Associations between clinical-pathological parameters and biomarkers, HER-2, TYMS, RRMI, and 21-gene recurrence score in breast cancer

e12093 Background: The Recurrence Score (RS) result based on the 21-gene Oncotype DX Breast Recurrence Score assay is standard of care in deciding adjuvant chemo-hormonal therapy versus hormone therapy alone in hormone-receptor positive (HR+), HER 2 negative, node–negative breast cancer. This study explores the role of RS result in predicting the response to neoadjuvant chemotherapy (NACT). Methods: In this retrospective single institution cohort study, electronic medical records of 148 women with HR+, HER 2 negative, non-metastatic breast cancer who received NACT from 2006 onward were screened. 38 patients were excluded due to lack of tissue for testing. Pretreatment biopsy blocks were sent to Genomic Health, Inc. for Oncotype Dx testing. Low RS result was defined as ≤25. Pathologic complete response (pCR) was defined as no residual tumor. Partial response (PR) was residual tumor with > 25% decrease in the largest dimension. No response (NR) was defined as < 25% decrease in the tumor post NACT. Progression (PD) was defined as increase in size of original tumor or new site(s) of disease. Results: Of the 110 patients studied, 58% were postmenopausal women. Fifty percent were African American, 12% were Caucasian and 27% were Hispanic. Invasive ductal carcinoma was the predominant histology (86%). Most patients had > T2 disease (97%) with 73% being clinically node positive. Adriamycin based NACT regimen was used in treating 86.3% of the women. Forty patients (36.4%) had tumor with RS≤25. NR/PD was significantly higher in tumors with RS≤25 (27/40) vs RS > 25 (13/70) (OR: 9.1, 95% CI: 3.7-22.2, P< 0.001). pCR was seen in 16% with RS > 25 and 0% with RS ≤25. Response to NACT (pCR/PR) was 32.5% in RS≤25 vs 81.4% in RS > 25. In tumors with response, RS > 25 was associated with a greater percent decrease in the tumor size compared to RS≤25 (median decrease of 71% vs 52%, P= 0.033). Conclusions: HR+, HER 2 negative, RS≤25 breast cancer is associated with increased rates of NR/PD and is unlikely to respond to NACT. Recurrence Score result determination in pretreatment breast cancer biopsy samples can be an effective tool to select patients with non-metastatic breast cancer for NACT. Studies are needed to determine novel neoadjuvant therapeutic approaches in patients who are candidates for neoadjuvant therapy but are unlikely to benefit from NACT.

Download Full-text

Abstract P6-07-41: Sub classification of early stage hormone positive (HP) Her-2 negative breast cancer (BC) by immunohistochemistry (IHC) into intrinsic subtypes (IS) and their correlation with Oncotype Recurrence Score (RS)

10.1158/0008-5472.sabcs12-p6-07-41 ◽

2012 ◽

Author(s):

S Mahesh ◽

J Lane ◽

P Ravichandran

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Recurrence Score ◽

Intrinsic Subtypes ◽

Her 2

Download Full-text

Clinicopathologic predictors of the 21-gene assay in a Hispanic cohort

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e22209 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e22209-e22209

Author(s):

