personalized medicine: patient and physician expectations of next-generation genomic sequencing in late-stage cancer care. Eur J Hum Genet 2014; 22:391-5. [PMID: 23860039 PMCID: PMC3925281 DOI: 10.1038/ejhg.2013.158] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/07/2013] [Accepted: 06/21/2013] [Indexed: 11/08/2022] Open
Abstract
Developments in genomics, including next-generation sequencing technologies, are expected to enable a more personalized approach to clinical care, with improved risk stratification and treatment selection. In oncology, personalized medicine is particularly advanced and increasingly used to identify oncogenic variants in tumor tissue that predict responsiveness to specific drugs. Yet, the translational research needed to validate these technologies will be conducted in patients with late-stage cancer and is expected to produce results of variable clinical significance and incidentally identify genetic risks. To explore the experiential context in which much of personalized cancer care will be developed and evaluated, we conducted a qualitative interview study alongside a pilot feasibility study of targeted DNA sequencing of metastatic tumor biopsies in adult patients with advanced solid malignancies. We recruited 29/73 patients and 14/17 physicians; transcripts from semi-structured interviews were analyzed for thematic patterns using an interpretive descriptive approach. Patient hopes of benefit from research participation were enhanced by the promise of novel and targeted treatment but challenged by non-findings or by limited access to relevant trials. Family obligations informed a willingness to receive genetic information, which was perceived as burdensome given disease stage or as inconsequential given faced challenges. Physicians were optimistic about long-term potential but conservative about immediate benefits and mindful of elevated patient expectations; consent and counseling processes were expected to mitigate challenges from incidental findings. These findings suggest the need for information and decision tools to support physicians in communicating realistic prospects of benefit, and for cautious approaches to the generation of incidental genetic information.
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Affiliation(s)
- Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Robin Z Hayeems
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jessica P Bytautas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Philippe L Bedard
- Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
| | - Scott Ernst
- London Health Sciences Centre, London, ON, Canada
| | - Hal Hirte
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Amit Oza
- Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
| | - Albiruni Razak
- Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
| | | | | | - Janet Dancey
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
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Treatment decisions in estrogen receptor-positive early breast cancer patients with intermediate oncotype DX recurrence score results. SPRINGERPLUS 2014; 3:71. [PMID: 24567880 PMCID: PMC3925494 DOI: 10.1186/2193-1801-3-71] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/26/2022]
Abstract
This retrospective study evaluated the impact of intermediate Recurrence Score® results on adjuvant treatment decisions in estrogen receptor-positive (ER+) early invasive breast cancer, comparing treatment recommendations pre-testing with actual treatments received post-testing. Of the 111 patients included in the analysis, 78 (70.3%) had hormonal therapy (HT) and 33 (29.7%) had chemohormonal therapy (CHT) recommendations pre-testing. The Recurrence Score was significantly higher in those with a pre-testing CHT recommendation compared with those with a pre-testing HT recommendation (median of 24 vs. 22; P = 0.047; Mann–Whitney–Wilcoxon [MWW] test). Post-testing, treatment of 24 patients (21.6%) was different from their pre-testing recommendation. The difference between CHT recommendation rate pre-testing and the rate of CHT received post-testing was nonsignificant for the entire cohort and for patients’ subgroups (by age, tumor size, and grade) (P >0.17; McNemar’s test). Following classification of the cohort into two Recurrence Score subcategories (low-intermediate, [18-25]; high-intermediate, [26-30]), changes in treatment decisions (pre-testing recommendations vs. actual treatments received post testing) were reported for 16.5% of low-intermediate and 34.4% of high-intermediate patients. Post-testing, the rate of CHT decreased (by 58%) in the low-intermediate subcategory and increased (by 64%) in the high-intermediate subcategory (P <0.01, both subcategories). In logistic regression analyses, the Recurrence Score subcategory was the only significant predictor of changes in treatment decisions (pre-testing recommendations vs. actual treatments received post testing; P <0.01). The only significant difference between the two subsets of patients with such a change (HT to CHT, 11 patients; CHT to HT, 13 patients) was the Recurrence Score (median of 28 vs. 20, respectively; P = 0.0014; MWW test). These findings demonstrate that intermediate Recurrence Score results provide clinically relevant information and impact treatment decisions in ER + early breast cancer.
