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01-03-2019 | Breast Oncology

OncotypeDX Recurrence Score Does Not Predict Nodal Burden in Clinically Node Negative Breast Cancer Patients

Authors: S. E. Tevis, MD, R. Bassett, MS, I. Bedrosian, MD, C. H. Barcenas, MD, MSc, D. M. Black, MD, A. S. Caudle, MD, MS, S. M. DeSnyder, MD, E. Fitzsullivan, MD, K. K. Hunt, MD, H. M. Kuerer, MD, PhD, A. Lucci, MD, F. Meric-Bernstam, MD, E. A. Mittendorf, MD, PhD, K. Park, MD, M. Teshome, MD, A. M. Thompson, MD, R. F. Hwang, MD

Published in: Annals of Surgical Oncology | Issue 3/2019

Abstract

Background

OncotypeDX recurrence score (RS)^® has been found to predict recurrence and disease-free survival in patients with node negative breast cancer. Whether RS is useful in guiding locoregional therapy decisions is unclear. We sought to evaluate the relationship between RS and lymph node burden.

Methods

Patients with invasive breast cancer who underwent sentinel lymph node dissection from 2010 to 2015 were identified from a prospectively maintained database. Patients were excluded if they were clinically node positive or if they received neoadjuvant chemotherapy. RS was classified as low (< 18), intermediate (18–30), or high (> 30). The association between RS, lymph node burden, and disease recurrence was evaluated. Statistical analyses were performed in R version 3.4.0; p < 0.05 was considered significant.

Results

A positive SLN was found in 168 (15%) of 1121 patients. Completion axillary lymph node dissection was performed in 84 (50%) of SLN-positive patients. The remaining 84 (50%) patients had one to two positive SLNs and did not undergo further axillary surgery. RS was low in 58.5%, intermediate in 32.6%, and high in 8.9%. RS was not associated with a positive SLN, number of positive nodes, maximum node metastasis size, or extranodal extension. The median follow-up was 23 months. High RS was not associated with locoregional recurrence (p = 0.07) but was significantly associated with distant recurrence (p = 0.0015).

Conclusions

OncotypeDX RS is not associated with nodal burden in women with clinically node-negative breast cancer, suggesting that RS is not useful to guide decisions regarding extent of axillary surgery for these patients.

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Paik S, Shak S, Tang G, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 2004;351(27):2817–26.CrossRef

Habel LA, Shak S, Jacobs MK, et al. A population-based study of tumor gene expression and risk of breast cancer death among lymph node-negative patients. Breast Cancer Res. 2006;8(3):R25.CrossRefPubMedPubMedCentral

Paik S, Tang G, Shak S, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006;24(23):3726–34.CrossRef

Sparano JA, Gray RJ, Makower DF, et al. Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med. 2015;373(21):2005–14.CrossRefPubMedPubMedCentral

Haffty BG, Buchholz TA. Molecular predictors of locoregional recurrence in breast cancer: ready for prime time? J Clin Oncol. 2010;28(10):1627–9.CrossRefPubMed

Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;2:111–21.CrossRef

Mamounas EP, Tang G, Fisher B, et al. Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J Clin Oncol. 2010;28(10):1677–83.CrossRefPubMedPubMedCentral

Mamounas EP, Tang G, Paik S, et al. 21-Gene Recurrence Score for prognosis and prediction of taxane benefit after adjuvant chemotherapy plus endocrine therapy: results from NSABP B-28/NRG Oncology. Breast Cancer Res Treat. 2017;1:69–77.

Roberts MC, Miller DP, Shak S, Petkov VI. Breast cancer-specific survival in patients with lymph node-positive hormone receptor-positive invasive breast cancer and Oncotype DX Recurrence Score results in the SEER database. Breast Cancer Res Treat. 2017;163(2):303–10.CrossRefPubMed

10.

Mamounas EP, Liu Q, Paik S, et al. 21-Gene recurrence score and locoregional recurrence in node-positive/ER-positive breast cancer treated with chemo-endocrine therapy. J Natl Cancer Inst. 2017;109(4).

11.

Albain KS, Barlow WE, Shak S, et al. Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial. Lancet Oncol. 2010;11(1):55–65.CrossRefPubMed

12.

Nitz U, Gluz O, Christgen M, et al. Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial. Breast Cancer Res Treat. 2017;165(3):573–83.CrossRefPubMedPubMedCentral

13.

Ramsey SD, Barlow WE, Gonzalez-Angulo AM, et al. Integrating comparative effectiveness design elements and endpoints into a phase III, randomized clinical trial (SWOG S1007) evaluating oncotypeDX-guided management for women with breast cancer involving lymph nodes. Contemporary Clin Trials. 2013;34(1):1–9.CrossRef

14.

Cardoso F, van’t Veer LJ, Bogaerts J, et al. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med. 2016;375(8):717–29.CrossRef

15.

Stemmer SM, Steiner M, Rizel S, et al. Clinical outcomes in ER + HER2 -node-positive breast cancer patients who were treated according to the Recurrence Score results: evidence from a large prospectively designed registry. NPJ Breast Cancer. 2017;3:32.CrossRefPubMedPubMedCentral

16.

Sparano JA, Solin LJ. Defining the clinical utility of gene expression assays in breast cancer: the intersection of science and art in clinical decision making. J Clin Oncol. 2010;28(10):1625–7.CrossRefPubMed

17.

Turashvili G, Chou JF, Brogi E, et al. 21-Gene recurrence score and locoregional recurrence in lymph node-negative, estrogen receptor-positive breast cancer. Breast Cancer Res Treat. 2017;166(1):69–76.CrossRefPubMedPubMedCentral

18.

Turashvili G, Brogi E, Morrow M, et al. Breast carcinoma with 21-gene recurrence score lower than 18: rate of locoregional recurrence in a large series with clinical follow-up. BMC Cancer. 2018;18(1):42.CrossRefPubMedPubMedCentral

19.

Pan H, Gray R, Braybrooke J, et al. 20-Year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med. 2017;377(19):1836–46.CrossRefPubMedPubMedCentral

Title: OncotypeDX Recurrence Score Does Not Predict Nodal Burden in Clinically Node Negative Breast Cancer Patients
Authors: S. E. Tevis, MD
R. Bassett, MS
I. Bedrosian, MD
C. H. Barcenas, MD, MSc
D. M. Black, MD
A. S. Caudle, MD, MS
S. M. DeSnyder, MD
E. Fitzsullivan, MD
K. K. Hunt, MD
H. M. Kuerer, MD, PhD
A. Lucci, MD
F. Meric-Bernstam, MD
E. A. Mittendorf, MD, PhD
K. Park, MD
M. Teshome, MD
A. M. Thompson, MD
R. F. Hwang, MD
Publication date: 01-03-2019
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 3/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-7059-4

At a glance: The STEP trials

Springer Medicine

OncotypeDX Recurrence Score Does Not Predict Nodal Burden in Clinically Node Negative Breast Cancer Patients

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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