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Prediction and prognosis: impact of gene expression profiling in personalized treatment of breast cancer patients.

Mallmann MR, Staratschek-Jox A, Rudlowski C, Braun M, Gaarz A, Wolfgarten M, Kuhn W, Schultze JL - EPMA J (2010)

Bottom Line: Consequently, new gene expression based prognostic and predictive tests are emerging that promise an improvement in predicting survival and therapy response.Moreover, pattern-based approaches have also been developed to predict response to endocrine therapy or particular chemotherapy regimens.Irrespective of current pitfalls such as lack of validation and standardization, these pattern-based biomarkers will prove useful for clinical decision making in the near future, especially if more patients get access to this form of personalized medicine.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics & Gynecology, Center for Integrated Oncology, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany ; LIMES (Life and Medical Sciences Bonn) Institute, Genomics and Immunoregulation, University Bonn, Carl-Troll-Strasse 31, 53115 Bonn, Germany.

ABSTRACT
Breast cancer is a complex disease, whose heterogeneity is increasingly recognized. Despite considerable improvement in breast cancer treatment and survival, a significant proportion of patients seems to be over- or undertreated. To date, single clinicopathological parameters show limited success in predicting the likelihood of survival or response to endocrine therapy and chemotherapy. Consequently, new gene expression based prognostic and predictive tests are emerging that promise an improvement in predicting survival and therapy response. Initial evidence has emerged that this leads to allocation of fewer patients into high-risk groups allowing a reduction of chemotherapy treatment. Moreover, pattern-based approaches have also been developed to predict response to endocrine therapy or particular chemotherapy regimens. Irrespective of current pitfalls such as lack of validation and standardization, these pattern-based biomarkers will prove useful for clinical decision making in the near future, especially if more patients get access to this form of personalized medicine.

No MeSH data available.


Related in: MedlinePlus

Overview of the TAILORx Trial. The TAILORx trial has been designed to evaluate the role of intermediate RS in the assignment to adjuvant hormonal therapy alone in comparison to hormonal therapy in combination with chemotherapy. Patients with ER-positive LN-negative breast cancer are stratified according to their OncotypeDX Recurrence score. Patients with a RS of less than 11 are considered for hormonal therapy only. Patients with a RS of 25 or higher are assigned to chemotherapy plus hormonal therapy. Patients with a RS between 11 and 25 are randomly assigned to chemotherapy plus hormonal therapy (the standard treatment arm) or hormonal therapy alone (the experimental-treatment arm)
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Fig5: Overview of the TAILORx Trial. The TAILORx trial has been designed to evaluate the role of intermediate RS in the assignment to adjuvant hormonal therapy alone in comparison to hormonal therapy in combination with chemotherapy. Patients with ER-positive LN-negative breast cancer are stratified according to their OncotypeDX Recurrence score. Patients with a RS of less than 11 are considered for hormonal therapy only. Patients with a RS of 25 or higher are assigned to chemotherapy plus hormonal therapy. Patients with a RS between 11 and 25 are randomly assigned to chemotherapy plus hormonal therapy (the standard treatment arm) or hormonal therapy alone (the experimental-treatment arm)

Mentions: To evaluate the effect of chemotherapy on women with midrange risk of cancer recurrence the Eastern Cooperative Oncology Group (ECOG) coordinates the TAILORx (Trial Assigning IndividuaLized Options for Treatment) Trial (Fig. 5). In this prospective study, patients are assigned to therapy according to their RS. Patients with a Recurrence Score of <11 (estimated 29% of the study population) receive antihormonal therapy, whereas patients with a Recurrence Score of >25 (estimated 27% of the study population) receive chemotherapy. About 44% of patients are considered to fall into the primary study group that contains patients with a midrange Recurrence score between 11 and 25. These patients, stratified into pre-, peri- or postmenopausal women, are randomized into a taxane-containing or a non-taxane containing chemotherapy to identify the best treatment option for this subset of patients.Fig. 5


Prediction and prognosis: impact of gene expression profiling in personalized treatment of breast cancer patients.