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Lamond NWD, Skedgel C, Younis T. Is the 21-gene recurrence score a cost-effective assay in endocrine-sensitive node-negative breast cancer? Expert Rev Pharmacoecon Outcomes Res 2014; 13:243-50. [DOI: 10.1586/erp.13.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Toole MJ, Kidwell KM, Van Poznak C. Oncotype dx results in multiple primary breast cancers. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2014; 8:1-6. [PMID: 24453493 PMCID: PMC3891573 DOI: 10.4137/bcbcr.s13727] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/12/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine whether multiple primary breast cancers have similar genetic profiles, specifically Oncotype Dx Recurrence Scores, and whether obtaining Oncotype Dx on each primary breast cancer affects chemotherapy recommendations. METHODS A database of patients with hormone receptor-positive, lymph node-negative, breast cancer was created for those tumors that were sent for Oncotype Dx testing from the University of Michigan Health System from 1/24/2005 to 2/25/2013. Retrospective chart review abstracted details of tumor location, histopathology, distance between tumors, Oncotype Dx results, and chemotherapy recommendations. RESULTS Six hundred and sixty-six patients for whom Oncotype Dx testing was sent were identified, with 22 patients having multiple breast tumor specimens sent. Of the 22 patients who had multiple samples sent for analysis, chemotherapy recommendations were changed in 6 of 22 patients (27%) based on significant differences in Oncotype Dx Recurrence Scores. Qualitatively, there seems to be a greater difference in genetic profile in tumors appearing simultaneously on different breasts when compared to multiple tumors on the same breast. There was no association between distance between tumors and difference in Oncotype Dx scores for tumors on the same breast. CONCLUSIONS Oncotype Dx testing on multiple primary breast cancers altered management in regards to chemotherapy recommendations and should be considered for multiple primary breast cancers.
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Affiliation(s)
- Michael J Toole
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Catherine Van Poznak
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI. ; Division of Hematology Oncology, University of Michigan, Ann Arbor, MI
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DeFrank JT, Carey LA, Brewer NT. Understanding how breast cancer patients use risk information from genomic tests. J Behav Med 2013; 36:567-73. [PMID: 22878783 PMCID: PMC3535460 DOI: 10.1007/s10865-012-9449-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
We sought to examine how patients' treatment decisions incorporate potentially conflicting information from standard clinical indicators (e.g., tumor size) and genomic tests for breast cancer recurrence risk. Participants were 77 early stage breast cancer survivors who previously received genomic testing. They read six hypothetical vignettes that varied recurrence risk indicated by standard tests (low or high risk) coupled with the genomic test (low, intermediate or high risk). For each vignette, women reported their perceived recurrence risk and treatment preferences. Test results indicating high recurrence risk increased perception of risk and preference for chemotherapy (p < .001 for all). Perceived risk explained (i.e., mediated) the effect of test results on chemotherapy preferences. When test results conflicted, women gave more weight to genomic over standard test results. Hypothetical genomic test results had the intended effect of influencing women's perceptions of recurrence risk and interest in chemotherapy.
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Affiliation(s)
- Jessica T DeFrank
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC, 27599-7440, USA,
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The impact of the Oncotype Dx breast cancer assay in clinical practice: a systematic review and meta-analysis. Breast Cancer Res Treat 2013; 141:13-22. [PMID: 23974828 DOI: 10.1007/s10549-013-2666-z] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/09/2013] [Indexed: 12/20/2022]
Abstract
The impact of the Oncotype Dx (ODX) breast cancer assay on adjuvant chemotherapy (ACT) treatment decisions has been evaluated in many previous studies. However, it can be difficult to interpret the collective findings, which were conducted in diverse settings with limited sample sizes. We conducted a systematic review and meta-analysis to synthesize the results and provide insights about ODX utility. Studies, identified from PubMed, Embase, ASCO, and SABCS, were included if patients had ER+, node -, early-stage breast cancer, reported use of ODX to inform actual ACT decisions. Information was summarized and pooled according to: (1) distribution of ODX recurrence scores (RS), (2) impact of ODX on ACT recommendations, (3) impact of ODX on ACT use, and (4) proportion of patients following the treatment suggested by the ODX RS. A total of 23 studies met inclusion criteria. The distribution of RS categories was 48.8 % low, 39.0 % intermediate, and 12.2 % high (21 studies, 4,156 patients). ODX changed the clinical-pathological ACT recommendation in 33.4 % of patients (8 studies, 1,437 patients). In patients receiving ODX, receipt of ACT were: 28.2 % overall, 5.8 % low, 37.4 % intermediate, and 83.4 % high. Low RS patients were significantly more likely to follow the treatment suggested by ODX versus high RS patients RR: 1.07 (1.01–1.14) [corrected].The pooled results are consistent with most individual studies to date. The increased proportion of intermediate scores relative to original estimates may have implications for the clinical utility and cost impacts of testing. In addition, low versus high RS patients were significantly more likely to follow the ODX results, suggesting a tendency toward less aggressive treatment, despite a high ODX RS. Finally, there was a lack of studies on the impact of ODX on ACT use versus standard approaches, suggesting that additional studies are warranted.
