Use of Adjuvant Chemoendocrine Therapy vs Adjuvant Endocrine Therapy in Node-Negative Early-Stage Breast Cancer Patients Stratified as Midrange Risk by 21-Gene Oncotype DX Breast Recurrence Score Assay: A Meta-Analysis Study

Purpose We previously identified three genes, HOXB13, IL17BR and CHDH, and the HOXB13:IL17BR ratio index in particular, that strongly predicted clinical outcome in breast cancer patients receiving tamoxifen monotherapy. Confirmation in larger independent patient cohorts was needed to fully validate their clinical utility. Patients and Methods Expression of HOXB13, IL17BR, CHDH, estrogen receptor (ER) and progesterone receptor (PR) were quantified by real-time polymerase chain reaction in 852 formalin-fixed, paraffin-embedded primary breast cancers from 566 untreated and 286 tamoxifen-treated breast cancer patients. Gene expression and clinical variables were analyzed for association with relapse-free survival (RFS) by Cox proportional hazards regression models. Results ER and PR mRNA measurements were in close agreement with immunohistochemistry. In the entire cohort, expression of HOXB13 was associated with shorter RFS (P = .008), and expression of IL17BR and CHDH was associated with longer RFS (P < .0001 for IL17BR and P = .0002 for CHDH). In ER+ patients, the HOXB13:IL17BR index predicted clinical outcome independently of treatment, but more strongly in node-negative patients. In multivariate analysis of the ER+ node-negative subgroup including age, PR status, tumor size, S phase fraction, and tamoxifen treatment, the two-gene index remained a significant predictor of RFS (hazard ratio = 3.9; 95% CI, 1.5 to 10.3; P = .007). Conclusion This tumor bank study demonstrated HOXB13:IL17BR index is a strong independent prognostic factor for ER+ node-negative patients irrespective of tamoxifen therapy.

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A prospective study of the impact of the 21-gene recurrence score assay on treatment decisions in N-, ER+ early stage breast cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.11008 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 11008-11008 ◽

Cited By ~ 7

Author(s):

N. Ben-Baruch ◽

A. Hammerman ◽

S. Klang ◽

N. Liebermann

Keyword(s):

Breast Cancer ◽

High Risk ◽

Cancer Patients ◽

Early Stage ◽

Significant Proportion ◽

Recurrence Score ◽

Treatment Decision ◽

Low Risk ◽

Breast Cancer Patients ◽

The Impact

11008 Background: The Oncotype DX™ Recurrence Score (RS) assay predicts distant recurrence risk and benefit of chemotherapy (CT) in N-, ER+ breast cancer patients (pts). In February 2006, Clalit Health Services in Israel (CHS) was the first public health insurer to reimburse the assay outside the USA. Methods: CHS requires a pre-authorization form with data on biological parameters and specification of treatment (Rx) recommendation (1) before knowledge of RS and (2) the Rx planned according to each of 3 possible RS risk levels. For the first 200 reimbursed assays, we compared: (1) the Rx offered without RS knowledge, (2) the Rx the patient actually received after RS, and (3) the planned Rx stated on the form to be given according to the RS. Results: 200 pts. Median age: 57 yrs (34–81). RS: Low risk (RS<18), 37.5%; Intermediate (int) risk (RS 18–30), 44.5%; High risk (RS≥31), 18%. In 20 pts, Rx recommendations before RS were not specified. Before the RS, CT was offered in 106/180 (59%) and hormonal therapy (HT) in 74/180 (41%). In 71/180 pts (39%) the actual Rx changed from the recommendation before RS - CT to HT in 62 pts (low risk: 37, int risk: 21, high risk: 4) and HT to CT in 9 pts (int risk: 4, high risk: 5). Suggested therapy by RS was not specified in 19 pts. In 30/181 (17%) actual Rx differed from planned - CT to HT in 20 pts (int risk: 17, high risk: 3) and HT to CT in 10 pts (low risk: 4, int risk: 6). Conclusions: RS changed the treatment decision in a significant proportion of pts (39%), mostly from CT to HT. In 58% of pts originally offered CT, knowledge of RS changed the Rx to HT. 12% of pts originally offered HT were treated with CT. Rx decisions in intermediate RS are sometimes not obvious. In 26% of intermediate RS, final Rx differed from original plan; in these cases, patients’ preferences might have had a major impact on decision making. No significant financial relationships to disclose.

