Pooled analysis of prospective European studies assessing the impact of using the 21-gene Recurrence Score assay on clinical decision making in women with oestrogen receptor–positive, human epidermal growth factor receptor 2–negative early-stage breast cancer

Albanell, Joan; Svedman, Christer; Gligorov, Joseph; Holt, Simon; Bertelli, Gianfilippo; Blohmer, Jens-Uwe; Rouzier, Roman; Lluch, Aña; Eiermann, W.

doi:10.1016/j.ejca.2016.06.027

Cited by 66 publications

(77 citation statements)

References 30 publications

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“…In the original series (2012-13), the number of cases that would have benefited from the genetic study corresponds to 41.5%; this percentage is higher than the 33% reported in the USA [55],and the 20% of a study that groups several European countries [56]. Despite this high percentage of cases, which would have benefited from its realization, the study was only carried out in less than 0, 3% of them.…”

Section: Discussionmentioning

confidence: 89%

Breast Cancer in Argentina: Feasibility for the Implementation of the New TNM Staging System 2018 in A Middle-Income Country

Kress¹

2018

J Can Epi Treat

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Background: Breast Cancer (BC) is the most commonly diagnosed cancer amongst women worldwide and also in Argentine a "medium human development" and "middleincome" country with an estimated incidence rate of 71, 2 per 100,000 in 2012. The implementation of the new TNM system for the staging of BC proposed by the AJCC and published in the VIII edition (2017) implies a substantial change with respect to the number of parameters and the criteria used until the present.

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Section: Discussionmentioning

confidence: 89%

Breast Cancer in Argentina: Feasibility for the Implementation of the New TNM Staging System 2018 in A Middle-Income Country

Kress¹

2018

J Can Epi Treat

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“…There have been several reports on the use of multigene assays in clinical practice and on the way in which they can alter treatment decisions for or against chemotherapy [30][31][32][33][34]. The results have so far been inconsistent, but this may change on the basis of 2 recently published randomized studies [21,22] suggesting that chemotherapy rates can be reduced by 20 and 29%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Decision-Making for or against Adjuvant and Neoadjuvant Chemotherapy in Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study

et al. 2016

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Background: Decision-making for or against neoadjuvant or adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive breast cancer does not follow any clear guidelines, and some patients may unnecessarily undergo chemotherapy and be exposed to the associated toxicity. The aim of this study was to identify the patient population for whom this issue may bear relevance. Methods: Patients being treated with letrozole in the prospective multicenter noninterventional EvAluate-TM study were recruited. The percentage of patients receiving chemotherapy and factors associated with chemotherapy administration were identified. Results: In all, 3,924 (37.4%) patients received chemotherapy before treatment with letrozole. Of these, 293 (20%) underwent neoadjuvant therapy. Younger age was predictive for both adjuvant and neoadjuvant therapy. Overall, decisions in favor of administering chemotherapy are more likely to be made in patients with a higher body mass index (BMI), and neoadjuvant chemotherapy is administered at a higher rate in women with a lower BMI. Concomitant medication influenced the overall decision-making regarding chemotherapy, irrespective of whether it was given on a neoadjuvant or adjuvant basis. Conclusion: There is an ongoing debate as to whether all of the many patients who receive chemotherapy actually benefit from it. Neoadjuvant chemotherapy is frequently administered in this patient population, and this should encourage further research to resolve current clinical and research issues.

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“…In total, 176 (29.7 %) patients were recommended CT, of which 2 (1.1 %) patients declined CT. Of 174 patients who received adjuvant CT, 12 (6.9 %) patients were classified as low risk by 21 [25][26][27][28][29][30].…”

Section: Treatment Characteristics By 21-gene Test Scorementioning

confidence: 99%

“…The results are combined into a single Recurrence Score (RS), quantified on a scale of 0 (lower risk of recurrence) to 100 (higher risk of recurrence). Women can be classified into three recurrence risk groups based on their test score: low (\18), intermediate (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and high ([30) [18].…”

Section: Introductionmentioning

confidence: 99%

“…To date, decision impact studies suggest that testing with the 21-gene test has lead to at least a 30 % change in adjuvant treatment recommendations. The main impact has been a reduction in use of adjuvant CT in the large number of patients with low risk RS's and the addition of CT to a smaller number of high risk RS patients who would otherwise be treated with anti-hormonal therapy (HT) alone [23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

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Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland

Smyth

Watson

Walsh

et al. 2015

Breast Cancer Res Treat

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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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Pooled analysis of prospective European studies assessing the impact of using the 21-gene Recurrence Score assay on clinical decision making in women with oestrogen receptor–positive, human epidermal growth factor receptor 2–negative early-stage breast cancer

Abstract: Recurrence Score testing led to changes in adjuvant chemotherapy use in approximately a third of patients, to an overall reduced chemotherapy use, and to more homogeneous decision making.

Cited by 66 publications

References 30 publications

Breast Cancer in Argentina: Feasibility for the Implementation of the New TNM Staging System 2018 in A Middle-Income Country

Breast Cancer in Argentina: Feasibility for the Implementation of the New TNM Staging System 2018 in A Middle-Income Country

Factors Influencing Decision-Making for or against Adjuvant and Neoadjuvant Chemotherapy in Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study

Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland

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