Roland C Y Leung1, Thomas C C Yau1, Miranda C M Chan2, Sharon W W Chan3, Terence W C Chan4, Yvonne Y Y Tsang5, Ting Ting Wong5, Calvin Chao6, Carl Yoshizawa6, Inda S Soong7, Wing-Hong Kwan8, Carol C H Kwok9, Joyce S J Suen10, Roger K C Ngan11, Polly S Y Cheung12. 1. Division of Medical Oncology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. 2. Breast Centre, Kwong Wah Hospital, Hong Kong. 3. Kowloon East Cluster Breast Centre, United Christian Hospital, Hong Kong. 4. New Territories Cluster Breast Centre, Northern District Hospital, Hong Kong. 5. St. Paul's Hospital, Hong Kong. 6. Genomic Health, Inc, Redwood City, CA. 7. Pamela Youde Nether Sole Eastern Hospital, Hong Kong. 8. Hong Kong Sanatorium and Hospital, Hong Kong. 9. Princess Margaret Hospital, Hong Kong. 10. Prince of Wales Hospital, Hong Kong. 11. Queen Elizabeth Hospital, Hong Kong. 12. Breast Care Centre, Hong Kong Sanatorium and Hospital, Hong Kong Breast Cancer Foundation, Hong Kong. Electronic address: pollyc@pca.hk.
Abstract
BACKGROUND: The Oncotype DX Breast Cancer Assay is validated to assess risk of distant recurrence and likelihood of chemotherapy (CT) benefit in estrogen receptor-positive ESBC in various populations. In Hong Kong, > 80% of breast cancers are early stage breast cancer (ESBC) and > 60% of these women receive CT. This prospective study measured changes in CT type and recommendations, as well as physician impression of assay impact in a homogenous Chinese population. METHODS: Consecutive patients with estrogen receptor-positive, T1-3 N0-1mi M0 ESBC were offered enrollment. After surgery, physicians discussed treatment options with patients, then ordered the assay, then reassessed treatment recommendation considering assay results. Changes in treatment recommendation, CT utilization, physician confidence, and physician rating of influence on their treatment recommendations were measured. RESULTS: A total of 146 evaluable patients received pre- and post-testing treatment recommendations. CT recommendations (including changes in intensity of CT) were changed for 34 of 146 patients (23.3%; 95% confidence interval, 16.7%-31.0%); change in intensity occurred in 7 of 146 (4.8%). There were 27 changes in treatment recommendations of adding or removing CT altogether (18.5% change; 95% confidence interval, 12.6%-25.8%). CT recommendations decreased from 52.1% to 37.7%, a net absolute reduction of 14.4% (P < .001; 27.6% net relative reduction). Pre-assay, 96% of physicians agreed/strongly agreed that they were confident in their treatment recommendation; post-assay, 90% of physicians agreed/strongly agreed with the same statement. Thirty percent of physicians agreed/strongly agreed that the test had influenced their recommendation, similar to the proportion of changed recommendations. CONCLUSIONS: The Oncotype DX Assay appears to influence physician ESBC adjuvant treatment recommendations in Hong Kong.
BACKGROUND: The Oncotype DX Breast Cancer Assay is validated to assess risk of distant recurrence and likelihood of chemotherapy (CT) benefit in estrogen receptor-positive ESBC in various populations. In Hong Kong, > 80% of breast cancers are early stage breast cancer (ESBC) and > 60% of these women receive CT. This prospective study measured changes in CT type and recommendations, as well as physician impression of assay impact in a homogenous Chinese population. METHODS: Consecutive patients with estrogen receptor-positive, T1-3 N0-1mi M0 ESBC were offered enrollment. After surgery, physicians discussed treatment options with patients, then ordered the assay, then reassessed treatment recommendation considering assay results. Changes in treatment recommendation, CT utilization, physician confidence, and physician rating of influence on their treatment recommendations were measured. RESULTS: A total of 146 evaluable patients received pre- and post-testing treatment recommendations. CT recommendations (including changes in intensity of CT) were changed for 34 of 146 patients (23.3%; 95% confidence interval, 16.7%-31.0%); change in intensity occurred in 7 of 146 (4.8%). There were 27 changes in treatment recommendations of adding or removing CT altogether (18.5% change; 95% confidence interval, 12.6%-25.8%). CT recommendations decreased from 52.1% to 37.7%, a net absolute reduction of 14.4% (P < .001; 27.6% net relative reduction). Pre-assay, 96% of physicians agreed/strongly agreed that they were confident in their treatment recommendation; post-assay, 90% of physicians agreed/strongly agreed with the same statement. Thirty percent of physicians agreed/strongly agreed that the test had influenced their recommendation, similar to the proportion of changed recommendations. CONCLUSIONS: The Oncotype DX Assay appears to influence physician ESBC adjuvant treatment recommendations in Hong Kong.
Authors: Mashuk Alam Khan; Laura Henderson; Dayalan Clarke; Simon Harries; Lucie Jones Journal: Breast Care (Basel) Date: 2018-07-13 Impact factor: 2.860