Olga Kantor1, Ermilo Barrera2,3, Katherine Kopkash2,3, Catherine Pesce2,3, Ermilo Barrera2,3, David J Winchester2,3, Katharine Yao4,5. 1. Department of Surgery, University of Chicago, Chicago, IL, USA. 2. Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. 3. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA. 4. Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. kyao@northshore.org. 5. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA. kyao@northshore.org.
Abstract
BACKGROUND: The utilization of OncotypeDx in the setting of neoadjuvant chemotherapy (NCT) is not well defined. The objective of this study was to determine what proportion of hormone receptor (HR)-positive patients undergoing NCT would not benefit from chemotherapy based on OncotypeDx recurrence scores (RS) and predictors of a high RS as defined by the TAILORx trial. METHODS: The National Cancer Data Base was used to identify patients with unilateral clinical stage I-III HR+/Her2- breast cancer who had an OncotypeDx score and who had undergone NCT. Patients undergoing adjuvant chemotherapy were used as a comparison group. RESULTS: Of 307,666 patients, 41.8% had testing with OncotypeDx. Of these, 76.6% had no chemotherapy, 22.3% adjuvant chemotherapy, and 1.1% NCT. OncotypeDx testing in NCT patients increased from 4.9% in 2010 to 8.2% in 2015. Of NCT patients with OncotypeDx testing, 11.6% had RS < 11, 44.4% RS 11-25, and 43.9% RS > 25. In patients age ≤ 50 years, 14.5% had RS < 11, 12.4% RS 11-15, 31.4% RS 16-25, and 41.7% RS > 25. Predictors of RS > 25 on multivariable analysis included grade 3 tumors (odds ratio [OR] 3.83) and PR-negative tumors (OR 5.26) but not clinical T or N stage (p > 0.05). CONCLUSIONS: More than half of patients with OncotypeDx testing are being overtreated with NCT, and a third of younger patients are being overtreated. Predictors of a high RS are reliably available at core biopsy, suggesting an application of OncotypeDx in determining the need for NCT for some HR-positive breast cancers.
BACKGROUND: The utilization of OncotypeDx in the setting of neoadjuvant chemotherapy (NCT) is not well defined. The objective of this study was to determine what proportion of hormone receptor (HR)-positive patients undergoing NCT would not benefit from chemotherapy based on OncotypeDx recurrence scores (RS) and predictors of a high RS as defined by the TAILORx trial. METHODS: The National Cancer Data Base was used to identify patients with unilateral clinical stage I-III HR+/Her2- breast cancer who had an OncotypeDx score and who had undergone NCT. Patients undergoing adjuvant chemotherapy were used as a comparison group. RESULTS: Of 307,666 patients, 41.8% had testing with OncotypeDx. Of these, 76.6% had no chemotherapy, 22.3% adjuvant chemotherapy, and 1.1% NCT. OncotypeDx testing in NCT patients increased from 4.9% in 2010 to 8.2% in 2015. Of NCT patients with OncotypeDx testing, 11.6% had RS < 11, 44.4% RS 11-25, and 43.9% RS > 25. In patients age ≤ 50 years, 14.5% had RS < 11, 12.4% RS 11-15, 31.4% RS 16-25, and 41.7% RS > 25. Predictors of RS > 25 on multivariable analysis included grade 3 tumors (odds ratio [OR] 3.83) and PR-negative tumors (OR 5.26) but not clinical T or N stage (p > 0.05). CONCLUSIONS: More than half of patients with OncotypeDx testing are being overtreated with NCT, and a third of younger patients are being overtreated. Predictors of a high RS are reliably available at core biopsy, suggesting an application of OncotypeDx in determining the need for NCT for some HR-positive breast cancers.
Authors: Tal Sella; Shari I Gelber; Philip D Poorvu; Hee-Jeong Kim; Laura Dominici; Yaileen D Guzman-Arocho; Laura Collins; Kathryn J Ruddy; Rulla M Tamimi; Jeffrey M Peppercorn; Lidia Schapira; Virginia F Borges; Steven E Come; Ellen Warner; Craig Snow; Debbie M Jakubowski; Christy A Russell; Eric P Winer; Shoshana M Rosenberg; Ann H Partridge Journal: Breast Cancer Res Treat Date: 2020-11-04 Impact factor: 4.872