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Relationship between cathepsin-D content and disease-free survival in node-negative breast cancer patients: a meta-analysis

British Journal of Cancer ◽

10.1038/bjc.1997.442 ◽

1997 ◽

Vol 76 (5) ◽

pp. 661-666 ◽

Cited By ~ 66

Author(s):

G Ferrandina ◽

G Scambia ◽

F Bardelli ◽

P Benedetti Panici ◽

S Mancuso ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Cathepsin D ◽

Meta Analysis ◽

Disease Free Survival ◽

Breast Cancer Patients ◽

Free Survival ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Disease Free

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Adjuvant chemotherapy and survival among patients 70 years of age and younger with node-negative breast cancer and the 21-gene recurrence score of 26–30

Breast Cancer Research ◽

10.1186/s13058-019-1190-4 ◽

2019 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Seho Park ◽

Yunan Han ◽

Ying Liu ◽

Adetunji T. Toriola ◽

Lindsay L. Peterson ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Recurrence Score ◽

Breast Cancer Patients ◽

Node Negative ◽

Hormone Receptor Positive ◽

Increased Risk ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Overall Mortality

Abstract Background The benefits of chemotherapy in node-negative, hormone receptor-positive, and human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients with the 21-gene recurrence score (RS) of 18–30, particularly those with RS 26–30, are not known. Methods Using the Surveillance, Epidemiology, and End Results (SEER) data, we retrospectively identified 29,137 breast cancer patients with the 21-gene RS of 18–30 diagnosed between 2004 and 2015. Mortality risks according to the RS and chemotherapy use were compared by the Kaplan-Meier method and Cox’s proportional hazards model. Results Among the breast cancer patients with the RS 18–30, 21% of them had RS 26–30. Compared to breast cancer patients with RS 18–25, patients with RS 26–30 had more aggressive tumor characteristics and chemotherapy use and increased risk of breast cancer-specific mortality and overall mortality. In breast cancer patients who were aged ≤ 70 years and had RS of 26–30, chemotherapy administration was associated with a 32% lower risk of breast cancer-specific mortality (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.47–0.99) and a 42% lower risk of overall mortality (HR, 0.58; 95% CI, 0.44–0.76). Survival benefits were most pronounced in breast cancer patients who were younger or had grade III tumor. Conclusions The 21-gene RS of 18–30 showed heterogeneous outcomes, and the RS 26–30 was a significant prognostic factor for an increased risk of mortality. Adjuvant chemotherapy could improve the survival of node-negative, hormone receptor-positive, and HER2-negative breast cancer patients with the 21-gene RS 26–30 and should be considered for patients, especially younger patients or patients with high-grade tumors.

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The Efficacy of Cognitive Behavioral Therapy to Treat Depression and Anxiety and Improve Quality of Life Among Early-Stage Breast Cancer Patients

Integrative Cancer Therapies ◽

10.1177/1534735419829573 ◽

2019 ◽

Vol 18 ◽

pp. 153473541982957 ◽

Cited By ~ 7

Author(s):

Haoyao Sun ◽

Hualei Huang ◽

Shengjun Ji ◽

Xiaochen Chen ◽

Yongqing Xu ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cognitive Behavioral Therapy ◽

Cancer Patients ◽

Early Stage ◽

Behavioral Therapy ◽

Meta Analysis ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients

Purpose: Positive results have appeared among nonmetastatic breast cancer patients with the use of cognitive behavioral therapy (CBT). However, earlier stage patient results have been mixed. This novelty of this study was the focus on stage I and II breast cancer patients. The objective of the current study was to conduct a meta-analysis of psychosocial functions in early-stage breast cancer survivors to determine its efficacy. Methods: A search of Cochrane Library, EMBASE, MEDLINE, PsycInfo, and PubMed yielded 3237 abstracts, which were independently evaluated by research pairs. Meta-analysis was conducted on 8 studies that included a total of 1053 patients. Psychosocial functions were categorized according to 3 domains: (1) anxiety, (2) depression, and (3) quality of life. Results: Improvement in anxiety was observed in patients treated with CBT relative to controls without CBT ( P = .04). Depression and quality of life improvement was not observed in the CBT group within or after 4 months of treatment ( P > .05). Conclusions: The results indicated that observed improvements in anxiety in patients with early-stage breast cancer were moderate. The effectiveness of CBT for the improvement of patient outcomes could not be determined, given the methodological and clinical shortcomings of the included trials.

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