The Era of Multigene Panels Comes? The Clinical Utility of Oncotype DX and MammaPrint

Abstract

The AJCC Cancer Staging Manual, eighth edition published in late 2016, will become the new global guideline for cancer diagnosis and treatment from January 1, 2018. The new edition for the tumor staging system has numerous updates, including building up the prognostic stage group of tumors for the first time and adding a large number of non-anatomical factors into the prognostic evaluation. Oncotype DX and MammaPrint are two of the genomic predictors that will be part of routine clinical practice in the future. Numerous studies have proved the clinical utility of multigene panels in predicting clinical outcome and treatment response. Here we present our review of the studies on these multigene panels and their application to breast cancer.

The Utility of Oncotype DX for Adjuvant Chemotherapy Treatment Decisions in Estrogen Receptor-positive, Human Epidermal Growth Factor Receptor 2-negative, Node-negative Breast Cancer

“…The final decision regarding the delivery of chemotherapy was based on the RS over a patient's PREDICT or NPI score. This practice, which enabled the MDT to safely spare patients from adjuvant chemotherapy treatment, is a strategy supported by published data that suggests that ODX is superior to other clinicopathological factors at identifying patients who may not benefit from chemotherapy [12]. In addition, as a tool for risk stratifying women with ER-positive, node-negative breast cancer, ODX testing has been shown to be superior to the utilisation of clinicopathological factors [13][14][15].…”

Adjuvant Systemic Treatment in Hormone Receptor Positive, HER2 Negative Breast Cancer

“…RS can predict chemotherapy sensitivity in patients with ER+, node-negative breast cancer [6]. Paik et al studied 651 cases of breast cancer who were enrolled in NSABP B-20 and randomly assigned them into a TAM group and a TAM combined with the chemotherapy group [chemotherapy regimen for cyclophosphamide & methotrexate & fluorouracil (CMF) or MF regimen, TAM + CMF/MF group] [4].…”

Long-term prognostic and predictive factors in hormone receptor positive breast cancer

“…One of the first genomic assays developed for this purpose was MammaPrint, which combines the gene expression of 70 genes [54]. It requires freshly frozen tissue collected into an RNA preservative solution, which makes it more complex to conduct than other panels [55]. Although MammaPrint has been shown to have prognostic significance, it performs best as a predictor of distant metastasis during the first 5 years after treatment.…”

“…A mathematical computation of the weighted expression of each gene results in a recurrence score which may be divided into three categories with low, intermediate and high risk [55]. BCI is another algorithmic gene expressionbased signature which also divides the patients into three groups, but involving fewer genes [60].…”

“…Several genomic predictors are already, or will be, part of routine clinical practice in the future [55,63]. Even though they have been shown to add predictive significance for early-stage breast cancer, there are some limitations.…”