Selection of neoadjuvant treatment based on the 21-GENE test results in luminal breast cancer

PURPOSE We evaluated the impact of 21-gene test results on treatment decisions for patients with early-stage breast cancer treated under the public health care system in Brazil, Sistema Único de Saúde. METHODS Eligible patients treated at Hospital Pérola Byington and Santa Casa de Misericórdia de São Paulo in Brazil were required to have the following characteristics: postsurgery with hormone receptor–positive, human epidermal growth factor 2–negative, node-negative and node-positive, and T1/T2 breast cancer and patients with these characteristics were candidates for adjuvant systemic therapy. Treatment recommendations, chemotherapy plus hormonal therapy (CT + HT) or HT alone, were captured before and after 21-gene test results. RESULTS From August 2018 to April 2019, 179 women were enrolled. The mean age was 58 years (29-86 years), 135 (76%) were postmenopausal, and 58 (32%) had node-positive breast cancer. Most patients (61%) had a tumor > 2 cm, including 7% with tumors > 4 cm. Using Recurrence Score (RS) result cut points on the basis of the TAILORx trial, 40 (22%) had RS 0-10, 91 (51%) had RS 11-25, and 48 (27%) had RS 26-100. Before 21-gene testing, 162 of 179 (91%) patients were recommended for CT. After testing, 117 of 179 patients (65%) had changes in CT recommendation: 112 (63%) who were initially recommended CT received HT alone and five (3%) who were initially recommended HT alone received CT + HT. After 21-gene testing, 99% of physicians reported strong confidence in their treatment recommendations. CONCLUSION The change in clinical practice at these public hospitals was greater than expected: 66% of initial treatment recommendations were changed to omit CT with 21-gene test results. Clinicopathologic features did not correlate well with 21-gene test results and did not adequately identify those most likely to benefit from CT.

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Strategy of post-neoadjuvant treatment of patients with residual breast cancer

Tumors of female reproductive system ◽

10.17650/1994-4098-2020-16-1-43-54 ◽

2020 ◽

Vol 16 (1) ◽

pp. 43-54

Author(s):

V. V. Semiglazov ◽

A. A. Natopkin

Keyword(s):

Breast Cancer ◽

Molecular Markers ◽

Systemic Treatment ◽

Neoadjuvant Treatment ◽

Breast Tumors ◽

Recurrence Risk ◽

Molecular Profile ◽

Malignant Breast ◽

Selection Of ◽

Biological Subtype

The article considers the aspects of selection of post-neoadjuvant therapy for patients with residual breast cancer depending on biological subtype and molecular profile of the tumor. Analysis of morphological and molecular markers allowing to evaluate sensitivity of malignant breast tumors with high recurrence risk to new types of systemic treatment is presented.

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Abstract PS12-03: Letrozole and palbociclib versus 3rdgeneration chemotherapy as neoadjuvant treatment in luminal breast cancer: Survival results of the UNICANCER-NeoPAL study

10.1158/1538-7445.sabcs20-ps12-03 ◽

2021 ◽

Author(s):

Suzette Delaloge ◽

Sylvain Dureau ◽

Véronique D'Hondt ◽

Isabelle Desmoulins ◽

Pierre-Etienne Heudel ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survival ◽

Neoadjuvant Treatment ◽

Breast Cancer Survival ◽

Luminal Breast Cancer

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RELATIONS OF PROTEASOMAL SYSTEM WITH TUMOR STAGE IN LUMINAL BREAST CANCER

Problems in oncology ◽

10.37469/0507-3758-2018-64-2-218-221 ◽

2018 ◽

Vol 64 (2) ◽

pp. 218-221

Author(s):

Yelena Shashova ◽

Natalya Tarabanovskaya ◽

Yevgeniya Fesik ◽

Yelena Slonimskaya ◽

Irina Kondakova

Keyword(s):

Breast Cancer ◽

Neoadjuvant Treatment ◽

Tumor Stage ◽

Subunit Composition ◽

Luminal Breast Cancer ◽

Luminal A ◽

Luminal B ◽

Lymphogenous Metastasis ◽

Total Pool ◽

Lymphogenic Metastasis

The aim of this study was to investigate characteristics of the proteasomal system in luminal breast cancer. There were included 124 patients with primary luminal breast cancer in stage Т13N0-2M0 who had not received neoadjuvant treatment. The process of lymphogenous metastasis was associated with a significant change in caspase-like activity (CL) and subunit composition of proteasomes. CL activity of proteasomes was increased in luminal A breast cancer with extensive lymphogenic metastasis (N2), while it was decreased in the luminal B subtype of cancer. It was accompanied by an increase in the composition of the proteasomal total pool subunits, regulatory and immune subunits. Decrease in CL activity of proteasomes can be poor prognostic sign which is associated with the lymphogenous invasion of the tumor process in luminal B breast cancer.

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Practice-Changing Use of the 21-Gene Test for the Management of Patients With Early-Stage Breast Cancer in Latin America

JCO Global Oncology ◽

10.1200/go.21.00008 ◽

2021 ◽

pp. 1364-1373

Author(s):

Henry L. Gomez ◽

Juan E. Bargallo-Rocha ◽

Roberto J. Billinghurst ◽

Aníbal R. Núñez De Pierro ◽

Federico A. Coló ◽

...

Keyword(s):

Breast Cancer ◽

Latin America ◽

Recurrence Score ◽

Treatment Decisions ◽

Test Results ◽

Node Negative ◽

Node Positive ◽

Gene Testing ◽

Before And After ◽

Gene Test

PURPOSE We present a physician survey of the impact of 21-gene Breast Recurrence Score test results on treatment decisions in clinical practice in Latin America. METHODS This prospective survey enrolled consecutive patients at 14 sites in Argentina, Colombia, Mexico, and Peru who had routine 21-gene testing. Physician surveys captured patient and tumor characteristics and treatment decisions before and after 21-gene test results. The survey spanned the period before and after Trial Assigning Individualized Options for Treatment (TAILORx) results reported (June 2018). Overall net percent change in adjuvant chemotherapy recommendations was estimated, and asymptotic 95% CIs with continuity correction were calculated. The proportion with a change between pretest treatment recommendation and actual treatment received was calculated overall and by Recurrence Score groups per TAILORx. RESULTS Between March 2015 and December 2019, the survey was completed for 647 patients; 20% were node-positive. The mean patient age was 54 years (24-85 years); 55% were postmenopausal; 17%, 63%, and 20% had grade 1, 2, and 3 tumors, respectively; and 30% had tumors > 2 cm. Recurrence Score (RS) results were as follows: 20% RS 0-10, 56% RS 11-25, and 24% RS 26-100. Overall, chemotherapy recommendations fell by a relative proportion of 39% (95% CI, 33.4 to 44.3) after 21-gene testing (33% decrease in node-negative and 55% decrease in node-positive). Among node-negative patients, the relative decrease in chemotherapy recommendations was 28% (95% CI, 18.9 to 39.5) before TAILORx and 36% (95% CI, 28.4 to 43.7) after. CONCLUSION To our knowledge, this large survey of 21-gene test practice patterns was the first conducted in Latin America and showed the relevance of 21-gene testing in low- and medium-resource countries to minimize chemotherapy overuse and underuse in breast cancer. The results showed substantial reductions in chemotherapy use overall—especially after TAILORx reported—indicating the practice-changing potential of that study.

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