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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Breast Cancer Index Is a Predictive Biomarker of Treatment Benefit and Outcome from Extended Tamoxifen Therapy: Final Analysis of the Trans-aTTom Study
TL;DR: The Breast Cancer Index (BCI) HOXB13/IL17BR (H/I) ratio predicts benefit from extended endocrine therapy in hormone receptor-positive (HR+) early stage breast cancer patients as mentioned in this paper .
Journal ArticleDOI
Multi-polar scripts: Techno-regulatory environments and the rise of precision oncology diagnostic tests.
TL;DR: Examination of the development and marketing of five multi-gene tests, a.k.a. as tumor signatures, designed to aid clinicians and cancer patients in therapeutic decision-making, and, in particular, to avoid overtreatment, confirms the heuristic value of the initial script-analysis but expands it to consider the multi-polar nature of the space within which multigene tests mutually position themselves.
Journal ArticleDOI
Computational approaches to support comparative analysis of multiparametric tests: Modelling versus Training
John M. S. Bartlett,John M. S. Bartlett,John M. S. Bartlett,Jane Bayani,Elizabeth N. Kornaga,Patrick Danaher,Cheryl Crozier,Tammy Piper,Cindy Q. Yao,Janet A. Dunn,Paul C. Boutros,Paul C. Boutros,Robert Stein +12 more
TL;DR: An approach is presented which can provide health care providers and researchers with the potential to perform robust and meaningful comparisons between multigene tests in a cost-effective manner and demonstrates that whilst viable estimates of gene signatures can be derived from modelling approaches, in this study using a training approach allowed a close approximation to true signature results.
Journal ArticleDOI
Late distant recurrence of breast carcinoma and metastasis to the main bronchus and choroid: A case report.
TL;DR: This case indicates that patients with HR positive breast carcinoma are more likely to develop late distant recurrence and clinicians should not ignore the follow-up examinations even more than 20 years after the surgery.
Journal ArticleDOI
Gene-expression Profiling - A Decision Impact Analysis: Decision Dependency on Oncotype DX® as a Function of Oncological Work Experience in 117 Cases.
Christian Eichler,Julia Fromme,Fabinshy Thangarajah,Julian Puppe,Stefan Paepke,Mathias Warm,Wolfram Malter +6 more
TL;DR: The likelihood of recommending chemotherapy was found to decrease with increasing oncological work experience, and it is the opinion of this study group that gene-expression testing is especially pertinent for these subgroups.
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TL;DR: The 10-year and 15-year effects of various systemic adjuvant therapies on breast cancer recurrence and survival are reported and it is found that the cumulative reduction in mortality is more than twice as big at 15 years as at 5 years after diagnosis.
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TL;DR: The gene-expression profile studied is a more powerful predictor of the outcome of disease in young patients with breast cancer than standard systems based on clinical and histologic criteria.
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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.
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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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