A Study of the Impact of the 21-Gene Breast Cancer Assay on the Use of Adjuvant Chemotherapy in Women With Breast Cancer in a Mexican Public Hospital

Bargalló-Rocha, Juan Enrique; Lara, Fernando; Dulin, R.J. Shaw; Pérez-Sánchez, Víctor Manuel; Villarreal-Garza, C.; Maldonado-Martínez, Héctor Aquiles; Mohar‐Betancourt, Alejandro; Yoshizawa, C.; Burke, Emily; Chao, Calvin

doi:10.1016/s0923-7534(20)32853-2

Cited by 8 publications

(9 citation statements)

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“…Similar rates were reported in studies from different parts of the world such as Mexico (45%), Hong Kong (50.7%), United Arab Emirates (53.2%), Turkey (57%), and the United States (59%) [14][15][16][17][18].…”

Section: Discussionsupporting

confidence: 84%

“…More recently, the value of ODX assay was investigated prospectively in the TAILOR-X trial. Patients with midrange RS (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) were randomly assigned to receive either chemo-endocrine therapy or endocrine therapy alone. Results showed that ACT did not improve the outcome of these patients [6].…”

Section: Introductionmentioning

confidence: 99%

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Adjuvant Chemotherapy for Patients with Breast Cancer Based on Clinical and Evolving Oncotype DX Criteria

et al. 2020

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Introduction: Oncotype DX assay recurrence score (ODX-RS) cutoff values have recently changed after the publication of the TAILOR-X trial results. We aim to explore decisions for adjuvant chemotherapy (ACT) based on physicians' clinical assessment and the evolving ODX-RS. Methodology: Patients who underwent ODX testing after curative surgical resection of estrogen receptor positive (ER+), Her2 non-overexpressed (Her2-) and lymph node-negative (LN-) breast cancer (BC) were eligible. Management of these patients was guided by the results of the old ODX-RS-1 (< 18, 18-30, and ≥31) risk grouping. For the purpose of this study, treatment decisions were also assumed according to TAILOR-X results (ODX-RS-2). Decisions of 3 medical oncologists on ACT were solicited by blinding them to the RS to investigate concordance with ODXA RS-1 and 2 recommendations. Results: Sixty-six consecutive patients were included. Median age was 50.5 (range: 21-73) years. There was 1 male patient, and 37/65 females (56.9%) were premenopausal. Among the 3 oncologists, recommendations for ACT based on clinical assessment were discrepant in 29 (43.9%) patients. Based on majority consensus (≥2 oncologists), ACT would have been recommended to 22/41 (53.7%) and 22/46 (47.82%) patients with low-risk tumors according to ODX-RS-1 and ODX-RS-2, respectively. Compared to ODX-RS-1, ODX-RS-2 identifies 12% (46 vs. 41) more low-risk patients and 66% (20 vs. 12 patients) more high-risk patients. Conclusion: Overtreatment and discrepancies in the management of patients with ER+/ Her2-/LN-early BC can be minimized by the implementation of ODX genomic assay. Some differences in ACT recommendations exist between ODX-RS-1 and ODX-RS-2.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Adjuvant Chemotherapy for Patients with Breast Cancer Based on Clinical and Evolving Oncotype DX Criteria

et al. 2020

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“…37% of treatment recommendations remained after knowledge of the Recurrence Score in women originally recommended to undergo HT + CT; thus, 63% of women were spared treatments including CT. While our results are marginally higher than other studies, these higher values may be reflective of higher perceived risk prior to Recurrence Score or higher histologic tumor grade (30% grade III vs 12%‐19%, P < .001) …”

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confidence: 93%

The impact of 21‐Gene Recurrence Score test and classic clinical‐pathologic factors in guiding adjuvant therapy for HER‐2 negative, ER‐positive, early‐stage breast cancer: A retrospective study

