Beyond the guidelines: Clinical investigators' (CI) self-reported use of genomic assays (GA) to assist in decision-making regarding use of neoadjuvant (NA) and adjuvant chemotherapy for patients (pts) with ER-positive/HER2-negative (ER+/HER2-) early breast cancer (BC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18187-e18187
Author(s):  
Neil Love ◽  
Harold J. Burstein ◽  
Tari A. King ◽  
Gloria Kelly ◽  
Kirsten Miller ◽  
...  
Keyword(s):  
Decision Making ◽  
Adjuvant Chemotherapy ◽  
Management Strategies ◽  
Recurrence Score ◽  
Tumor Stage ◽  
Third Party ◽  
Node Negative ◽  
Node Positive ◽  
Node Positive Disease ◽  
Do So

e18187 Background: GA, specifically the 21-gene Recurrence Score (RS), have been widely used to help inform decisions regarding use of adjuvant chemotherapy in ER+/HER2- node-negative BC. Although substantial anecdotal evidence exists that clinicians, particularly BC-focused CI, are employing these tests in other situations (node-positive disease, the NA setting), ASCO guidelines do not endorse these practices. Here we aimed to quantify self-reported CI use of GA across a spectrum of hypothetical BC presentations. Methods: In December 2016, a 225-item survey was sent to 97 US-based surgical (S) and medical oncology (MO) CI from a proprietary database. A modest honorarium was provided. Results: 51 CI (26 S and 25 MO) completed the survey. CI generally recommend GA for node-negative tumors but less so for older pts with smaller lesions. 75% of CI reported that they would recommend GA for pts with 1 involved node and 55% would do so for those with 2 to 3 nodes. 31% of CI use GA to guide NA chemotherapy decisions, and 53% who do not use GA in NA decision-making altered their treatment approach when a GA result was available. Conclusions: CI prefer GA when the benefit of chemotherapy is uncertain based on tumor stage and pt age. CI are comfortable using GA in node-negative and node-positive hypothetical cases, and some do so to aid in decisions regarding NA therapy. Quantitative assessment of self-reported CI practice patterns can serve as a complement to established guidelines and provide physicians, pts and third-party payers additional viewpoints on possible appropriate management strategies. [Table: see text]

1317: Significance of Lymph Node Positive Disease in Patients Treated with Neoadjuvant Chemotherapy: Is Adjuvant Chemotherapy Beneficial?

2005 ◽  
Vol 173 (4S) ◽  
pp. 358-358
Author(s):  
Wassim Kassouf ◽  
Dan Leibovici ◽  
Xian Zhou ◽  
Colin P.N. Dinney ◽  
G.H. Barton ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Node Positive ◽  
Node Positive Disease ◽  
Lymph Node Positive

scholarly journals The impact of Oncotype DX testing on adjuvant chemotherapy decision making in 1–3 node positive breast cancer

2021 ◽  
Author(s):  
Yogeshkumar Malam ◽  
Mohamed Rabie ◽  
Konstantinos Geropantas ◽  
Susanna Alexander ◽  
Simon Pain ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Adjuvant Chemotherapy ◽  
Oncotype Dx ◽  
Node Positive ◽  
The Impact ◽  
Positive Breast Cancer

Cost Effectiveness of Molecular Profiling for Adjuvant Decision Making in Patients With Node-Negative Breast Cancer

2014 ◽  
Vol 32 (31) ◽  
pp. 3513-3519 ◽  
Author(s):  
Julia Bonastre ◽  
Sophie Marguet ◽  
Beranger Lueza ◽  
Stefan Michiels ◽  
Suzette Delaloge ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cost Effectiveness ◽  
Adjuvant Chemotherapy ◽  
Cost Effective ◽  
Gene Signature ◽  
Node Negative ◽  
Node Negative Breast Cancer ◽  
Life Years ◽  
Er Positive

Purpose To conduct an economic evaluation of the 70-gene signature used to guide adjuvant chemotherapy decision making both in patients with node-negative breast cancer (NNBC) and in the subgroup of estrogen receptor (ER) –positive patients. Patients and Methods We used a mixed approach combining patient-level data from a multicenter validation study of the 70-gene signature (untreated patients) and secondary sources for chemotherapy efficacy, unit costs, and utility values. Three strategies on which to base the decision to administer adjuvant chemotherapy were compared: the 70-gene signature, Adjuvant! Online, and chemotherapy in all patients. In the base-case analysis, costs from the French National Insurance Scheme, life-years (LYs), and quality-adjusted life-years (QALYs) were computed for the three strategies over a 10-year period. Cost-effectiveness acceptability curves using the net monetary benefit were computed, combining bootstrap and probabilistic sensitivity analyses. Results The mean differences in LYs and QALYs were similar between the three strategies. The 70-gene signature strategy was associated with a higher cost, with a mean difference of €2,037 (range, €1,472 to €2,515) compared with Adjuvant! Online and of €657 (95% CI, −€642 to €3,130) compared with systematic chemotherapy. For a €50,000 per QALY willingness-to-pay threshold, the probability of being the most cost-effective strategy was 92% (76% in ER-positive patients) for the Adjuvant! Online strategy, 6% (4% in ER-positive patients) for the systematic chemotherapy strategy, and 2% (20% in ER-positive patients) for the 70-gene strategy. Conclusion Optimizing adjuvant chemotherapy decision making based on the 70-gene signature is unlikely to be cost effective in patients with NNBC.

