Effect of PREDICT on chemotherapy/trastuzumab recommendations in HER2-positive patients with early-stage breast cancer

Abstract

PREDICT is an online prognostication tool for early-stage breast cancer, which incorporates human epidermal growth factor 2 (HER2) status and stratifies absolute treatment benefits for hormone therapy, chemotherapy and trastuzumab. The present study compared historical multidisciplinary team (MDT) decisions regarding adjuvant treatment with PREDICT estimates, to determine whether certain patients are being over- or undertreated, particularly when stratified by age and oestrogen-receptor (ER) status. HER2-positive early-stage breast cancer cases over a five-year period at the Cambridge Breast Unit (Addenbrooke’s Hospital, Cambridge, UK) were retrospectively reviewed. Patients receiving neo-adjuvant therapy were excluded. Adjuvant chemotherapy/trastuzumab recommendations based on PREDICT (<3%, no benefit; 3–5%, discuss treatment; and >5%, recommend treatment) were compared with actual MDT decisions. In total, 109 eligible patients were identified. The average age at diagnosis was 59.6 years, with 21 patients older than 70 years (19%). Four patients were predicted to gain an absolute benefit of >5% from chemotherapy/ trastuzumab, but were not offered treatment (all >70 years). Amongst the 19 patients aged >70 years predicted to benefit >3%, six were not offered treatment (32%). In the patients aged <69 years, there was evidence of overtreatment with adjuvant chemotherapy/trastuzumab in 8 out of 12 cases with <3% benefit using PREDICT. For all 20 patients with ER-negative tumours, the MDT and PREDICT decisions correlated, whilst for ER-positive cases, more than half (8 out of 14) were offered treatment despite a <3% predicted benefit. PREDICT can aid decision-making in HER2-positive early-stage breast cancer by identifying older patients at risk of undertreatment with chemotherapy/trastuzumab, and by reducing the overtreatment of patients with little predicted benefit, particularly in ER-positive disease.

Development and External Validation of Prediction Models for 10-Year Survival of Invasive Breast Cancer. Comparison with PREDICT and CancerMath

“…As already mentioned, risks between 14% and 23% correspond to absolute risk reductions from chemotherapy treatment, in the range 3-5%. In this range adjuvant chemotherapy is discussed as a treatment option (15). Risk >23% correspond to absolute risk reductions of 5% or more where chemotherapy is firmly recommended.…”

“…In practice, treatment for breast cancer is given if it is expected to reduce the predicted risk by some desired magnitude, or more. For instance, clinicians in the Cambridge Breast Unit (Addenbrooke's Hospital, Cambridge, UK) use the absolute 10-year survival benefit from chemotherapy to guide decision making for adjuvant chemotherapy as follows: <3% no chemotherapy; 3-5% chemotherapy discussed as a possible option; >5% chemotherapy recommended (15). Assuming that chemotherapy reduces the 10-year risk of death by 22% (22), a target risk reduction between 3-5%, corresponds to risks between 14% and 23% on the decision curves.…”

“…"Utility" is defined precisely below, however, conceptually, it balances the number of patients whose lives are saved against the cost of unnecessarily treating patients who would have survived anyway. In practice, adjuvant chemotherapy is recommended as a treatment option from the Cambridge Breast Unit (Addenbrooke’s Hospital, Cambridge, UK) if a patient's 10-year predicted survival probability using chemotherapy, minus their predicted probability without, is greater than 5% (15). Hence, it would be of interest to evaluate whether or not using the existing thresholds alongside the current prediction models lead to better clinical utility.…”

A Comparison of the Performance of EndoPredict Clinical and NHS PREDICT in 120 Patients Treated for ER-positive Breast Cancer

“…Adjuvant Online! and PREDICT are widely used free online predictive models that aid with adjuvant chemotherapy decisionmaking based on data generated by large cancer registries (16,42).…”

Chemotherapy effectiveness in trial-underrepresented groups with early breast cancer: A retrospective cohort study

“…decision tool, in which the clinician could specify an additional risk of mortality [13]). Mean benefit from chemotherapy and the proportion of women with benefit at or above the guideline thresholds of 3% and 5% [14] were calculated.…”