scholarly journals Impact of Recurrence Score on type and duration of chemotherapy in breast cancer

2019 ◽  
Vol 27 (2) ◽  
Author(s):  
K. Willemsma ◽  
W. Yip ◽  
N. LeVasseur ◽  
K. Dobosz ◽  
C. Illmann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Recurrence Score ◽  
Population Based ◽  
Oncotype Dx ◽  
Myelosuppressive Chemotherapy ◽  
Hormone Receptor Positive ◽  
Short Course ◽  
Long Course ◽  
Selection Of

Background The use of Oncotype dx (Genomic Health, Redwood City, CA, U.S.A.) testing has been shown to change treatment decisions in approximately 30% of breast cancer (bca) cases, but research on how Recurrence Score testing has affected the type of chemotherapy offered is limited. We sought to determine if the availability of Oncotype dx testing resulted in a change to the type and duration of chemotherapy regimens used in the treatment of early-stage hormone receptor–positive bca. Methods In a population-based cohort study, patients treated in the 2 years before the availability of Oncotype dx testing were compared with patients treated in the 2 years after testing availability. Charts were audited and divided into 2 groups: pre-Oncotype dx and post-Oncotype dx. The groups were compared for differences in duration of chemotherapy (12 weeks vs. >12 weeks), types of agents used (anthracycline vs. non-anthracycline), and myelosuppressive potential of the chosen regimen. Results Of 834 patients who fulfilled the enrolment criteria, 360 fell into the pre-Oncotype dx era, and 474, into the post-Oncotype dx era. An increase of 11.2 percentage points, to 69.5% from 58.3%, was observed in the proportion of patients receiving short-course compared with long-course chemotherapy (p = 0.068). The proportion of patients prescribed anthracycline-containing regimens declined in the post-Oncotype dx era (47.7% pre vs. 32.2% post, p = 0.016). The selection of more-myelosuppressive chemotherapy protocols increased in the post-Oncotype dx era (67.4% pre vs. 78.8% post, p = 0.044). Conclusions In the present study, the availability of Oncotype dx testing was observed to influence the choice of chemotherapy type in the setting of early-stage bca.

The potential economic impact of the 21-gene recurrence score: Guided chemotherapy in a population-based cohort with node-negative and node-positive early-stage breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 201-201
Author(s):  
N. W. D. Lamond ◽  
C. Skedgel ◽  
D. Rayson ◽  
L. Lethbridge ◽  
T. Younis
Keyword(s):  
Breast Cancer ◽  
Hormone Receptor ◽  
Early Stage ◽  
Recurrence Score ◽  
Cost Effective ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Effective Strategy ◽  
Node Negative ◽  
Hormone Receptor Positive

201 Background: The 21-gene recurrence score (Oncotype DX: RS) appears to augment clinical-pathological prognostication and predicts adjuvant chemotherapy (chemo) benefits in patients with node-negative (N-) and node-positive (N+) hormone-receptor positive early-stage breast cancer. Economic analyses suggest that RS-guided chemo is a cost-effective strategy in N- breast cancer, but no evaluations were reported for N+ disease based on pre RS chemo utilization in clinical practice. We examined the cost-utility (CU) of a RS-guided chemo strategy, compared to current practice without RS in a population based cohort, in N- and N+ early-stage breast cancer. Methods: A generic state-transition model was developed to compute cumulative costs and quality-adjusted life years (QALY) over a 25-year horizon for patients with hormone-receptor positive early-stage breast cancer considered for chemo. We examined outcomes with and without chemo in RS-untested cohorts and in those with low, intermediate and high RS based on the reported prognostic and predictive impact of the RS. Chemo utilizations (current vs RS-guided), costs and utilities were derived from a Nova Scotia population based cohort, local resources and the literature. Sensitivity analyses were conducted for key model assumptions/parameters. Results: RS-guided chemo strategy is associated with incremental costs and QALY gains compared to chemo with no RS testing in both N- and N+ patients. The resultant CU ratios are $17,141/QALY and $5,772/QALY for N- and N+ disease, respectively. These CU ratios are well below commonly quoted thresholds and were most sensitive to RS-distribution, upfront chemo costs, chemo utilization rates and relative benefits of chemo in various RS-strata. Conclusions: RS-guided chemo in a population based cohort appears to be a cost-effective strategy, compared to chemo with no RS testing, in N- and N+ early-stage breast cancer.

