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Objetivos El objetivo primario del presente estudio es analizar cómo la utilización del ensayo Oncotype Dx modifica y condiciona la elección del tratamiento adyuvante. En segundo lugar, nos propusimos evaluar la evolución de aquellas pacientes con score de recurrencia menor a 10, las cuales han sido clasificadas en el ensayo clínico TailorX como pacientes de bajo riesgo pasibles de ser tratadas solo con terapia hormonal adyuvante Por último, buscamos evaluar si existe correlación entre el valor de Ki 67, la invasión linfovascular (ILV) y el score del Oncotype Dx. Material y método Analizamos retrospectivamente 62 pacientes con cáncer de mama con receptores hormonales positivos, her2 Neu negativo y ganglios negativos, a las cuales se les solicitó el score de recurrencia Oncotype Dx, y comparamos con las indicaciones de terapia adyuvante surgidas previamente de factores de riesgo clínicos y anátomo-patológicos. Resultados Treinta pacientes (48,4%) presentaron score de bajo riesgo, 25 (40,3%) score de riesgo intermedio y las 7 restantes (11,3%) score de alto riesgo de recurrencia. Analizando el cambio de conducta, una vez obtenido el resultado del Oncotype Dx, encontramos un cambio de decisión en 16 pacientes (26%). Según la indicación de los factores de riesgo clínicos y anátomo-patológicos, de las 62 pacientes incluidas en este estudio, se había indicado adyuvancia con quimioterapia y hormonoterapia a 26 pacientes y hormonoterapia solamente a las 36 pacientes restantes. Posterior a la realización del Oncotype Dx, de las 26 pacientes a las cuales se les había indicado quimioterapia, en 12 se modificó el tratamiento a adyuvancia hormonal solamente (46,15% de reducción de la indicación en este grupo). Por otra parte, en aquellas 36 pacientes respecto de las cuales nuestra indicación previa había sido solamente adyuvancia hormonal, el resultado del Oncotype Dx determinó la realización de quimioterapia en 4 (11,1%). Cotejando la correlación entre Oncotype Dx y factores anátomo-patológicos, encontramos como dato interesante que todas aquellas pacientes con score de alto riesgo presentaban Ki 67 elevado, pero no a la inversa, mientras que no hallamos relación entre invasión linfovascular (ilv) presente y Oncotype Dx elevado. Conclusiones Consideramos que la utilización de plataformas genómicas como el Oncotype Dx es un elemento útil a la hora de tomar decisiones sobre el tratamiento adyuvante del carcinoma de mama Luminal con ganglios negativos, donde la indicación de la quimioterapia adyuvante debe ser cuidadosamente evaluada.
Objectives The primary objective is to analyze how the use of Oncotype Dx modifies and conditions the choice of adjuvant treatment. Second, to evaluate the evolution of those patients with score of recurrence <10 of low risk in TailorX Clinical Trial, treatable with hormonal adjuvancy only. Finally, compare correlation between lymphovascular invasion (ilv), Ki 67 and Oncotype High Dx. Materials and method We retrospectively analyzed 62 breast cancer patients with hormone receptor positive, hers Neu negative and negative lymph nodes, who were asked for the Oncotype Dx recurrence score and compared with the indications for adjuvant therapy that had previously arisen from clinical and anatomic risk factors pathological. Results Thirty patients (48.4%) presented a low risk score, 25 patients (40.3%) intermediate risk and the remaining 7 patients (11.3%), a high risk score for recurrence. Once the Oncotype Dx result was obtained, we found a decision change in 16 patients (26%). According to the indication of the clinical and anatomopathological risk factors, of the 62 patients included in this study, adjuvancy had been indicated with chemotherapy and hormone therapy to 26 patients and only hormone therapy to the remaining 36 patients. After the Oncotype Dx, of the 26 patients to whom chemotherapy had been indicated, in 12 of them the treatment was modified to hormonal adjuvancy only (46.15% reduction of the indication in this group). On the other hand, in those 36 patients that our previous indication had been only hormonal adjuvancy, the result of the Oncotype Dx determined the accomplishment of chemotherapy in 4 of them (11.1%). Comparing the correlation between Oncotype Dx and anatomopathological factors, we found that all those patients with a high risk score had elevated Ki 67, but not inversely, whereas we did not find a relation between present lymphovascular invasion (ilv) and Oncotype High Dx. Conclusions We believe that the use of genomic platforms such as Oncotype Dx is a useful element when making decisions about the adjuvant treatment of Luminal breast cancer with negative ganglia, where the indication of adjuvant chemotherapy should be carefully evaluated.