Cured of breast cancer?

1995 ◽  
Vol 13 (1) ◽  
pp. 62-69 ◽  
Author(s):  
H Joensuu ◽  
S Toikkanen
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Survival Rates ◽  
Locoregional Therapy ◽  
Short Term ◽  
Node Negative ◽  
Node Positive ◽  
Node Positive Disease ◽  
Histologic Types

PURPOSE That patients can be ultimately cured of breast cancer has been questioned, because late deaths from the disease have been observed even several decades after the diagnosis. The purpose of this study was to investigate late mortality caused by breast cancer. PATIENTS AND METHODS Using the files of local hospitals and the Finnish Cancer Registry, we identified all patients with histologically diagnosed invasive breast cancer in a defined urban area (city of Turku, Finland) from 1945 to 1969 (n = 601). In 563 cases (94%), clinical data and histologic and autopsy slides could be reviewed, and these women had been monitored for a median of 29 years (range, 22 to 44; n = 66) or until death (n = 497). RESULTS Mortality from breast cancer was observed even during the fourth follow-up decade, but if women who were diagnosed with contralateral breast cancer were excluded (n = 30), no deaths from breast cancer were identified after the 27th year of follow-up evaluation. The 30-year survival rates were 62% (95% confidence interval [CI], 54% to 70%), 19% (95% CI, 13% to 25%), and 0% for women with pN0 (node-negative) and pN1 or pN2 (node-positive) disease, respectively. High 30-year survival rates were found in small (pT1N0M0) unilateral cancers (80% alive; 95% CI, 66 to 94%), and in the lobular (45% alive; 95% CI, 31% to 59%) and the special histologic types (81% alive; 95% CI, 67% to 95%). These survival rates were obtained when correcting either for known intercurrent deaths or for mortality in the age- and sex-matched general population. CONCLUSION Breast cancer, node-negative and node-positive, may be permanently cured even if treated with locoregional therapy only. The survival figures listed here may be considered as minimum values, because women with breast cancer diagnosed in the same area from 1970 to 1984 showed significantly improved short-term (< 20 years) survival rates over those diagnosed from 1945 to 1969.

scholarly journals Real-World Outcomes of Adjuvant Chemotherapy for Node-Negative and Node-Positive HER2-Positive Breast Cancer

2019 ◽  
Vol 17 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Zachary Veitch ◽  
Omar F. Khan ◽  
Derek Tilley ◽  
Domek Ribnikar ◽  
Xanthoula Kostaras ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Real World ◽  
Her2 Positive ◽  
Node Negative ◽  
Node Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

Improvement in the prognosis of breast cancer from 1965 to 1984.

1998 ◽  
Vol 16 (3) ◽  
pp. 1030-1035 ◽  
Author(s):  
M J Edwards ◽  
J W Gamel ◽  
E J Feuer
Keyword(s):  
Breast Cancer ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Parametric Analysis ◽  
Parametric Models ◽  
Node Negative ◽  
Node Positive ◽  
Significant Difference ◽  
Node Positive Disease

PURPOSE The prognosis of breast cancer has improved over the past three decades. It is uncertain, however, whether this improvement results from an increase in the cure rate, extension of the life span of uncured patients, or some combination. METHODS From the Connecticut Tumor Registry, we obtained data on 25,091 patients with localized (node-negative) and regionally metastatic (node-positive) breast cancer who were diagnosed over the two decades between 1965 and 1984, with follow-up through 1993. The data for these patients were analyzed using a variety of parametric models to quantitate likelihood of cure and median survival time among uncured patients. These models incorporate the assumption that time to death from breast cancer follows a specific distribution. RESULTS For patients with node-negative disease, parametric analysis revealed no significant difference in cured-fraction or median survival time over the two decades studied. For patients with node-positive disease, however, a significant increase in median survival time (P < .001) was found during the second decade (1970 to 1979). There was also a trend toward a higher cured-fraction over time, but this was not statistically significant. CONCLUSION This study confirms that patients with node-positive disease had an improved prognosis over the two decades studied. Parametric analysis suggests that this improvement reflects primarily an increase in the median survival time for uncured patients, although there is a trend toward an increase in the likelihood of cure.

Prediction of recurrence with the Oncotype DX recurrence score in node-positive, HR-positive, breast cancer patients treated with adjuvant chemotherapy: Results from PACS01 trial.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. 11052-11052 ◽  
Author(s):  
Frederique Madeleine Penault-Llorca ◽  
Thomas Filleron ◽  
Bernard Asselain ◽  
Frederick L. Baehner ◽  
Pierre Fumoleau ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Recurrence Score ◽  
Oncotype Dx ◽  
Breast Cancer Patients ◽  
Node Positive ◽  
Oncotype Dx Recurrence Score ◽  
Positive Breast Cancer
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