Association between estrogen receptor status and Oncotype Dx breast recurrence score.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12519-e12519
Author(s):  
Noman Ahmed Jang Khan ◽  
Mahmoud Abdallah ◽  
Todd W. Gress ◽  
Mohamed Farouq Alsharedi
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Adjuvant Chemotherapy ◽  
Hormone Receptor ◽  
Early Stage ◽  
Recurrence Score ◽  
Tumor Grade ◽  
Oncotype Dx ◽  
Hormone Receptor Positive ◽  
Positive Breast Cancer

e12519 Background: The 21 gene assay Oncotype Dx Breast Recurrence Score (RS) is currently the standard of care to determine if adjuvant chemotherapy is needed in early stage node negative, hormone receptor positive, HER-2 negative breast cancer. In current American society of clinical oncology (ASCO) guidelines there is little or no benefit of adjuvant chemotherapy in patients older than 50 years whose tumors have Oncotype DX RS <26, and for patients 50 years or less whose tumors have Oncotype DX RS <16. We sought to evaluate the percentage of estrogen receptor (ER) expression as a surrogate measure of determining adjuvant chemotherapy by examining the relationship between ER expression and RS. Methods: We identified 301 patients from years 2015 to 2019 from our cancer registry with early stage hormone receptor positive breast cancer and had oncotype DX testing performed. We divided patients into three groups: Group 1 (ERG1) with ER <10%; Group 2 (ERG2) with ER 10-49%; and Group 3 (ERG3) with ER equal or >50%. We also collected information on tumor size (cm), tumor grade, Nottingham score, and ki-67 percentage. A sub-group analysis was performed for patients < 50 years age (n=30). We compared all continuous variables across ER groups using the Kruskal-Wallis rank test and individual between group comparisons using the Wilcoxon rank sum test. All statistical tests performed utilized a two-tailed p value of <0.05 with the Bonferroni correction for multiple comparisons. Results: Among 301 patients with early stage hormone receptor positive breast cancer, 89.1% were ductal, 7.9% lobular, and 2.9% mixed histology. Median age was 68, 58 and 66 for ERG1, ERG2, and ERG3, respectively (p = 0.41). Median RS was 36 (ERG1), 23 (ERG2), and 16 (ERG3) (p = 0.78 for ERG1 vs. ERG2; p = 0.01 for ERG1 vs. ERG3). As expected, tumor grade, tumor size, and Nottingham score decreased significantly from ERG1 to ERG3. For patients <50 years, median age was 44, 46 and 45 for ERG1, ERG2, and ERG3, respectively (p = 0.75). Median RS was 10 (ERG1), 24 (ERG2) and 18 (ERG3) (p = 0.04 for ERG1 vs. ERG2; p = 0.17 for ERG1 vs. ERG3). Conclusions: We found a significant association between estrogen receptor levels and Oncotype Dx recurrence score (RS) in patients with early stage hormone receptor positive breast cancer patients. Further studies are needed to determine the predictive ability of hormone receptor levels on the outcomes of patients treated for early stage hormone receptor positive breast cancer.

scholarly journals The 21-Gene Recurrence Score Assay and Prediction of Chemotherapy Benefit: A Propensity Score-Matched Analysis of the SEER Database

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1829
Author(s):  
In Sil Choi ◽  
Jiwoong Jung ◽  
Byoung Hyuck Kim ◽  
Sohee Oh ◽  
Jongjin Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Early Stage ◽  
Recurrence Score ◽  
Node Negative ◽  
Hormone Receptor Positive ◽  
Breast Cancer Specific Mortality ◽  
Real World Evidence ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Background: To evaluate the performance of the 21-gene recurrence score (RS) assay in predicting chemotherapy benefit in the Surveillance, Epidemiology, and End Results population, we aimed to assess breast cancer-specific mortality (BCSM) by chemotherapy use within each of the RS categories. Methods: Data on breast cancer (BC) cases diagnosed between 2004 and 2015 with available RS results were released. Our analysis included patients with hormone receptor-positive, node-negative early-stage BC (n = 89,402), and three RS groups were defined; RS < 11, low; RS 11–25, intermediate; RS > 25, high. A propensity score matched-analysis was performed to assess and compare BCSM. Results: Chemotherapy was significantly associated with a reduced risk of BC death among patients in the high RS group (hazard ratio = 0.782; 95% CI, 0.618–0.990; p = 0.041). However, in the low and intermediate RS groups, there were no significant differences in BCSM between patients who received chemotherapy and those who did not. Among those with RS 11–25, chemotherapy benefit varied with tumor size (p = 0.001). Conclusions: Our findings provide real-world evidence that the 21-gene RS assay is predictive of chemotherapy benefit among patients in clinical practice. More refined risk estimates would be needed for patients with an intermediate RS.

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