Use of 21-Gene Recurrence Score vs Adjuvant! Online May Alter Chemotherapy Decisions in Breast Cancer
In a population-based cohort study in Ontario, Canada, reported in the Journal of Clinical Oncology, Levine et al found that use of the 21-gene recurrence score (RS) assay altered decisions regarding receipt of chemotherapy compared with use of Adjuvant! Online in patients with axillary node–negative or nodal micrometastatic, estrogen receptor–positive, HER2-negative breast cancer. The major change was from unsure about chemotherapy to no chemotherapy.
Study Details
A total of 1,000 patients were recruited from all cancer treatment centers in Ontario between January 2012 and July 2013. Oncologists made a preliminary recommendation for endocrine therapy with or without chemotherapy based on Adjuvant! Online risk estimation, and patients were asked for preference regarding chemotherapy. Patients returned for final decision-making after recurrence scores were available.
Risk Estimate Changes
Recurrence scores were available for 979 patients; among them, the risk was categorized as low in 58% (RS = 0–18), intermediate in 33% (RS = 19–30), and high in 9% (RS ≥ 31. Correlations between the 21-gene recurrence score and Adjuvant! Online risk categorization were poor (eg, Pearson r = 0.23). Of 530 patients with low risk on Adjuvant! Online, 349 (66%) had low risk by recurrence score, 159 (30%) had intermediate risk, and 22 (4%) had high risk. Of 151 patients with intermediate risk on Adjuvant! Online, 41% had low risk by recurrence score, and 44% had intermediate risk. Of 298 patients with high risk on Adjuvant! Online, 16% had high risk by recurrence score. None of 236 patients with grade I tumors had a high-risk recurrence score.
Recommendations for Chemotherapy
Oncologist recommendations after a recurrence score was obtained remained the same in 464 patients (48%), changed from unsure or chemotherapy to no chemotherapy in 365 patients (38%) and changed from unsure or no chemotherapy to chemotherapy in 143 patients (15%). After recurrence score testing, oncologists recommended chemotherapy for 236 patients, with 81% receiving it. Overall, 79% of patients with high risk by recurrence score received chemotherapy, compared with 31% of patients at high risk on Adjuvant! Online (P < .001). Patient satisfaction measured by mean total decisional conflict scale score significantly improved from pretest to post-test (P < .001).
The investigators concluded: “The recurrence score substantially influenced both oncologists’ recommendations and patients’ preferences for chemotherapy. The major effect was avoidance of chemotherapy when Adjuvant! Online indicated high or intermediate risk.”
The study was supported by the Ontario Ministry of Health and Long-Term Care.
Mark N. Levine, MD, of Hamilton Health Sciences-Juravinski Hospital, Ontario, Canada, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
