J Loncaster1, A Armstrong1, S Howell1, G Wilson1, R Welch2, A Chittalia1, W J Valentine3, N J Bundred4. 1. The Christie Hospital, Department of Medical Oncology, 550 Wilmslow Rd, Manchester, M20 4BX, UK. 2. The Christie Hospital, Department of Medical Oncology, 550 Wilmslow Rd, Manchester, M20 4BX, UK; Bolton Hospital NHS Foundation Trust, Bolton Breast Unit, Minerva Rd, Farnworth, Bolton, BL4 0JR, UK. 3. Ossian Health Economics and Communications, Bäumleingasse 20, 4051 Basel, Switzerland. 4. Institute of Cancer Sciences, University of Manchester, Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK; University Hospital of South Manchester, Department of Surgery, Southmoor Road, Manchester, M23 9LT, UK. Electronic address: nigel.bundred@manchester.ac.uk.
Abstract
BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) recommended the Oncotype DX® Breast Recurrence Score® (RS) assay as an option for informing adjuvant chemotherapy decisions in node-negative, oestrogen receptor (ER)+, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer assessed to be at intermediate risk of recurrence based on clinicopathological factors. We evaluated the impact of RS testing on adjuvant chemotherapy decision-making in routine clinical practice in a UK Cancer Network. METHODS: RS testing was performed in 201 females with newly diagnosed, ER+, HER2-negative, invasive breast cancer who underwent breast surgery with curative intent, were calculated to have a >3% overall survival benefit at 10 years from adjuvant chemotherapy based on PREDICT, and were considered for adjuvant chemotherapy. The impact of RS testing on adjuvant treatment decisions/associated cost was assessed. RESULTS: In all patients, the multi-disciplinary team recommended chemotherapy but the RS result allowed 127/201 patients (63.2%) to avoid unnecessary adjuvant chemotherapy. Amongst ER+, HER2-negative, node-negative patients (eligible for Oncotype DX testing in UK guidelines), 60.3% were spared chemotherapy. In node-positive patients, the assay reduced the use of chemotherapy by 69.2%. The use of RS testing to guide treatment in these 201 patients was associated with significant cost saving (when considering the cost of RS testing for all patients plus chemotherapy and its associated cost for 74 patients). CONCLUSIONS: Incorporating RS testing into routine clinical practice for selected node-negative and node-positive breast cancer patients significantly reduces the use of chemotherapy (p < 0.001) with its associated morbidity and costs.
BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) recommended the Oncotype DX® Breast Recurrence Score® (RS) assay as an option for informing adjuvant chemotherapy decisions in node-negative, oestrogen receptor (ER)+, humanepidermal growth factor receptor 2 (HER2)-negative early breast cancer assessed to be at intermediate risk of recurrence based on clinicopathological factors. We evaluated the impact of RS testing on adjuvant chemotherapy decision-making in routine clinical practice in a UK Cancer Network. METHODS: RS testing was performed in 201 females with newly diagnosed, ER+, HER2-negative, invasive breast cancer who underwent breast surgery with curative intent, were calculated to have a >3% overall survival benefit at 10 years from adjuvant chemotherapy based on PREDICT, and were considered for adjuvant chemotherapy. The impact of RS testing on adjuvant treatment decisions/associated cost was assessed. RESULTS: In all patients, the multi-disciplinary team recommended chemotherapy but the RS result allowed 127/201 patients (63.2%) to avoid unnecessary adjuvant chemotherapy. Amongst ER+, HER2-negative, node-negative patients (eligible for Oncotype DX testing in UK guidelines), 60.3% were spared chemotherapy. In node-positive patients, the assay reduced the use of chemotherapy by 69.2%. The use of RS testing to guide treatment in these 201 patients was associated with significant cost saving (when considering the cost of RS testing for all patients plus chemotherapy and its associated cost for 74 patients). CONCLUSIONS: Incorporating RS testing into routine clinical practice for selected node-negative and node-positive breast cancerpatients significantly reduces the use of chemotherapy (p < 0.001) with its associated morbidity and costs.
Authors: Mashuk Alam Khan; Laura Henderson; Dayalan Clarke; Simon Harries; Lucie Jones Journal: Breast Care (Basel) Date: 2018-07-13 Impact factor: 2.860
Authors: Nicholas Acuna; Jesse J Plascak; Jennifer Tsui; Antoinette M Stroup; Adana A M Llanos Journal: Int J Environ Res Public Health Date: 2021-05-12 Impact factor: 3.390