Oncotype DX: Where Does It Stand in India?

Batra, Atul; Patel, Amol; Gupta, Vineet; Mehta, Prashant G.; Tilak, Tvsvgk; Biswas, Bivas; Pramanik, Raja; Das, Chandan Krushna; Srivastava, Priyanka

doi:10.1200/jgo.19.00151

Cited by 14 publications

(19 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, this multigene assay is not available in some countries, the high price also prevented a lot of patients from receiving the test. 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 ].…”

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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…Fifty-eight percent of Indian oncologists surveyed as part of a recent study reported using the online tool PREDICT to help decide on a course of adjuvant treatment. 59 Using molecular profiling and gene expression testing, it has become possible to predict the future behavior of breast cancer, thereby marking the beginning of the era of precision medicine in the disease. 57 This concept of identifying patients with breast cancer who could be safely spared chemotherapy was considered the topmost priority area in a 2007 Web-based survey of multidisciplinary cancer experts from around the world.…”

Section: Breast Cancer Overtreatment and Its Prevention: Role Of Progmentioning

confidence: 99%

“…Such concerns have been raised by Indian oncologists recently as well. 59 The Asian Breast Cancer Cooperative Group 2019 consensus document advocates evidence-based yet flexible and individualized use of international treatment guidelines in Asia because these guide-lines are based on data from predominantly non-Asian postmenopausal women, whereas young Asian women have distinctive clinicopathologic characteristics. 103 …”

Section: Breast Cancer Overtreatment and Its Prevention: Role Of Progmentioning

confidence: 99%

Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective

Bhattacharyya¹,

Doval

Desai

et al. 2020

JCO Global Oncology

View full text Add to dashboard Cite

The prevalence and mortality of breast cancer is increasing in Asian countries, including India. With advances in medical technology leading to better detection and characterization of the disease, it has been possible to classify breast cancer into various subtypes using markers, which helps predict the risk of distant recurrence, response to therapy, and prognosis using a combination of molecular and clinical parameters. Breast cancer and its therapy, mainly surgery, systemic therapy (anticancer chemotherapy, hormonal therapy, targeted therapy, and immunotherapy), and radiation therapy, are associated with significant adverse influences on physical and mental health, quality of life, and the economic status of the patient and her family. The fear of recurrence and its devastating effects often leads to overtreatment, with a toxic cost to the patient financially and physically in cases in which this is not required. This article discusses some aspects of a breast cancer diagnosis and its impact on the various facets of the life of the patient and her family. It further elucidates the role of prognostic factors, the currently available biomarkers and prognostic signatures, and the importance of ethnically validating biomarkers and prognostic signatures.

show abstract

“…However, in the case of ER-positive, HER 2-negative and node-negative patients, most suffer from being overtreated because the clinical decisions for adjuvant chemotherapy are made only on the basis of the histopathologic and clinical features of the tumor. 14 The Cochrane Review compiled data from 14 randomized clinical trials that included 5,600 women suffering from breast cancer. Data from this study showed that higher doses of chemotherapy did not indicate increased survival in these patients with early-stage breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Individualized Chemotherapy Benefit Prediction by EndoPredict in Patients With Early Breast Cancer in an Indian Cohort

Somashekhar

Zaveri

Vijay

et al. 2020

JCO Global Oncology

View full text Add to dashboard Cite

PURPOSE There are new advancements in the modulation of the treatment of patients with early-stage breast cancer, including the use of several molecular profiling tests to identify or select those patients who require additional adjuvant chemotherapy together with hormonal therapy on the basis of a recurrence score. One such tool is EndoPredict (Myriad Genetics; Salt Lake City, UT), which provides support in clinical decision making. The objective of this analysis was to study the landscape of absolute chemotherapy benefit and the likelihood of recurrence within 5 to 15 years in Indian patients with breast cancer who are undergoing EndoPredict testing. PATIENTS AND METHODS This study included 308 patients with hormone-positive, human epidermal growth factor receptor 2–negative early breast cancer. Their postsurgical blocks were analyzed using the EndoPredict test. The MEDCALC statistical tool (Panum Education; Seoul, Republic of Korea) was used to estimate the correlation coefficient and to conduct multiple regression analysis. RESULTS On the basis of the EndoPredict EPclin Risk Score, 52.12% of patients were classified as being in the low-risk category and could safely forgo adjuvant chemotherapy. For every unit increase in the EPclin Risk Score, the percentage increase in absolute chemotherapy benefit was 6.82%. Similarly, the correlation between the likelihood of recurrence within 5 to 15 years and the EPclin Risk Score suggested that there is a 10.34% increase in recurrence for each unit of EPclin Risk Score. CONCLUSION The EPclin Risk Score has good prognostic and predictive power; it also provides the range of chemotherapy benefit for Indian patients.

show abstract

Oncotype DX: Where Does It Stand in India?

Cited by 14 publications

References 11 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

Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective

Individualized Chemotherapy Benefit Prediction by EndoPredict in Patients With Early Breast Cancer in an Indian Cohort

Contact Info

Product

Resources

About