Subject(s)
Humans , Female , Breast Neoplasms , Chemotherapy, AdjuvantABSTRACT
Detection of Oncotype DX and MammaPrint has been recommended by the American Society of Clinical 0ncology.For specific populations,such as early endocrine-dependent breast cancer,under the condition of sufficient evidence in the evidence-based medicine,we can choose genetic testing in combination with clinical pathologic factors to guide clinical treatment,which has reached the goal of micro combined with macro,more detailed division of the patients,and individualized treatment.
ABSTRACT
Introducción Las plataformas genómicas han tomado gran relevancia como factores pronósticos y predictivos para definir tratamiento adyuvante en pacientes con cáncer de mama. Su uso permitiría discriminar un subgrupo de pacientes en quienes la indicación de quimioterapia podría ofrecer más morbilidad que verdadero beneficio. Objetivos Describir las características de las pacientes en quienes se utilizó la plataforma Oncotype DX® y evaluar el impacto del Score de Recurrencia (Recurrence Score) como herramienta de decisión para la indicación de adyuvancia. Material y método Se consideraron pacientes operadas entre 2013 y 2017 en el Hospital Italiano de Buenos Aires, Argentina, con diagnóstico de carcinoma invasor primario de mama de subtipo Luminal A o B, her2neu negativas. Se seleccionaron los casos en los que se solicitó Oncotype DX® y se describieron sus características clínicas e histológicas. Resultados Se utilizó Oncotype DX® en 47 pacientes con cáncer de mama invasor. En el 48,9% se obtuvo un Recurrence Score de riesgo bajo, en el 40,4% de riesgo intermedio y en el 10,6% de riesgo alto. En 22 casos (46,8%) consideramos que hubo un cambio de conducta en la indicación de adyuvancia. Conclusiones En nuestra experiencia, hemos visto que la plataforma genómica Oncotype DX® sería una herramienta útil para definir tratamiento adyuvante en tumores de tipo Luminal, her2neu negativo.
Introduction Over the past decade, gene expression assays have become relevant prognostic factors for guiding clinical decision-making in patients with breast cancer. Their use allows to discriminate which patients are most likely to benefit from chemotherapy in the adjuvant setting, avoiding unnecessary toxicity. Objectives To describe the clinical and pathologic characteristics of patients in whom Oncotype DX® was used as a prognostic factor and assess the impact of the Recurrence Score on clinical decision-making. Materials and method Patients who underwent surgery at the Hospital Italiano de Buenos Aires, Argentina, between 2013 and 2017 for Estrogen-Receptor positive (er+), her2neu negative primary breast cancer were considered eligible. We evaluated the cases in which Oncotype DX® was ordered and described the clinical and pathologic characteristics, as well as whether Recurrence Score (rs) modified the prescription of adjuvant therapy. Results Oncotype DX® was performed in 47 patients. The distribution of patients according to rs was as follows: low risk rs 48,9%, intermediate risk 40,4% and high risk 10,6%. We considered that adjuvant therapy decision was modified after rs in 22 patients (46,8%). Conclusions Oncotype DX® and its resulting Recurrence Score appear to be a clinically useful tool for decision-making in the adjuvant setting for patients with er+, her2neu negative breast cancer.
