Oncotype DX results increase concordance in adjuvant chemotherapy recommendations for early-stage breast cancer

被引：0

作者：

Luca Licata

Giulia Viale

Mario Giuliano

Giuseppe Curigliano

Mariana Chavez-MacGregor

Julia Foldi

Oluchi Oke

Joseph Collins

Lucia Del Mastro

Fabio Puglisi

Filippo Montemurro

Claudio Vernieri

Lorenzo Gerratana

Sara Giordano

Alessia Rognone

Lorenzo Sica

Oreste Davide Gentilini

Stefano Cascinu

Lajos Pusztai

Antonio Giordano

Carmen Criscitiello

Giampaolo Bianchini

机构：

[1] San Raffaele Hospital,Department of Medical Oncology

[2] Vita-Salute San Raffaele University,School of Medicine and Surgery

[3] University of Naples Federico II,Department of Clinical Medicine and Surgery

[4] European Institute of Oncology,Division of New Drugs and Early Drug Development

[5] IRCCS,Department of Oncology and Hemato

[6] University of Milan,Oncology

[7] The University of Texas MD Anderson Cancer Center,Departments of Breast Medical Oncology and Health Services Research

[8] Yale School of Medicine,Section of Medical Oncology

[9] The University of Texas MD Anderson Cancer Center,Department of General Oncology

[10] South Carolina,Oncology Associates

[11] University of Genova,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine

[12] Clinical Unit of Medical Oncology,Department of Medical Oncology

[13] IRCCS Hospital Policlinico San Martino,Department of Medical Oncology

[14] Unit of Medical Oncology and Cancer Prevention,Department of Medicine (DAME)

[15] Centro di Riferimento Oncologico di Aviano (CRO) IRCCS,Breast Surgery Strategic Program

[16] University of Udine,Department of Medical Oncology

[17] Candiolo Cancer Institute,Breast Surgery Unit

[18] Fondazione del Piemonte per l’Oncologia - IRCCS,Yale Cancer Center

[19] Breast Unit,undefined

[20] Fondazione IRCCS Istituto Nazionale dei Tumori,undefined

[21] IFOM ETS - the AIRC Institute of Molecular Oncology,undefined

[22] Aviano Oncology Reference Center (IRCCS),undefined

[23] Dana-Farber Cancer Institute,undefined

[24] Harvard Medical School,undefined

[25] San Raffaele Hospital,undefined

[26] Yale School of Medicine,undefined

来源：

npj Breast Cancer | / 9卷

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摘要：

Adjuvant chemotherapy recommendations for ER+/HER2− early-stage breast cancers (eBC) involve integrating prognostic and predictive information which rely on physician judgment; this can lead to discordant recommendations. In this study we aim to evaluate whether Oncotype DX improves confidence and agreement among oncologists in adjuvant chemotherapy recommendations. We randomly select 30 patients with ER+/HER2− eBC and recurrence score (RS) available from an institutional database. We ask 16 breast oncologists with varying years of clinical practice in Italy and the US to provide recommendation for the addition of chemotherapy to endocrine therapy and their degree of confidence in the recommendation twice; first, based on clinicopathologic features only (pre-RS), and then with RS result (post-RS). Pre-RS, the average rate of chemotherapy recommendation is 50.8% and is higher among junior (62% vs 44%; p < 0.001), but similar by country. Oncologists are uncertain in 39% of cases and recommendations are discordant in 27% of cases (interobserver agreement K 0.47). Post-RS, 30% of physicians change recommendation, uncertainty in recommendation decreases to 5.6%, and discordance decreases to 7% (interobserver agreement K 0.85). Interpretation of clinicopathologic features alone to recommend adjuvant chemotherapy results in 1 out of 4 discordant recommendations and relatively high physician uncertainty. Oncotype DX results decrease discordancy to 1 out of 15, and reduce physician uncertainty. Genomic assay results reduce subjectivity in adjuvant chemotherapy recommendations for ER +/HER2− eBC.

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