Does oncotype DX recurrence score affect the management of patients with early-stage breast cancer?

Asad, Juhi; Jacobson, Allyson F.; Estabrook, Alison; Smith, Sharon R.; Boolbol, Susan K.; Feldman, Sheldon; Osborne, Michael P.; Boachie‐Adjei, Kwadwo; Twardzik, Wendy; Tartter, Paul Ian

doi:10.1016/j.amjsurg.2008.06.021

Cited by 118 publications

(91 citation statements)

References 5 publications

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“…Several other studies have similarly determined RS changes adjuvant treatment recommendations by 18%-44% [25][26][27][28][29]. Moreover, the most common change in recommendations was from chemotherapy plus hormonal therapy to hormonal therapy alone.…”

Section: Discussionmentioning

confidence: 94%

The Effect of Oncotype DX Recurrence Score on Treatment Recommendations for Patients with Estrogen Receptor–Positive Early Stage Breast Cancer and Correlation with Estimation of Recurrence Risk by Breast Cancer Specialists

et al. 2011

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Purpose. The Oncotype DX assay predicts likelihood of distant recurrence and improves patient selection for adjuvant chemotherapy in estrogen receptor-positive (ER-positive) early stage breast cancer. This study has two primary endpoints: to evaluate the impact of Oncotype DX recurrence scores (RS) on chemotherapy recommendations and to compare the estimated recurrence risk predicted by breast oncology specialists to RS.Methods. One hundred fifty-four patients with ERpositive early stage breast cancer and available RS results were selected. Clinicopathologic data were provided to four surgeons, four medical oncologists, and four pathologists. Participants were asked to estimate recurrence risk category and offer their chemotherapy recommendations initially without and later with knowledge of RS results. The three most important clinicopathologic features guiding their recommendations were requested.Results. Ninety-five (61.7%), 45 (29.2%), and 14 (9.1%) tumors were low, intermediate, and high risk by RS, respectively. RS significantly correlated with tumor grade, mitotic activity, lymphovascular invasion, hormone receptor, and HER2/neu status. Estimated recurrence risk by participants agreed with RS in 54.2% ؎ 2.3% of cases. Without and with knowledge of RS, 82.3% ؎ 1.3% and 69.0% ؎ 6.9% of patients may be overtreated, respectively (p ‫؍‬ 0.0322). Inclusion of RS data resulted in a 24.9% change in treatment recommendations. There was no significant difference in recommendations between groups of participants.Conclusions. Breast oncology specialists tended to overestimate the risk of tumor recurrence compared with RS.

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Section: Discussionmentioning

confidence: 94%

The Effect of Oncotype DX Recurrence Score on Treatment Recommendations for Patients with Estrogen Receptor–Positive Early Stage Breast Cancer and Correlation with Estimation of Recurrence Risk by Breast Cancer Specialists

et al. 2011

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“…Several studies have demonstrated that gep results are an important factor in the treatment recommendations made by oncologists [18][19][20][21] . Studies also indicate that patients are interested in receiving gep tests and that, in surveys posing hypothetical questions, gep results would affect patient treatment preferences to a greater extent than do standard recurrence measures.…”

Section: Discussionmentioning

confidence: 99%

Patients’ Perceptions of Gene Expression Profiling in Breast Cancer Treatment Decisions

et al. 2014

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“…For example, higher Oncotype DX s recurrence scores have been shown to correlate with high grade, PR negativity, and HER2 positivity. 8,16,17,30 Furthermore, an immunohistochemical panel of ER, PR, HER2, and Ki67 in conjunction with standard clinicopathological parameters (IHC4 score) has been shown to provide similar prognostic information to the recurrence score in hormone receptor-positive patients treated with endocrine therapy. 31 Integration of such an immunohistochemical panel into routine practice would merely require the addition of Ki67 to the pathologist's workload.…”

Section: Lp Feeley Et Almentioning

confidence: 99%

Distinguishing luminal breast cancer subtypes by Ki67, progesterone receptor or TP53 status provides prognostic information

et al. 2014

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The objectives of this study were to determine the prognostic significance of subgrouping estrogen receptor (ER)-positive breast tumors into low-and high-risk luminal categories using Ki67 index, TP53, or progesterone receptor (PR) status. The study group comprised 540 patients with lymph node negative, invasive breast carcinoma. Luminal A subtype was defined as being ER positive, HER2 negative, and Ki67 low (o14% cells positive) and luminal B subtype as being ER positive, HER2 negative, and Ki67 high (Z14% cells positive). Luminal tumors were also subgrouped into risk categories based on the PR and TP53 status. Survival analysis was performed. Patients with luminal B tumors (n ¼ 173) had significantly worse disease-free survival compared to those with luminal A tumors (n ¼ 186) (log rank P-value ¼ 0.0164; univariate Cox regression relative risk 2.00; 95% CI, 1.12-3.58; P ¼ 0.0187). Luminal subtype remained an independent prognostic indicator on multivariate analysis including traditional prognostic factors (relative risk 2.12; 95% CI, 1.16-3.88; P ¼ 0.0151). Using TP53 status or PR negativity rather than Ki67 to classify ER-positive luminal tumors gave similar outcome results to those obtained using the proliferation index. However, it was a combination of the three markers, which proved the most powerful prognostically. Ki67 index, TP53 status, or PR negativity can be used to segregate ERpositive, HER2-negative tumors into prognostically meaningful subgroups with significantly different clinical outcomes. These biomarkers particularly in combination may potentially be used clinically to guide patient management.

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Does oncotype DX recurrence score affect the management of patients with early-stage breast cancer?

Cited by 118 publications

References 5 publications

The Effect of Oncotype DX Recurrence Score on Treatment Recommendations for Patients with Estrogen Receptor–Positive Early Stage Breast Cancer and Correlation with Estimation of Recurrence Risk by Breast Cancer Specialists

The Effect of Oncotype DX Recurrence Score on Treatment Recommendations for Patients with Estrogen Receptor–Positive Early Stage Breast Cancer and Correlation with Estimation of Recurrence Risk by Breast Cancer Specialists

Patients’ Perceptions of Gene Expression Profiling in Breast Cancer Treatment Decisions

Distinguishing luminal breast cancer subtypes by Ki67, progesterone receptor or TP53 status provides prognostic information

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