Prediction of late distant recurrence in patients with oestrogen-receptor-positive breast cancer: a prospective comparison of the breast-cancer index (BCI) assay, 21-gene recurrence score, and IHC4 in the TransATAC study population
Dennis C. Sgroi,Ivana Sestak,Jack Cuzick,Yi Zhang,Catherine A. Schnabel,Brock Schroeder,Mark G. Erlander,Anita K. Dunbier,Anita K. Dunbier,Kally Sidhu,Elena Lopez-Knowles,Paul E. Goss,Mitch Dowsett +12 more
TLDR
This prospective comparison study compared the prognostic ability of the breast-cancer index (BCI) assay, 21-gene recurrence score (Oncotype DX), and an immunohistochemical prognostic model (IHC4) for both early and late recurrence in patients with oestrogen-receptor-positive, node-negative breast cancer who took part in the Arimidex, Tamoxifen, Alone or in Combination clinical trial.Abstract:
Summary Background Biomarkers to improve the risk–benefit of extended adjuvant endocrine therapy for late recurrence in patients with oestrogen-receptor-positive breast cancer would be clinically valuable. We compared the prognostic ability of the breast-cancer index (BCI) assay, 21-gene recurrence score (Oncotype DX), and an immunohistochemical prognostic model (IHC4) for both early and late recurrence in patients with oestrogen-receptor-positive, node-negative (N0) disease who took part in the Arimidex, Tamoxifen, Alone or in Combination (ATAC) clinical trial. Methods In this prospective comparison study, we obtained archival tumour blocks from the TransATAC tissue bank from all postmenopausal patients with oestrogen-receptor-positive breast cancer from whom the 21-gene recurrence score and IHC4 values had already been derived. We did BCI analysis in matched samples with sufficient residual RNA using two BCI models—cubic (BCI-C) and linear (BCI-L)—using previously validated cutoffs. We assessed prognostic ability of BCI for distant recurrence over 10 years (the primary endpoint) and compared it with that of the 21-gene recurrence score and IHC4. We also tested the ability of the assays to predict early (0–5 years) and late (5–10 years) distant recurrence. To assess the ability of the biomarkers to predict recurrence beyond standard clinicopathological variables, we calculated the change in the likelihood-ratio χ 2 (LR-Δχ 2 ) from Cox proportional hazards models. Findings Suitable tissue was available from 665 patients with oestrogen-receptor-positive, N0 breast cancer for BCI analysis. The primary analysis showed significant differences in risk of distant recurrence over 10 years in the categorical BCI-C risk groups (p 2 =22·69; p 2 =13·68; p=0·0002) and IHC4 was similar (HR 1·69 [95% CI 1·51–2·56]; LR-Δχ 2 =22·83; p 2 =15·42, p 2 =18·48, p 2 =29·14, p 2 =7·97, p=0·0048; 21-gene recurrence score HR 1·13 [0·82–1·56], LR-Δχ 2 =0·48, p=0·47; IHC4 HR 1·30 [0·88–1·94], LR-Δχ 2 =1·59, p=0·20). Interpretation BCI-L was the only significant prognostic test for risk of both early and late distant recurrence and identified two risk populations for each timeframe. It could help to identify patients at high risk for late distant recurrence who might benefit from extended endocrine or other therapy. Funding Avon Foundation, National Institutes of Health, Breast Cancer Foundation, US Department of Defense Breast Cancer Research Program, Susan G Komen for the Cure, Breakthrough Breast Cancer through the Mary-Jean Mitchell Green Foundation, AstraZeneca, Cancer Research UK, and the National Institute for Health Research Biomedical Research Centre at the Royal Marsden (London, UK).read more
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Intrinsic Subtypes of Primary Breast Cancer - Gene Expression Analysis
TL;DR: Commercially available gene expression signatures like Prosigna, MammaPrint, Oncotype DX, and EndoPredict are recommended by the Arbeitsgemeinschaft Gynäkologische Onkologie for use in selected patients.
Journal ArticleDOI
Issues Affecting the Loco‐regional and Systemic Management of Patients with Invasive Lobular Carcinoma of the Breast
Carmel Maree Jacobs,Mark Clemons,Mark Clemons,Christina L. Addison,Susan J. Robertson,Angel Arnaout,Angel Arnaout +6 more
TL;DR: Some of the unique challenges ILC presents are discussed and possible management strategies to best overcome the difficulties in the loco‐regional and systemic management of patients with ILC are discussed.
Journal ArticleDOI
Risk stratification with Breast Cancer Index for late distant recurrence in patients with clinically low-risk (T1N0) estrogen receptor-positive breast cancer.
Brock Schroeder,Yi Zhang,Olle Stål,Tommy Fornander,Adam Brufsky,Dennis C. Sgroi,Catherine A. Schnabel +6 more
TL;DR: The incremental utility of genomic classification to stratify clinically low-risk patients for late distant recurrence was evaluated using the Breast Cancer Index and findings support consideration of genomic classified patients to identify candidates for extended endocrine therapy.
Journal ArticleDOI
Adjuvant endocrine therapy for premenopausal women with hormone-responsive breast cancer
Aju Mathew,Nancy E. Davidson +1 more
TL;DR: It is suggested in aggregate that 10 years of tamoxifen are better than 5 years and that a program of extended adjuvant therapy of tamxifen for 5 years followed by aromatase inhibitor for 5 Years is effective for suitable candidates.
Journal ArticleDOI
Extended adjuvant endocrine therapy - A standard to all or some?
TL;DR: The most important issue in deciding prolonged duration of ET is undoubtfully how to identify ER+ patients who benefit most from this approach, and not only efficacy, but also toxicity of such prolonged treatment is essential for optimal use, particularly maintained compliance in a routine clinical practice.
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Marc J. van de Vijver,Yudong D. He,Laura J. van't Veer,Hongyue Dai,Augustinus A. M. Hart,D.W. Voskuil,George J. Schreiber,Johannes L. Peterse,Christopher J. Roberts,Matthew J. Marton,Mark Parrish,Douwe Atsma,Anke T. Witteveen,Annuska M. Glas,Leonie J. M. J. Delahaye,Tony van de Velde,Harry Bartelink,Sjoerd Rodenhuis,Emiel J. Th. Rutgers,Stephen H. Friend,René Bernards +20 more
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A Multigene Assay to Predict Recurrence of Tamoxifen-Treated, Node-Negative Breast Cancer
Soonmyung Paik,Steven Shak,Gong Tang,Chungyeul Kim,Joffre B. Baker,Maureen T. Cronin,Frederick L. Baehner,Michael G. Walker,Drew Watson,Taesung Park,William Hiller,Edwin R. Fisher,D. Lawrence Wickerham,John Bryant,Norman Wolmark +14 more
TL;DR: The recurrence score has been validated as quantifying the likelihood of distant recurrence in tamoxifen-treated patients with node-negative, estrogen-receptor-positive breast cancer and could be used as a continuous function to predict distant recurrent in individual patients.
Journal ArticleDOI
Gene-expression profiles to predict distant metastasis of lymph-node-negative primary breast cancer.
Yixin Wang,Jan Klijn,Yi Zhang,Anieta M. Sieuwerts,Maxime P. Look,Fei Yang,Dmitri Talantov,Mieke Timmermans,Marion E. Meijer-van Gelder,Jack X. Yu,Tim Jatkoe,Els M.J.J. Berns,David Atkins,John A. Foekens +13 more
TL;DR: The ability to identify patients who have a favourable prognosis could, after independent confirmation, allow clinicians to avoid adjuvant systemic therapy or to choose less aggressive therapeutic options.
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