Chemotherapy Costs and 21-Gene Recurrence Score Genomic Testing Among Medicare Beneficiaries With Early-Stage Breast Cancer, 2005 to 2011

Dinan, Michaela A.; Wilson, Lauren; Reed, Shelby D.

doi:10.6004/jnccn.2018.7097

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…Literature reported that only a quarter to a third of the eligible patients in the United States had this assay performed [7,12], and in developing countries, certain controversy remained regarding the applicability of this testing [13]. On another hand, cost-effectiveness analysis demonstrated that the 21-gene RS testing was only associated with lower cost in patients with clinical high-risk [14,15]. Thus, a surrogate for the 21-gene RS testing is needed for those who have no access to this assay, as well as to relieve the heavy financial burden of patients for whom the testing is not cost-efficient [16].…”

Section: Discussionmentioning

confidence: 99%

A nomogram to predict the high-risk RS in HR+/HER2-breast cancer patients older than 50 years of age

Huang

et al. 2021

J Transl Med

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Background The 21-gene recurrence score (RS) testing can predict the prognosis for luminal breast cancer patients. Meanwhile, patients > 50 years with RS > 25 have improved survival with adjuvant chemotherapy. The current study aimed to develop a nomogram with routine parameters to predict RS. Methods We included patients diagnosed with hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER2)-negative who underwent the 21-gene RS testing and aged > 50 years. The primary outcome was high-risk RS (> 25). Univariate and multivariate analyses were performed to identify significant predictors. A predictive nomogram based on logistic model was developed and evaluated with receiver operating characteristic (ROC) curves. The nomogram was internally validated for discrimination and calibration with bootstrapping method, and externally validated in another cohort. We then assessed the nomogram in different subgroups of patients and compared it with several published models. Results A total of 1100 patients were included. Five clinicopathological parameters were used as predictors of a high-risk RS, including tumor grade, histologic subtype, ER expression, PR expression, and Ki-67 index. The area under the curve (AUC) was 0.798 (95% CI 0.772–0.825) and optimism adjusted AUC was 0.794 (95% CI 0.781–0.822). External validation demonstrated an AUC value of 0.746 (95% CI 0.685–0.807), which had no significant difference with the training cohort (P = 0.124). Calibration plots indicated that the nomogram-predicted results were well fitted to the actual outcomes in both internal and external validation. The nomogram had better discriminate ability in patients who had tumors > 2 cm (AUC = 0.847, 95% CI 0.804–0.890). When compared with four other existing models, similar AUC was observed between our nomogram and the model constructed by discriminate Lee et al. Conclusions We developed a user-friendly nomogram to predict the high-risk RS in luminal breast cancer patients who were older than 50 years of age, which could guide treatment decision making for those who have no access to the 21-gene RS testing.

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Section: Discussionmentioning

confidence: 99%

A nomogram to predict the high-risk RS in HR+/HER2-breast cancer patients older than 50 years of age

Huang

et al. 2021

J Transl Med

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show abstract

“…Literature reported that only a quarter to a third of the eligible patients in the United States had this assay performed (7,12), and in developing countries, certain controversy remained regarding the applicability of this testing (13). On another hand, cost-effectiveness analysis demonstrated that the 21-gene RS testing was only associated with lower cost in patients with clinical high-risk (14,15). Thus, a surrogate for the 21-gene RS testing is needed for those who have no access to this assay, as well as to relieve the heavy nancial burden of patients for whom the testing is not cost-e cient (16).…”

Section: Discussionmentioning

confidence: 99%

A nomogram to predict the high-risk RS in HR+/HER2-breast cancer patients older than 50 years of age

