The Story of the Magee Equations: The Ultimate in Applied Immunohistochemistry

Abstract

Magee equations (MEs) are a set of multivariable models that were developed to estimate the actual Oncotype DX (ODX) recurrence score in invasive breast cancer. The equations were derived from standard histopathologic factors and semiquantitative immunohistochemical scores of routinely used biomarkers. The 3 equations use slightly different parameters but provide similar results. ME1 uses Nottingham score, tumor size, and semiquantitative results for estrogen receptor (ER), progesterone receptor, HER2, and Ki-67. ME2 is similar to ME1 but does not require Ki-67. ME3 includes only semiquantitative immunohistochemical expression levels for ER, progesterone receptor, HER2, and Ki-67. Several studies have validated the clinical usefulness of MEs in routine clinical practice. The new cut-off for ODX recurrence score, as reported in the Trial Assigning IndividuaLized Options for Treatment trial, necessitated the development of Magee Decision Algorithm (MDA). MEs, along with mitotic activity score can now be used algorithmically to safely forgo ODX testing. MDA can be used to triage cases for molecular testing and has the potential to save an estimated $300,000 per 100 clinical requests. Another potential use of MEs is in the neoadjuvant setting to appropriately select patients for chemotherapy. Both single and multi-institutional studies have shown that the rate of pathologic complete response (pCR) to neoadjuvant chemotherapy in ER+/HER2-negative patients can be predicted by ME3 scores. The estimated pCR rates are 0%, <5%, 14%, and 35 to 40% for ME3 score <18, 18 to 25, >25 to <31, and 31 or higher, respectively. This information is similar to or better than currently available molecular tests. MEs and MDA provide valuable information in a time-efficient manner and are available free of cost for anyone to use. The latter is certainly important for institutions in resource-poor settings but is also valuable for large institutions and integrated health systems.

Association Between Ki-67 Proliferative Index and Oncotype-Dx Recurrence Score in Hormone Receptor-Positive, HER2-Negative Early Breast Cancers. A Systematic Review of the Literature

“…The incorporation of these equations into the decision-making algorithm may be cost-effective for LMICs. 35 …”

The Canadian Breast Cancer Symposium 2023 Meeting Report

“…Additionally, gene expression profiling, through polymerase chain reaction (PCR) nano-string or RNA sequencing, provides an Oncotype recurrence score used for its predictive value in assessing the likelihood of disease recurrence. The Magee Decision Algorithm TM can be used to triage cases for molecular testing [49].…”

Development of a nomogram to predict recurrence scores obtained using Oncotype DX in Japanese patients with breast cancer

“…In the TAILORx study, chemotherapy could be safely omitted in the low-risk group (RS, 0-10) of patients without axillary lymph node metastases. The intermediate-risk group (RS, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] revealed no effect of adding chemotherapy to endocrine therapy, while an RS within the range of 16-25 was associated with a prognostic benefit of chemotherapy only in patients under 50 years of age [7][8][9]. This indicated that in patients without axillary lymph node metastasis, a significant additive effect of chemotherapy existed if the RS was ≥ 26 and ≥16 in those with age > 50 years and ≦ 50 years, respectively.…”

“…Identifying patients to be tested is important for reducing healthcare costs, as performing this test on patients at low clinical risk based on clinicopathological variables is not economical. Nomograms using clinicopathological variables have been reported to identify groups of patients who require chemotherapy [14][15][16]. However, these studies were conducted in Western populations and Asian women, excluding Japanese women, and data showing that these nomograms are predictive of recurrence in Japanese women are scarce.…”