Impact of Oncotype DX Recurrence Score in the Management of Breast Cancer Cases

Nguyen, Michaela T.; Stessin, A.; Nagar, Himanshu; D’Alfonso, Timothy M.; Chen, Zhengming; Cigler, Tessa; Hayes, M.; Shin, Sandra J.

doi:10.1016/j.clbc.2013.12.002

Cited by 19 publications

(17 citation statements)

References 14 publications

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“…The rate of RS testing of node negative women fell within ranges found in other studies. 44,45 In concert with Nguyen and colleagues (2012) our results show that RS testing increased over the study period suggesting greater dissemination and/or adoption of testing. 45 Most of the initial studies of RS testing were in samples of mostly Whites (e.g., De Frank et al, 2013).…”

Section: Discussionsupporting

confidence: 84%

Patterns of 21-Gene Assay Testing and Chemotherapy Use in Black and White Breast Cancer Patients

Sheppard

O’Neill

Dilawari

et al. 2015

Clinical Breast Cancer

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Purpose In women with early stage, estrogen-receptor (HR)-positive 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 socio-demographic, clinical, and attitudinal factors associated with RS testing receipt and the RS testing impact on chemotherapy use in Black and White patients. Patients and Methods Women with newly diagnosed invasive, non-metastatic breast cancer were recruited and interviewed to collect socio-cultural and healthcare process data; clinical data were collected from charts. Of the sample (n=359), 270 had HR-positive disease. Primary analysis focused on those with HR-positive 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, 43% received RS testing. In multivariable analysis, higher age (OR=1.04 per one year increase; 95% CI: 1.01–1.08) was associated with RS testing adjusting for covariates. Chemotherapy use was 23%. In multivariable analysis, positive attitudes about chemotherapy and higher risk of recurrence were associated with chemotherapy use (p<.05). Conclusion Patterns of genomic testing may vary by age. Efforts to understand factors associated with low testing will be important.

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Section: Discussionsupporting

confidence: 84%

Patterns of 21-Gene Assay Testing and Chemotherapy Use in Black and White Breast Cancer Patients

Sheppard

O’Neill

Dilawari

et al. 2015

Clinical Breast Cancer

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“…Utilization of GEP among California breast cancer patients was lower than found at a large academic health center in New York, where 27% of patients were tested in 2007 and 42% in 2010 (13). The patients in the current population-based study were treated in a wide variety of community and academic settings, and it is likely that there is a heterogeneous understanding and acceptance of GEP in these diverse care settings.…”

Section: Discussionmentioning

confidence: 80%

Underutilization of gene expression profiling for early-stage breast cancer in California

Cress

Chen

Morris

et al. 2016

Cancer Causes Control

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Purpose To describe the utilization of gene expression profiling (GEP) among California breast cancer patients, identify predictors of use of GEP, and evaluate how utilization of GEP influenced treatment of early stage breast cancer. Methods All women diagnosed with hormone receptor positive, node-negative breast cancer reported to the California Cancer Registry between January 2008 and December 2010 were linked to Oncotype DX (ODX) assay results. Results Overall, 26.7% of 23,789 eligible patients underwent the assay during the study period. Women age 65 or older were much less likely than women under age 50 to be tested (15.1% versus 41.4%, p<0.001). Black women were slightly less likely and Asian women slightly more likely than non-Hispanic white women to undergo GEP with the ODX assay (22.2% and 28.9% versus 26.9% respectively, p<0.001). Patients residing in low SES census tracts had the lowest use of the test (8.9%), with the proportion increasing with higher SES category. Women with Medicaid health insurance were less likely than other women to be tested (17.7% versus 27.5%, p<0.001). Receipt of adjuvant chemotherapy (ACT) was associated with the ODX recurrence score, although only 63% of patients whose recurrence scores indicated a high benefit received ACT. Of patients not tested, 15% received ACT. Conclusions Nearly three-fourths of eligible breast cancer patients in California during the 3-year period 2008 through 2010 did not undergo GEP. As a result, it is likely that many women unnecessarily received ACT and suffered associated morbidity. In addition, some high risk women who would have benefited most from ACT were not identified.

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“…In turn, patients are stratified into high (>31), intermediate [18][19][20][21][22][23][24][25][26][27][28][29][30] and low (<18) risk for distant recurrence. Validation studies have shown that there is a correlation between Oncotype DX (Genomic Health ® ) score and risk of distant recurrence as well as response to chemotherapy (14)(15)(16). The purpose of this tool is to tailor treatment of BC to the genomic characteristics of each specific tumor.…”

Section: Introductionmentioning

confidence: 99%

21-gene recurrence assay in patients receiving intraoperative radiotherapy: are “favorable” characteristics a surrogate for low recurrence?

et al. 2017

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Background: Intraoperative radiotherapy (IORT) has gained momentum for early stage and favorable breast cancers (BC). The 21-gene recurrence assay guides treatment of hormone positive and node-negative BC. Data collection included patient demographics, tumor characteristics, nodal status, recurrence test (RS) and adjuvant therapy.Results: The mean age was 68 years. Tumors were stage Ia (86.6%), 3.6% Ib and 9.8% IIa. Of 50 patients (61.0%) with RS testing, 72% (n=36) were low risk (RS 0-17), with 28% (n=14) at intermediate risk . The 39% (n=32) of patients without RS testing, were more likely to have smaller tumors (1.3 vs. 0.9 cm) and age >70 (P<0.05).Conclusions: Most patients selected for IORT based on clinical features were indeed low risk based on RS. Given the limited long-term clinical outcome and safety data of this technique, additional investigation is needed.

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Impact of Oncotype DX Recurrence Score in the Management of Breast Cancer Cases

Cited by 19 publications

References 14 publications

Patterns of 21-Gene Assay Testing and Chemotherapy Use in Black and White Breast Cancer Patients

Patterns of 21-Gene Assay Testing and Chemotherapy Use in Black and White Breast Cancer Patients

Underutilization of gene expression profiling for early-stage breast cancer in California

21-gene recurrence assay in patients receiving intraoperative radiotherapy: are “favorable” characteristics a surrogate for low recurrence?

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