Huang

et al. 2020

Preprint

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Background: The 21-gene recurrence score (RS) testing can predict the prognosis for luminal breast cancer patients. Meanwhile, patients >50 years with RS >25 have improved survival with adjuvant chemotherapy. The current study aimed to develop a nomogram with routine parameters to predict RS.Methods: We included patients diagnosed with hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER2)-negative who underwent the 21-gene RS testing and aged >50 years. The primary outcome was high-risk RS (>25). Univariate and multivariate analyses were performed to identify significant predictors. A predictive nomogram based on logistic model was developed and evaluated with receiver operating characteristic (ROC) curves. The nomogram was internally validated for discrimination and calibration with bootstrapping method. We then assessed the nomogram in different subgroups of patients and compared it with several published models.Results: A total of 1100 patients were included. Five clinicopathological parameters were used as predictors of a high-risk RS, including tumor grade, histologic subtype, ER expression, PR expression, and Ki-67 index. The area under the curve (AUC) was 0.798 (95% CI 0.772-0.825) and optimism adjusted AUC was 0.794 (95% CI, 0.781-0.822). Calibration plots indicated that the nomogram-predicted results were well fitted to the actual outcomes. The nomogram had better discriminate ability in patients who had tumors >2cm (AUC=0.847, 95% CI 0.804-0.890). When compared with four other existing models, similar AUC was observed between our nomogram and the model constructed by discriminate Lee et al.Conclusions: We developed a user-friendly nomogram to predict the high-risk RS in luminal breast cancer patients who were older than 50 years of age, which could guide treatment decision making for those who have no access to the 21-gene RS testing.

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“…Indeed, 21-gene assay can guide treatment-related decision for patients with breast cancer. [21][22][23] St. Gallen International Expert Consensus also has great benefits for treatment-related decision in patients with cancer. 24 Our study confirmed these advantages for treatment-related decision in patients with early-stage invasive breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…7 Total RNA was extracted from breast cancer samples and RT-PCR was performed. Ct value in 21 endocrine therapy only or chemoendocrine therapy, as these patients did not benefit from chemotherapy alone. In contrast, patients with high RS received chemoendocrine therapy.…”

Section: Introductionmentioning

confidence: 85%

Comparison of 21-gene assay and St.Gallen International Expert Consensus in the treatment decision for patients with early invasive breast cancers

Luo

et al. 2019

Cancer Biology & Therapy

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This study aimed to evaluate the impacts of 21-gene recurrence score (RS) and St. Gallen International Expert Consensus on treatment decision and prognosis of patients with invasive breast cancer. We retrospectively analyzed the therapy protocol and outcome of 134 cases based on age, body mass index (BMI), menopause, pathological types, tumor-node-metastasis (TNM) stages, percentage of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), Ki-67, molecular subtype, and tumor biomarkers. RS was calculated based on 21-gene assay following traditional (old RS cutoff) and updated (new RS cutoff) National Comprehensive Cancer Network (NCCN) guideline. In addition, we also compared treatment protocol of NCCN guidelines with St. Gallen International Expert Consensus. The results showed that BMI, PR, Ki-67, and molecular subtype are critical for the evaluation of risk factors. Based on the new cutoff, low, middle, and high RS were 18%, 66%, and 16%, respectively. In contrast, based on the old cutoff, low, middle, and high RS were 60%, 29%, and 11%, respectively. The agreement rate of NCCN guidelines and St. Gallen International Expert Consensus for adjuvant treatment was 50. However, there is minimal agreement (0.151, 0.071) in kappa coefficient of old and new cutoff. This study revealed that the combination of NCCN guidelines and St. Gallen International Expert Consensus might improve the benefits of adjuvant treatment in patients with early invasive breast cancer.

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Chemotherapy Costs and 21-Gene Recurrence Score Genomic Testing Among Medicare Beneficiaries With Early-Stage Breast Cancer, 2005 to 2011

Cited by 10 publications

References 19 publications

A nomogram to predict the high-risk RS in HR+/HER2-breast cancer patients older than 50 years of age

A nomogram to predict the high-risk RS in HR+/HER2-breast cancer patients older than 50 years of age

A nomogram to predict the high-risk RS in HR+/HER2-breast cancer patients older than 50 years of age

Comparison of 21-gene assay and St.Gallen International Expert Consensus in the treatment decision for patients with early invasive breast cancers

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