A. Khan ◽

C. Rodriguez ◽

Y. E. Tovar ◽

B. Rajabi ◽

Z. D. Mulla ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Recurrence Score ◽

Tumor Grade ◽

Positive Lymph Node ◽

Proliferative Index ◽

Ki 67 ◽

Predominantly Hispanic ◽

Er Positive ◽

Her 2

e22209 Background: The 21-gene recurrence score (RS) assay became commercially available (Oncotype DX) in January 2005. It is used to predict the likelihood of distant recurrence in women with estrogen-receptor (ER)-positive, lymph node-negative invasive breast cancer treated with adjuvant tamoxifen. We aimed to identify clinicopathologic predictors of an elevated recurrence score in a group of women with invasive breast cancer living in a predominantly Hispanic population on the Texas-Mexico border. Methods: A retrospective cohort study of 60 consecutive patients with primary ER-positive, lymph node-negative invasive breast cancer who had an Oncotype DX assay performed by Genomic Health, Inc. on paraffin-embedded tumor between March 2006 and November 2008. ER, PR and HER-2 was performed by immunohistochemistry. Patients were classified as low RS (<18), intermediate RS (18–30), or high RS (≥31). Ordinal logistic regression was used to calculate odds ratios (OR) for an increasing RS. Patient age and tumor pathological features were documented in each group. There was no selection bias in ordering the assay. Results: 95% of the cohort was Hispanic. Average age was 55.5 years. 29 patients (48%) had a low RS, 15 (25%) had an intermediate RS, while 16 (27%) had a high RS. HER-2 was amplified in 8 patients (13%). HER-2 positivity was strongly associated with a high RS (p<0.0001). Tumor grade and Ki-67 proliferative index were correlated with one another in a positive fashion (weighted kappa=0.46, p<0.05) and in univariate analyses both factors were significant predictors of a higher RS: tumor grade 3 vs. 1 OR=26.6 (p<0.0001) and Ki-67 proliferative index high vs. low OR=6.59 (p=0.0033). After adjustment, neither OR was significant. A negative progesterone receptor (PR) status was a strong risk factor for a higher RS (adjusted OR=21.64, p=0.0002). Univariate and multivariate ORs for higher RS for invasive ductal vs. invasive lobular carcinoma were, respectively, 4.3 (p=0.051) and 2.23 (p=0.4). Conclusions: Initially, a tumor grade of 3 and a high Ki-67 proliferative index were strong risk factors for a higher RS. However, after controlling for multiple factors, neither tumor grade nor Ki-67 proliferative index had an impact on RS in this predominantly Hispanic cohort. No significant financial relationships to disclose.

Download Full-text

Did Oncotype DX® Recurrence Score Accurately Predict the Risk of Recurrence in Breast Cancer? A 10 Year Period Study in a Single Institution

Open Medicine Journal ◽

10.2174/1874220301401010037 ◽

2015 ◽

Vol 2 (1) ◽

pp. 37-42

Author(s):

Vanda Farahmand Torous ◽

Sophia K Apple

Keyword(s):

Breast Cancer ◽

High Risk ◽

Risk Group ◽

Recurrence Score ◽

High Risk Group ◽

Oncotype Dx ◽

Ki 67 ◽

Risk Of Recurrence ◽

Node Positive ◽

Her 2

The 21-gene Recurrence Score (RS) assay (Oncotype DX®) predicts the risk of recurrence and benefit from chemotherapy in estrogen receptor (ER) positive, Her-2/neunegative, node negative and, more recently, limited node-positive (≤3) breast cancer. The 21-gene RS is divided into low, intermediate and high risk groups corresponding to a likelihood of recurrence within 10 years of initial diagnosis. Clinicians utilize 21-gene RS to guide treatment, particularly whether to add adjuvant chemotherapy to endocrine therapy. This study aimed to determine if 21-gene RS accurately predicts the rate of recurrence with respect to each category. A cohort of 236 patients was studied retrospectively and analyzed, based on correlation between histologic and immunohistochemical (IHC) findingsversus21-gene RS stratification in relation to clinical outcomes.In the cohort examined, no deaths occurred in all the patients studied. Six patients had recurrence or metastatic disease. Of these six patients, only one had been stratified to the high risk group by 21-gene RS analysis, while four were stratified to the low risk group, and one to the intermediate risk group. 21-gene RS accurately predicted 97% of the low RS stratified patients to avoid receiving chemotherapy. However, addition of chemotherapy in the treatment regimen for node positive, Her-2/neupositive, high Ki-67, and PR negative tumors may be beneficial regardless of 21-gene RS. Our investigation found that there is a high concordance rate between 21-gene RS and IHC of ER, progesterone receptor (PR), and Her-2/neu.

Download Full-text