The impact of Oncotype DX testing on breast cancer management and chemotherapy prescribing patterns in a tertiary referral centre

Abstract

IntroductionThe use of chemotherapy in node-negative, (O)Estrogen Receptor (ER)-positive breast cancer has changed significantly since the introduction of Oncotype DX to determine systemic recurrence risk based on tumour genomic signature.AimsThis study aims toDocument longitudinal changes in chemotherapy use,Assess the impact of new evidence on local protocol.MethodsA cohort study was undertaken, including consecutive patients with early node-negative, ER-positive breast cancer diagnosed between 2006 and May 2013, including a period of prospective clinical trial (Trial Assigning Individualised Options for Treatment (TAILORx)) recruitment. Data were collected regarding patient demographics, tumour clinico-pathological features, Oncotype DX use and recurrence score and chemotherapy use. All therapeutic decisions were made following multidisciplinary discussion, with adherence to guidelines and consideration of trial protocol and Oncotype DX recurrence scores.Results479 consecutive patients were included in the study, of whom 241 (50%) underwent Oncotype DX testing, 97 as part of the TAILORx clinical trial. Oncotype DX testing began on a trial basis in 2007 and until October 2011, only patients enrolled on TAILORx availed of genomic profiling. From October 2011, Oncotype DX was used in all eligible patients as per National Cancer Control Programme (NCCP) guidelines. A total of 216 (45%) patients received chemotherapy. The use of chemotherapy changed in inverse proportion to the availability of the genomic assay. Of those patients in whom Oncotype DX was utilised, 138 (57%) were spared chemotherapy.ConclusionThis study validates the use of molecular testing in the rationalisation of systemic therapy.

Using a gene expression signature when controversy exists regarding the indication for adjuvant systemic treatment reduces the proportion of patients receiving adjuvant chemotherapy: a nationwide study

“…12,14 Similar results were reported regarding the impact of the 21-gene Recurrence Score (OncotypeDx) on the administration of adjuvant CT. [15][16][17] In addition, high compliance rates with the test results in patients with early-stage ER+, node-negative breast cancer have been reported. 18 Yet, to our knowledge, there are no nationwide studies assessing the impact on the administration of adjuvant CT for either OncotypeDx or the 70-GS.…”

Clinical use of the Oncotype DX genomic test to guide treatment decisions for patients with invasive breast cancer

“…Currently, management of the patient with an intermediate RS poses a significant clinical challenge. In the absence of evidence-based practice regarding incorporation of Oncotype DX RS, we have observed that oncologists revert back to traditional prognostic indicators in decision making for such patients 26. The absolute RS is, however, predictive of chemotherapy use when treated as a continuous variable, even in patients in the intermediate-risk group 26,37.…”

“…We have also identified a shift in prescribing patterns among Irish medical oncologists in the years since the development of Oncotype DX, even in intervals during which the assay could not be utilized,26 reflecting a change in the paradigm of management of ER-positive lower-risk tumors.…”

Integration of advances in social media and mHealth technology are pivotal to successful cancer prevention and control

“…In breast cancer, for example, this approach has yielded a 21 gene based prognostic indicator to identify patients that would benefit from adjuvant chemotherapy (31). This test, known as Oncotype DX, has been used to identify patients who would most benefit from adjuvant chemotherapy (32). This approach has also been used in colon cancer (33).…”