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Paulden M, Franek J, Pham B, Bedard PL, Trudeau M, Krahn M. Cost-effectiveness of the 21-gene assay for guiding adjuvant chemotherapy decisions in early breast cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:729-739. [PMID: 23947965 DOI: 10.1016/j.jval.2013.03.1625] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Adjuvant chemotherapy decisions in early breast cancer are complex. The 21-gene assay can potentially aid such decisions, but costs US $4175 per patient. Adjuvant! Online is a freely available decision aid. We evaluate the cost-effectiveness of using the 21-gene assay in conjunction with Adjuvant! Online, and of providing adjuvant chemotherapy conditional upon risk classification. METHODS A probabilistic Markov decision model simulated risk classification, treatment, and the natural history of breast cancer in a hypothetical cohort of 50-year-old women with lymph node-negative, estrogen receptor- and/or progesterone receptor-positive, human epidermal growth factor receptor 2/neu-negative early breast cancer. Cost-effectiveness was considered from an Ontario public-payer perspective by deriving the lifetime incremental cost (2012 Canadian dollars) per quality-adjusted life-year (QALY) for each strategy, and the probability each strategy is cost-effective, assuming a willingness-to-pay of $50,000 per QALY. RESULTS The 21-gene assay has an incremental cost per QALY in patients at low, intermediate, or high Adjuvant Online! risk of $22,440 (probability cost-effective 78.46%), $2,526 (99.40%), or $1,111 (99.82%), respectively. In patients at low (high) 21-gene assay risk, adjuvant chemotherapy increases (reduces) costs and worsens (improves) health outcomes. For patients at intermediate 21-gene assay risk and low, intermediate, or high Adjuvant! Online risk, chemotherapy has an incremental cost per QALY of $44,088 (50.59%), $1,776 (77.65%), or $1,778 (82.31%), respectively. CONCLUSIONS The 21-gene assay appears cost-effective, regardless of Adjuvant! Online risk. Adjuvant chemotherapy appears cost-effective for patients at intermediate or high 21-gene assay risk, although this finding is uncertain in patients at intermediate 21-gene assay and low Adjuvant! Online risk.
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Affiliation(s)
- Mike Paulden
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada.
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Chen C, Dhanda R, Tseng WY, Forsyth M, Patt DA. Evaluating use characteristics for the oncotype dx 21-gene recurrence score and concordance with chemotherapy use in early-stage breast cancer. J Oncol Pract 2013; 9:182-7. [PMID: 23942918 PMCID: PMC3710166 DOI: 10.1200/jop.2012.000638] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Oncotype Dx 21-gene assay recurrence score (RS) predicts recurrence of early-stage breast cancer (ESBC). We investigated whether patient, tumor, or practice characteristics drive its use and explored Oncotype DX RS and chemotherapy use in subgroups. METHODS Patients with ESBC with documented estrogen receptor-positive, lymph node-negative, human epidermal growth factor receptor 2-negative tumors registered within McKesson Specialty Health's iKnowMed electronic health record were included. Patient and practice characteristics by region and size were analyzed. The association between Oncotype DX RS value and use of chemotherapy were assessed. RESULTS The study included 6,229 patients. Of these, 1,822 (29%) had an Oncotype DX RS result. Test use was 36%, 38%, 34%, 25%, and 6%, respectively, in patients age ≤ 45, 46-55, 56-65, 66-75, and ≥ 76 years; 33%, 25%, and 9% in patients with Eastern Cooperative Oncology Group performance status of 0, 1, and ≥ 2; 7%, 9%, 25%, 38%, 27%, and 10% in T1mic, T1a, T1b, T1c, T2, and T3 tumors; and 26%, 32%, and 33% for grades 1, 2, and 3 tumors. Of the 1,822 patients with available Oncotype DX RS, adjuvant chemotherapy use was 6%, 42%, and 84% in the low-, intermediate-, and high-risk groups. CONCLUSION Patients who were younger, had better ECOG performance status, or had higher grade tumors were more likely to undergo RS testing. It appears that the RS test may have influenced the decision about whether to administer adjuvant chemotherapy: a low RS score was associated with lower chemotherapy use and a high RS score was associated with higher chemotherapy use.