Subject(s)
Humans , Female , Breast Neoplasms , Recurrence , Therapeutics , Genomics , Drug Therapy , GenesABSTRACT
Several multi-gene assays have been developed to predict the risk of recurrence in patients with early-stage, estrogen receptor (ER) positive breast cancer. Among them, Oncotype DX 21-gene assay is widely applied among node-negative patients because of its unique prediction of therapeutic benefit. Although many retrospective stud-ies have proved its prognostic and predictive value in node-positive population, evidence from large prospective clinical trials remains insufficient. When combined with clinicopathological variables, the assay has been shown to impact adjuvant treatment decision making in a cost-effective manner. This article reviewed the available clinical evidence for the prognostic and predictive value, unique advantages, the effect on treatment decision making, cost-effectiveness and contradictories of 21-gene assay in early-stage luminal breast cancer patients.
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PURPOSE: The 21-gene (Oncotype DX) recurrence score (RS) assay is useful in predicting the benefits of adjuvant chemotherapy for early breast cancer patients and is widely used in Western countries. However, to date, it has not gained much popularity in East Asia. We analyzed the results from five institutions' experience from using the 21-gene assay and examined the impact of assay results on decision making of chemotherapy in Korean breast cancer patients and the associations between RS and clinicopathologic characteristics. MATERIALS AND METHODS: The 21-gene assay was performed on 212 patients with estrogen receptor-positive early breast cancer in five institutions. Each center made systemic treatment decisions both before and after the knowledge of assay results. RESULTS: Among the 212 patients, 132 (62.3%) had a low RS of or = 31. Histologic grade, presence of micrometastases, Ki-67, and presence of lymphatic invasion were statistically associated with the RS results. Treatment decisions were changed in 115 of 212 patients (54.2%) in 109 of 212 (51.4%) from chemotherapy plus hormone therapy to hormone therapy, and in six of 212 (2.8%) from hormone therapy to chemotherapy plus hormone therapy. CONCLUSION: The 21-gene breast cancer assay proved to have a significant impact on treatment decision- making. The test reduces chemotherapy use in more than 50% of Korean estrogen receptor-positive, early breast cancer patients.
Subject(s)
Humans , Breast Neoplasms , Chemotherapy, Adjuvant , Decision Making , Drug Therapy , Estrogens , Asia, Eastern , Korea , Neoplasm Micrometastasis , RecurrenceABSTRACT
Node negative breast cancer is a prevalent form of breast cancer .With the improvement of breast cancer screening and disease awareness ,the rates of node negative breast cancer are gradually increasing . Although node negative breast cancer patients have much lower recurrence rates as compared with node positive patients,node-negative breast cancer is unequal to a low risk disease .Thus,it is important for oncologist to esti-mate the risk factors of node negative disease ,to carry out risk assessment and to guide the best regimen for these patients.In current review ,we discuss the value of traditional prognostic factors and new prognostic factors ,such as the urokinase -type plasminogen activator/plasminogen activator inhibitor 1,oncotype DX,MammaPrint and tumor associated macrophages ,on the predictive and treatment decisions in node negative breast cancer .
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Objective To study the prognostic and predictive significance of 21-gene assay ( oncotype DX)in breast cancer.Methods Real-time quantitative PCR(RT-QPCR)was used to detect 21 gene expression in breast cancer tissues (100 cases)and recurrence score(RS)was calculated.Results Among the 100 cases, 52 cases had low RS , 22 cases had middle RS , and 26 cases had high RS .The recurrence rate of five years was 1.92%,4.55%and 15.38%respectively.21 gene expression had nothing to do with patients'age, tumor size, histological grade , lymph node metastasis state , ER expression , or PR expression .It was associated with HER 2 expression .Conclusions 21 genes is a good prediction factor in breast cancer and its prognosis .
ABSTRACT
Currently the most effective treatment strategy for breast cancer is standardized multi-discipline comprehensive treatment. However, there are no effective models that can accurately predict prognosis, so that no guidance of individualized treatment has yet been set up, resulting in a proportion of patients with low risk who received chemotherapy with little benefit. With the development of genomics, several gene sets have been demonstrated to be helpful in predicting of breast cancer prognosis and grading the patients' benefit from chemotherapy, thus avoid overtreatment. 21-gene Oncotype Dx was reported as one of them and has been demonstrated to be effective and accurate in various clinical studies. This paper summarizes researches on 21-gene Oncotype Dx in breast cancer.