The influence of 21-gene recurrence score assay on chemotherapy use in a population-based sample of breast cancer patients

Details

• Alternative Title:
  Breast Cancer Res Treat
• Personal Author:
  Li, Yun ; Kurian, Allison W. ; Bondarenko, Irina ; Taylor, Jeremy M.G. ; Jagsi, Reshma ; Ward, Kevin C. ; Hamilton, Ann S. ; Katz, Steven J. ; Hofer, Timothy P.
• Description:
  Purpose
  
  To quantify the influence of RS assay on changing chemotherapy plans in a general practice setting use using causal inference methods.
  
  Methods
  
  We surveyed 3,880 newly-diagnosed breast cancer patients in Los Angeles and Georgia in 2013-14. We used inverse propensity weighting and multiple imputations to derive complete information for each patient about treatment status with and without testing.
  
  Results
  
  Half of the 1,545 women eligible for testing (ER+ or PR+, HER2−, and stage I-II) received RS. We estimate that 30% (95% confidence interval (CI): 10% - 49%) of patients would have changed their treatment selections after RS assay, with 10% (CI: 0%-20%) being encouraged to undergo chemotherapy and 20% (CI: 10% -30%) being discouraged from chemotherapy. The subgroups whose treatment selections would be changed the most by RS were patients with positive nodes (44%; CI: 24% - 64%), larger tumor (43% for tumor size >2 cm; CI: 23% - 62%) or younger age (41% for <50 years, CI: 23% - 58%). The assay was associated with a net reduction in chemotherapy use by 10% (CI: 4% - 16%). The reduction was much greater for women with positive nodes (31%; CI: 21% - 41%), larger tumor (30% for tumor size >2 cm; CI: 22% - 38%) or younger age (22% for <50 years; CI: 9% - 35%).
  
  Conclusion
  
  RS substantially changed chemotherapy treatment selections with the largest influence among patients with less favorable pre-test prognosis. Whether this is optimal awaits the results of clinical trials addressing the utility of RS testing in selected subgroups.
  
  
• Subjects:
  Adult Aged Antineoplastic Combined Chemotherapy Protocols Biomarkers, Tumor Breast Neoplasms Female Humans Middle Aged Neoplasm Grading Neoplasm Metastasis Neoplasm Recurrence, Local Neoplasm Staging Pharmacogenomic Testing Risk Factors SEER Program Young Adult

  More +
• Source:
  Breast Cancer Res Treat. 161(3):587-595.
• Pubmed ID:
  28012085
• Pubmed Central ID:
  PMC5243200
• Document Type:
  Journal Article
• Funding:
  HHSN261201000035C/PC,CA/None/None ; HHSN261201000140C/CA/NCI NIH HHS/United States ; P01 CA163233/CA/NCI NIH HHS/United States ; U58 DP003875/DP/NCCDPHP CDC HHS/United States ; HHSN261201300015C/RC/CCR NIH HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; U58 DP003862/DP/NCCDPHP CDC HHS/United States
• Volume:
  161
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:b8977ef2a7021cae75dc23720e8f035523cb2d847984e65bf15ee31fee59d005
• Download URL:
  https://stacks.cdc.gov/view/cdc/43926/cdc_43926_DS1.pdf
• File Type:
  [PDF - 260.28 KB ]