Mallmann MR, Staratschek-Jox A, Rudlowski C, Braun M, Gaarz A, Wolfgarten M, Kuhn W, Schultze JL - EPMA J (2010)

Overview of the TAILORx Trial. The TAILORx trial has been designed to evaluate the role of intermediate RS in the assignment to adjuvant hormonal therapy alone in comparison to hormonal therapy in combination with chemotherapy. Patients with ER-positive LN-negative breast cancer are stratified according to their OncotypeDX Recurrence score. Patients with a RS of less than 11 are considered for hormonal therapy only. Patients with a RS of 25 or higher are assigned to chemotherapy plus hormonal therapy. Patients with a RS between 11 and 25 are randomly assigned to chemotherapy plus hormonal therapy (the standard treatment arm) or hormonal therapy alone (the experimental-treatment arm)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3405335&req=5

Fig5: Overview of the TAILORx Trial. The TAILORx trial has been designed to evaluate the role of intermediate RS in the assignment to adjuvant hormonal therapy alone in comparison to hormonal therapy in combination with chemotherapy. Patients with ER-positive LN-negative breast cancer are stratified according to their OncotypeDX Recurrence score. Patients with a RS of less than 11 are considered for hormonal therapy only. Patients with a RS of 25 or higher are assigned to chemotherapy plus hormonal therapy. Patients with a RS between 11 and 25 are randomly assigned to chemotherapy plus hormonal therapy (the standard treatment arm) or hormonal therapy alone (the experimental-treatment arm)
Mentions: To evaluate the effect of chemotherapy on women with midrange risk of cancer recurrence the Eastern Cooperative Oncology Group (ECOG) coordinates the TAILORx (Trial Assigning IndividuaLized Options for Treatment) Trial (Fig. 5). In this prospective study, patients are assigned to therapy according to their RS. Patients with a Recurrence Score of <11 (estimated 29% of the study population) receive antihormonal therapy, whereas patients with a Recurrence Score of >25 (estimated 27% of the study population) receive chemotherapy. About 44% of patients are considered to fall into the primary study group that contains patients with a midrange Recurrence score between 11 and 25. These patients, stratified into pre-, peri- or postmenopausal women, are randomized into a taxane-containing or a non-taxane containing chemotherapy to identify the best treatment option for this subset of patients.Fig. 5

Bottom Line: Consequently, new gene expression based prognostic and predictive tests are emerging that promise an improvement in predicting survival and therapy response.Moreover, pattern-based approaches have also been developed to predict response to endocrine therapy or particular chemotherapy regimens.Irrespective of current pitfalls such as lack of validation and standardization, these pattern-based biomarkers will prove useful for clinical decision making in the near future, especially if more patients get access to this form of personalized medicine.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics & Gynecology, Center for Integrated Oncology, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany ; LIMES (Life and Medical Sciences Bonn) Institute, Genomics and Immunoregulation, University Bonn, Carl-Troll-Strasse 31, 53115 Bonn, Germany.

ABSTRACT
Breast cancer is a complex disease, whose heterogeneity is increasingly recognized. Despite considerable improvement in breast cancer treatment and survival, a significant proportion of patients seems to be over- or undertreated. To date, single clinicopathological parameters show limited success in predicting the likelihood of survival or response to endocrine therapy and chemotherapy. Consequently, new gene expression based prognostic and predictive tests are emerging that promise an improvement in predicting survival and therapy response. Initial evidence has emerged that this leads to allocation of fewer patients into high-risk groups allowing a reduction of chemotherapy treatment. Moreover, pattern-based approaches have also been developed to predict response to endocrine therapy or particular chemotherapy regimens. Irrespective of current pitfalls such as lack of validation and standardization, these pattern-based biomarkers will prove useful for clinical decision making in the near future, especially if more patients get access to this form of personalized medicine.

No MeSH data available.


Related in: MedlinePlus