A breast cancer gene signature for indolent disease

Abstract

PurposeEarly-stage hormone-receptor positive breast cancer is treated with endocrine therapy and the recommended duration of these treatments has increased over time. While endocrine therapy is considered less of a burden to patients compared to chemotherapy, long-term adherence may be low due to potential adverse side effects as well as compliance fatigue. It is of high clinical utility to identify subgroups of breast cancer patients who may have excellent long-term survival without or with limited duration of endocrine therapy to aid in personalizing endocrine treatment.MethodsWe describe a new ultralow risk threshold for the 70-gene signature (MammaPrint) that identifies a group of breast cancer patients with excellent 20 year, long-term survival prognosis. Tumors of these patients are referred to as “indolent breast cancer.” We used patient series on which we previously established and assessed the 70-gene signature high–low risk threshold.ResultsIn an independent validation cohort, we show that patients with indolent breast cancer had 100% breast cancer-specific survival at 15 years of follow-up.ConclusionsOur data indicate that patients with indolent disease may be candidates for limited treatment with adjuvant endocrine therapy based on their very low risk of distant recurrences or death of breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-017-4262-0) contains supplementary material, which is available to authorized users.

Role of dynamic contrast‐enhanced MRI in evaluating the association between contralateral parenchymal enhancement and survival outcome in ER‐positive, HER2‐negative, node‐negative invasive breast cancer

“…Our results are consistent with previous literature regarding the prognostic value of Ki‐67 in breast cancer patients, and recent studies emphasizing the important role of proliferation in breast cancer prognosis, especially in ER‐positive breast cancer . Recently, an ultralow‐risk classification based on the 70‐gene signature was reported, of which 96% were Ki67‐low and 89% were designated as luminal A . Our results also support that Ki‐67 is an important prognostic parameter in ER‐positive invasive breast cancer, whereas BPE may not provide prognostic information in node‐negative tumors, which generally have a good outcome …”

“…[21][22][23][24] Recently, an ultralow-risk classification based on the 70-gene signature was reported, of which 96% were Ki67-low and 89% were designated as luminal A. 25,26 Our results also support that Ki-67 is an important prognostic parameter in ER-positive invasive breast cancer, whereas BPE may not provide prognostic information in node-negative tumors, which generally have a good outcome. 27 Recently, van der Velden reported that contralateral BPE was significantly associated with long-term outcome, particularly in ER-positive, HER2-negative invasive breast cancer patients.…”

Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study

“…Third, the interviews were conducted in a hospital setting, which could have resulted in a social desirability bias leading to under-reporting of patient and diagnostic delays and over-reporting of desirable behaviour such as self-breast examination. Fourth, it is possible that the long waiting period for some of the cases may reflect indolent breast cancer cases54 or benign breast conditions. Fifth, the study was a hospital-based study, and thus might not capture the experience of women who solely seek care elsewhere (eg, traditional or spiritual healers) or women who are seen only at primary care facilities and do not get to the hospital.…”

Prognostic value of PAM50 and risk of recurrence score in patients with early-stage breast cancer with long-term follow-up

“…Additional data derived from larger untreated (and unselected) patient series to support these results are warranted but difficult to obtain. Delahaye et al recently reported an ultralow/indolent signature based on the 70-gene signature, identifying a small subgroup of patients not receiving adjuvant treatment who had 100% 15 years of BCSS [ 30 ]. Comparison of this ultralow signature with the low-risk ROR score would be of interest.…”