Fabinshy Thangarajah1,2, Christian Eichler3,4,5, Julia Fromme3, Wolfram Malter3,4, Julia Caroline Radosa6, Sebastian Ludwig3, Julian Puppe3, Stefan Paepke7, Matthias Warm5. 1. Department of Gynecology and Obstetrics, University of Cologne, Medical Faculty, Cologne, Germany. Fabinshy.Thangarajah@uk-koeln.de. 2. Breast Center, University of Cologne, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany. Fabinshy.Thangarajah@uk-koeln.de. 3. Department of Gynecology and Obstetrics, University of Cologne, Medical Faculty, Cologne, Germany. 4. Breast Center, University of Cologne, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany. 5. Breast Cancer Center, Municipal Hospital Holweide, Cologne, Germany. 6. Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Germany. 7. Breast Cancer Center, Technical University Munich, Munich, Germany.
Abstract
BACKGROUND: Estimating distant recurrence risk in women with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer is still challenging. EndoPredict® is a gene expression-based test predicting the likelihood of recurrent disease. We analyzed the difference in oncological decision making with and without the knowledge of gene expression tests. PATIENTS AND METHODS: This is a retrospective analysis including patients diagnosed with hormone-receptor positive, Her2 negative breast cancer between 2011 and 2015 at the Municipal Breast Cancer Centre Cologne, Germany. All patients received an evaluation by EndoPredict®. An oncological tumor board (TB) with knowledge of these results served as a baseline (control group). This baseline was compared to the treatment decision (adjuvant chemotherapy yes vs. no) made by oncologists with different experience levels (less than 5 years, between 5 and 15 years, and more than 15 years) who were not provided the EndoPredict® scores. All clinicians had access to clinical as well to histopathological data. RESULTS: There was no significant difference between control group and the oncologists with different experience levels concerning a chemotherapy indication. A trend could be shown in the subgroup of nodal negative patients between the treatment recommendation and physicians with more than 15 years of experience (p = 0.088). A further trend could be demonstrated in the subgroup of patients with a low Ki67 index (≤ 14%) (p = 0.063) between physician with 5-10 years of clinical experience and official treatment recommendation. CONCLUSION: It seems that inexperienced physicians may profit from the use of EndoPredict® to avoid an overtreatment. In nodal negative patients and patients with a low Ki67 index, undertreatment can be avoided with the use of EndoPredict® (borderline significance). Further prospective studies with larger study cohorts are needed to further validate this tool.
BACKGROUND: Estimating distant recurrence risk in women with estrogen receptor-positive, humanepidermal growth factor receptor 2 (HER2)-negative early breast cancer is still challenging. EndoPredict® is a gene expression-based test predicting the likelihood of recurrent disease. We analyzed the difference in oncological decision making with and without the knowledge of gene expression tests. PATIENTS AND METHODS: This is a retrospective analysis including patients diagnosed with hormone-receptor positive, Her2 negative breast cancer between 2011 and 2015 at the Municipal Breast Cancer Centre Cologne, Germany. All patients received an evaluation by EndoPredict®. An oncological tumor board (TB) with knowledge of these results served as a baseline (control group). This baseline was compared to the treatment decision (adjuvant chemotherapy yes vs. no) made by oncologists with different experience levels (less than 5 years, between 5 and 15 years, and more than 15 years) who were not provided the EndoPredict® scores. All clinicians had access to clinical as well to histopathological data. RESULTS: There was no significant difference between control group and the oncologists with different experience levels concerning a chemotherapy indication. A trend could be shown in the subgroup of nodal negative patients between the treatment recommendation and physicians with more than 15 years of experience (p = 0.088). A further trend could be demonstrated in the subgroup of patients with a low Ki67 index (≤ 14%) (p = 0.063) between physician with 5-10 years of clinical experience and official treatment recommendation. CONCLUSION: It seems that inexperienced physicians may profit from the use of EndoPredict® to avoid an overtreatment. In nodal negative patients and patients with a low Ki67 index, undertreatment can be avoided with the use of EndoPredict® (borderline significance). Further prospective studies with larger study cohorts are needed to further validate this tool.
Authors: Julian Puppe; Tabea Seifert; Christian Eichler; Henryk Pilch; Peter Mallmann; Wolfram Malter Journal: Breast Care (Basel) Date: 2020-07-21 Impact factor: 2.860
Authors: Carlos Martínez-Pérez; Jess Leung; Charlene Kay; James Meehan; Mark Gray; J Michael Dixon; Arran K Turnbull Journal: J Pers Med Date: 2021-06-29