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Affiliation(s)
- Clara Chen
- McKesson Specialty Health, The Woodlands; Texas Oncology, Austin, TX; and Rocky Mountain Cancer Center, Greenwood Village, CO
| | - Rahul Dhanda
- McKesson Specialty Health, The Woodlands; Texas Oncology, Austin, TX; and Rocky Mountain Cancer Center, Greenwood Village, CO
| | - Wan-Yu Tseng
- McKesson Specialty Health, The Woodlands; Texas Oncology, Austin, TX; and Rocky Mountain Cancer Center, Greenwood Village, CO
| | - Michael Forsyth
- McKesson Specialty Health, The Woodlands; Texas Oncology, Austin, TX; and Rocky Mountain Cancer Center, Greenwood Village, CO
| | - Debra A. Patt
- McKesson Specialty Health, The Woodlands; Texas Oncology, Austin, TX; and Rocky Mountain Cancer Center, Greenwood Village, CO
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Biroschak JR, Schwartz GF, Palazzo JP, Toll AD, Brill KL, Jaslow RJ, Lee SY. Impact of Oncotype DX on Treatment Decisions in ER-Positive, Node-Negative Breast Cancer with Histologic Correlation. Breast J 2013; 19:269-75. [DOI: 10.1111/tbj.12099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Julianne R. Biroschak
- Department of Obstetrics and Gynecology; The George Washington University Hospital; Washington; District of Columbia
| | - Gordon F. Schwartz
- Department of Surgery; Thomas Jefferson University Hospital; Philadelphia; Pennsylvania
| | - Juan P. Palazzo
- Department of Pathology; Anatomy, and Cell Biology; Thomas Jefferson University Hospital; Philadelphia; Pennsylvania
| | - Adam D. Toll
- Department of Pathology, Johns Hopkins; Baltimore; MD
| | - Kristin L. Brill
- Department of Surgery; Cooper University Hospital; Voorhees; New Jersey
| | - Rebecca J. Jaslow
- Department of Medical Oncology; Thomas Jefferson University Hospital; Philadelphia; Pennsylvania
| | - Sun Yong Lee
- Department of Surgery; Aria Health System; Philadelphia; Pennsylvania
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Reed SD, Dinan MA, Schulman KA, Lyman GH. Cost-effectiveness of the 21-gene recurrence score assay in the context of multifactorial decision making to guide chemotherapy for early-stage breast cancer. Genet Med 2013; 15:203-11. [PMID: 22975761 PMCID: PMC3743447 DOI: 10.1038/gim.2012.119] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE New evidence is available regarding the utility of the 21-gene recurrence score assay in guiding chemotherapy use for node-negative, estrogen receptor-positive breast cancer. We applied this evidence in a decision-analytic model to re-evaluate the cost-effectiveness of the assay. METHODS We cross-classified patients by clinicopathologic characteristics from the Adjuvant! risk index and by recurrence score risk group. For non-recurrence score-guided treatment, we assumed patients receiving hormonal therapy alone had low-risk characteristics and patients receiving chemotherapy and hormonal therapy had higher-risk characteristics. For recurrence score-guided treatment, we assigned chemotherapy probabilities conditional on recurrence score risk group and clinicopathologic characteristics. RESULTS An estimated 40.4% of patients in the recurrence score-guided strategy and 47.3% in the non-recurrence score-guided strategy were expected to receive chemotherapy. The incremental gain in quality-adjusted life-years was 0.16 (95% confidence interval, 0.08-0.28) with the recurrence score-guided strategy. Lifetime medical costs to the health system were $2,692 ($1,546-$3,821) higher with the recurrence score-guided strategy, for an incremental cost-effectiveness ratio of $16,677/quality-adjusted life-year ($7,613-$37,219). From a societal perspective, the incremental cost-effectiveness was $10,788/quality-adjusted life-year ($6,840-$30,265). CONCLUSION The findings provide supportive evidence for the economic value of the 21-gene recurrence score assay in node-negative, estrogen receptor-positive breast cancer.
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Affiliation(s)
- Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
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