Palleiro

Waltier

2020

Breast J

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“… 19 - 38 One such study conducted in Mexico (N = 96; node-negative and node-positive breast cancer) showed that knowledge of RS results led to a 28% reduction in recommendations for chemotherapy at one center. 24 Another study (N = 551; node-negative and node-positive breast cancer) showed that physicians in Peru made treatment recommendations in line with RS results such that the rate of chemotherapy recommendations increased with RS groups of higher risk (13% with RS 0-17, 77% with RS 18-30, and 98% with RS 31-100). 39 …”

Section: Introductionmentioning

confidence: 99%

“…16,18 The clinical utility of the Breast Recurrence Score test, or the capacity of the test to change clinical practice and improve outcomes of patients with node-negative or node-positive breast cancer in a costeffective manner, has been demonstrated in numerous studies conducted worldwide. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] One such study conducted in Mexico (N = 96; node-negative and node-positive breast cancer) showed that knowledge of RS results led to a 28% reduction in recommendations for chemotherapy at one center. 24 Another study (N = 551; node-negative and node-positive breast cancer) showed that physicians in Peru made treatment recommendations in line with RS results such that the rate of chemotherapy recommendations increased with RS groups of higher risk (13% with RS 0-17, 77% with RS 18-30, and 98% with RS 31-100).…”

Section: Introductionmentioning

confidence: 99%

Practice-Changing Use of the 21-Gene Test for the Management of Patients With Early-Stage Breast Cancer in Latin America

Gómez

Bargalló-Rocha

Billinghurst

et al. 2021

JCO Global Oncology

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PURPOSE We present a physician survey of the impact of 21-gene Breast Recurrence Score test results on treatment decisions in clinical practice in Latin America. METHODS This prospective survey enrolled consecutive patients at 14 sites in Argentina, Colombia, Mexico, and Peru who had routine 21-gene testing. Physician surveys captured patient and tumor characteristics and treatment decisions before and after 21-gene test results. The survey spanned the period before and after Trial Assigning Individualized Options for Treatment (TAILORx) results reported (June 2018). Overall net percent change in adjuvant chemotherapy recommendations was estimated, and asymptotic 95% CIs with continuity correction were calculated. The proportion with a change between pretest treatment recommendation and actual treatment received was calculated overall and by Recurrence Score groups per TAILORx. RESULTS Between March 2015 and December 2019, the survey was completed for 647 patients; 20% were node-positive. The mean patient age was 54 years (24-85 years); 55% were postmenopausal; 17%, 63%, and 20% had grade 1, 2, and 3 tumors, respectively; and 30% had tumors > 2 cm. Recurrence Score (RS) results were as follows: 20% RS 0-10, 56% RS 11-25, and 24% RS 26-100. Overall, chemotherapy recommendations fell by a relative proportion of 39% (95% CI, 33.4 to 44.3) after 21-gene testing (33% decrease in node-negative and 55% decrease in node-positive). Among node-negative patients, the relative decrease in chemotherapy recommendations was 28% (95% CI, 18.9 to 39.5) before TAILORx and 36% (95% CI, 28.4 to 43.7) after. CONCLUSION To our knowledge, this large survey of 21-gene test practice patterns was the first conducted in Latin America and showed the relevance of 21-gene testing in low- and medium-resource countries to minimize chemotherapy overuse and underuse in breast cancer. The results showed substantial reductions in chemotherapy use overall—especially after TAILORx reported—indicating the practice-changing potential of that study.

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A Study of the Impact of the 21-Gene Breast Cancer Assay on the Use of Adjuvant Chemotherapy in Women With Breast Cancer in a Mexican Public Hospital

Cited by 8 publications

References 0 publications

Adjuvant Chemotherapy for Patients with Breast Cancer Based on Clinical and Evolving Oncotype DX Criteria

Adjuvant Chemotherapy for Patients with Breast Cancer Based on Clinical and Evolving Oncotype DX Criteria

The impact of 21‐Gene Recurrence Score test and classic clinical‐pathologic factors in guiding adjuvant therapy for HER‐2 negative, ER‐positive, early‐stage breast cancer: A retrospective study

Practice-Changing Use of the 21-Gene Test for the Management of Patients With Early-Stage Breast Cancer in Latin America

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