Prognostic utility of the 21-gene assay in hormone receptor-positive operable breast cancer compared with classical clinicopathologic features

Lori J. Goldstein, Robert Gray, Sunil Badve, Barrett H. Childs, Carl Yoshizawa, Steve Rowley, Steven Shak, Frederick L. Baehner, Peter M. Ravdin, Nancy E. Davidson, George W. Sledge, Edith A. Perez, Lawrence N. Shulman, Silvana Martino, Joseph A. Sparano

Research output: Contribution to journalArticle

Abstract

Purpose: Adjuvant! is a standardized validated decision aid that projects outcomes in operable breast cancer based on classical clinicopathologic features and therapy. Genomic classifiers offer the potential to more accurately identify individuals who benefit from chemotherapy than clinicopathologic features. Patients and Methods: A sample of 465 patients with hormone receptor (HR) -positive breast cancer with zero to three positive axillary nodes who did (n = 99) or did not have recurrence after chemohormonal therapy had tumor tissue evaluated using a 21-gene assay. Histologic grade and HR expression were evaluated locally and in a central laboratory. Results: Recurrence Score (RS) was a highly significant predictor of recurrence, including node-negative and node-positive disease (P <.001 for both) and when adjusted for other clinical variables. RS also predicted recurrence more accurately than clinical variables when integrated by an algorithm modeled after Adjuvant! that was adjusted to 5-year outcomes. The 5-year recurrence rate was only 5% or less for the estimated 46% of patients who have a low RS (<18). Conclusion: The 21-gene assay was a more accurate predictor of relapse than standard clinical features for individual patients with HR-positive operable breast cancer treated with chemohormonal therapy and provides information that is complementary to features typically used in anatomic staging, such as tumor size and lymph node involvement. The 21-gene assay may be used to select low-risk patients for abbreviated chemotherapy regimens similar to those used in our study or high-risk patients for more aggressive regimens or clinical trials evaluating novel treatments.

Original languageEnglish (US)
Pages (from-to)4063-4071
Number of pages9
JournalJournal of Clinical Oncology
Volume26
Issue number25
DOIs
StatePublished - 2008
Externally publishedYes

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Hormones
Breast Neoplasms
Recurrence
Genes
Drug Therapy
Decision Support Techniques
Therapeutics
Neoplasms
Lymph Nodes
Clinical Trials

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Prognostic utility of the 21-gene assay in hormone receptor-positive operable breast cancer compared with classical clinicopathologic features. / Goldstein, Lori J.; Gray, Robert; Badve, Sunil; Childs, Barrett H.; Yoshizawa, Carl; Rowley, Steve; Shak, Steven; Baehner, Frederick L.; Ravdin, Peter M.; Davidson, Nancy E.; Sledge, George W.; Perez, Edith A.; Shulman, Lawrence N.; Martino, Silvana; Sparano, Joseph A.

In: Journal of Clinical Oncology, Vol. 26, No. 25, 2008, p. 4063-4071.

Research output: Contribution to journalArticle

Goldstein, LJ, Gray, R, Badve, S, Childs, BH, Yoshizawa, C, Rowley, S, Shak, S, Baehner, FL, Ravdin, PM, Davidson, NE, Sledge, GW, Perez, EA, Shulman, LN, Martino, S & Sparano, JA 2008, 'Prognostic utility of the 21-gene assay in hormone receptor-positive operable breast cancer compared with classical clinicopathologic features', Journal of Clinical Oncology, vol. 26, no. 25, pp. 4063-4071. https://doi.org/10.1200/JCO.2007.14.4501
Goldstein, Lori J. ; Gray, Robert ; Badve, Sunil ; Childs, Barrett H. ; Yoshizawa, Carl ; Rowley, Steve ; Shak, Steven ; Baehner, Frederick L. ; Ravdin, Peter M. ; Davidson, Nancy E. ; Sledge, George W. ; Perez, Edith A. ; Shulman, Lawrence N. ; Martino, Silvana ; Sparano, Joseph A. / Prognostic utility of the 21-gene assay in hormone receptor-positive operable breast cancer compared with classical clinicopathologic features. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 25. pp. 4063-4071.
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T1 - Prognostic utility of the 21-gene assay in hormone receptor-positive operable breast cancer compared with classical clinicopathologic features

AU - Goldstein, Lori J.

AU - Gray, Robert

AU - Badve, Sunil

AU - Childs, Barrett H.

AU - Yoshizawa, Carl

AU - Rowley, Steve

AU - Shak, Steven

AU - Baehner, Frederick L.

AU - Ravdin, Peter M.

AU - Davidson, Nancy E.

AU - Sledge, George W.

AU - Perez, Edith A.

AU - Shulman, Lawrence N.

AU - Martino, Silvana

AU - Sparano, Joseph A.

PY - 2008

Y1 - 2008

N2 - Purpose: Adjuvant! is a standardized validated decision aid that projects outcomes in operable breast cancer based on classical clinicopathologic features and therapy. Genomic classifiers offer the potential to more accurately identify individuals who benefit from chemotherapy than clinicopathologic features. Patients and Methods: A sample of 465 patients with hormone receptor (HR) -positive breast cancer with zero to three positive axillary nodes who did (n = 99) or did not have recurrence after chemohormonal therapy had tumor tissue evaluated using a 21-gene assay. Histologic grade and HR expression were evaluated locally and in a central laboratory. Results: Recurrence Score (RS) was a highly significant predictor of recurrence, including node-negative and node-positive disease (P <.001 for both) and when adjusted for other clinical variables. RS also predicted recurrence more accurately than clinical variables when integrated by an algorithm modeled after Adjuvant! that was adjusted to 5-year outcomes. The 5-year recurrence rate was only 5% or less for the estimated 46% of patients who have a low RS (<18). Conclusion: The 21-gene assay was a more accurate predictor of relapse than standard clinical features for individual patients with HR-positive operable breast cancer treated with chemohormonal therapy and provides information that is complementary to features typically used in anatomic staging, such as tumor size and lymph node involvement. The 21-gene assay may be used to select low-risk patients for abbreviated chemotherapy regimens similar to those used in our study or high-risk patients for more aggressive regimens or clinical trials evaluating novel treatments.

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