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The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer.

Exner R, Bago-Horvath Z, Bartsch R, Mittlboeck M, Retèl VP, Fitzal F, Rudas M, Singer C, Pfeiler G, Gnant M, Jakesz R, Dubsky P - Br. J. Cancer (2014)

Bottom Line: Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy.The use of MP was also found to be more cost effective.The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

ABSTRACT

Background: Validated multigene signatures (MGS) provide additional prognostic information when evaluating clinical features of ER(+), HER2(-) early breast cancer. We have studied the quantitative and qualitative impact of MGS on multidisciplinary team (MDT) recommendations.

Methods: We prospectively recruited 75 ER(+), HER2(-) breast cancer patients. Inclusion was based on biopsy assessment of grade, hormone receptor status, HER2, clinical tumour and nodal status. A fresh tissue sample was sent for MammaPrint (MP), TargetPrint analysis at surgery. Clinical risk was decided by the MDT in the absence of MP results and repeated following the collection of MP results. Decision changes were recorded and a health technology assessment was undertaken to compare cost effectiveness.

Results: The majority of patients were assigned low to intermediate clinical risk by the MDT. According to MP, 76% were low risk. A very high correlation between local IHC and the TargetPrint assessment was shown. In over a third of patients, discordance between clinical and molecular risk was observed. Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy. The use of MP was also found to be more cost effective.

Conclusions: The multigene signature MP revealed clinical and molecular risk discordance in a third of patients. The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy. The use of MGS is unlikely to have an impact in either clinically low-risk women or in patients with more than one relative indication for chemotherapy.

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Correlation of proliferation (MIB-1) and gene expression analysis MammaPrint (MP).
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fig1: Correlation of proliferation (MIB-1) and gene expression analysis MammaPrint (MP).

Mentions: All locally assessed IHC results were compared with the TargetPrint assay (both assessing ER/PgR and Her2). There were highly significant correlations between IHC and target prints (ER: rs=0.47, P<0.0001, PgR: rs=0.72, P<0.0001, Her2: rs=0.29, P=0.0135). Local IHC analysis of Ki67 also highly correlated with MP results (P<0.0001; Table 2 and Figure 1).


The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer.

Exner R, Bago-Horvath Z, Bartsch R, Mittlboeck M, Retèl VP, Fitzal F, Rudas M, Singer C, Pfeiler G, Gnant M, Jakesz R, Dubsky P - Br. J. Cancer (2014)

Correlation of proliferation (MIB-1) and gene expression analysis MammaPrint (MP).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150264&req=5

fig1: Correlation of proliferation (MIB-1) and gene expression analysis MammaPrint (MP).
Mentions: All locally assessed IHC results were compared with the TargetPrint assay (both assessing ER/PgR and Her2). There were highly significant correlations between IHC and target prints (ER: rs=0.47, P<0.0001, PgR: rs=0.72, P<0.0001, Her2: rs=0.29, P=0.0135). Local IHC analysis of Ki67 also highly correlated with MP results (P<0.0001; Table 2 and Figure 1).

Bottom Line: Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy.The use of MP was also found to be more cost effective.The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Medical University of Vienna and Comprehensive Cancer Centre Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

ABSTRACT

Background: Validated multigene signatures (MGS) provide additional prognostic information when evaluating clinical features of ER(+), HER2(-) early breast cancer. We have studied the quantitative and qualitative impact of MGS on multidisciplinary team (MDT) recommendations.

Methods: We prospectively recruited 75 ER(+), HER2(-) breast cancer patients. Inclusion was based on biopsy assessment of grade, hormone receptor status, HER2, clinical tumour and nodal status. A fresh tissue sample was sent for MammaPrint (MP), TargetPrint analysis at surgery. Clinical risk was decided by the MDT in the absence of MP results and repeated following the collection of MP results. Decision changes were recorded and a health technology assessment was undertaken to compare cost effectiveness.

Results: The majority of patients were assigned low to intermediate clinical risk by the MDT. According to MP, 76% were low risk. A very high correlation between local IHC and the TargetPrint assessment was shown. In over a third of patients, discordance between clinical and molecular risk was observed. Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy. The use of MP was also found to be more cost effective.

Conclusions: The multigene signature MP revealed clinical and molecular risk discordance in a third of patients. The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy. The use of MGS is unlikely to have an impact in either clinically low-risk women or in patients with more than one relative indication for chemotherapy.

Show MeSH
Related in: MedlinePlus