Breast medical oncologists' use of standard prognostic factors to predict a 21-gene recurrence score

Arif H. Kamal, Charles Lawrence Loprinzi, Carol Reynolds, Amylou Dueck, Xochiquetzal J. Geiger, James N. Ingle, Robert W. Carlson, Timothy James Hobday, Eric P. Winer, Matthew Philip Goetz

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background. Half of all breast cancers are early stage, lymph node negative, and hormone receptor positive. A 21-gene (Oncotype DX®; Genomic Health, Inc., Redwood City, CA) recurrence score (RS) is prognostic for recurrence and predictive of chemotherapy benefit. We explored the ability of oncologists to predict the RS using standard prognostic criteria. Methods. Standard demographic and tumor prognostic criteria were obtained from patients with an available RS. Two academic pathologists provided tumor grade, histologic type, and hormone receptor status. Six academic oncologists predicted the RS category (low, intermediate, or high) and provided a recommendation for therapy. The oncologists were then given the actual RS and provided recommendations for therapy. Analysis for agreement was performed. Results. Thirty-one cases, including nine additional cases with variant pathology reads, were presented. There was substantial agreement in oncologists' ability to discriminate between true low or true intermediate and true high (κ = 0.75; p<.0001). Predictions between low and intermediate were not consistent. The most common discrepancies were predictions of a low RS risk when cases were true intermediate and predictions of an intermediate RS risk when cases were true low. The actual RS resulted in a change in the treatment recommendations in 19% of cases. Of the 186 scenarios and six oncologists in aggregate, five fewer chemotherapy recommendations resulted with the actual RS. Conclusions. Oncologists are able to differentiate between a low or intermediate RS and a high RS using standard prognostic criteria. However, provision of the actual RS changed the treatment recommendations in nearly 20% of cases, suggesting that the RS may reduce chemotherapy use. This effect was observed in particular in intermediate-risk cases. Prospective clinical trials are necessary to determine whether decisions based on the RS change outcomes.

Original languageEnglish (US)
Pages (from-to)1359-1366
Number of pages8
JournalOncologist
Volume16
Issue number10
DOIs
StatePublished - 2011

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Breast
Recurrence
Genes
Oncologists
Drug Therapy
Sequoia
Hormones
Therapeutics
Neoplasms
Lymph Nodes
Demography
Clinical Trials
Pathology
Breast Neoplasms

Keywords

  • Breast cancer
  • Recurrence disease management

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Breast medical oncologists' use of standard prognostic factors to predict a 21-gene recurrence score. / Kamal, Arif H.; Loprinzi, Charles Lawrence; Reynolds, Carol; Dueck, Amylou; Geiger, Xochiquetzal J.; Ingle, James N.; Carlson, Robert W.; Hobday, Timothy James; Winer, Eric P.; Goetz, Matthew Philip.

In: Oncologist, Vol. 16, No. 10, 2011, p. 1359-1366.

Research output: Contribution to journalArticle

Kamal, Arif H. ; Loprinzi, Charles Lawrence ; Reynolds, Carol ; Dueck, Amylou ; Geiger, Xochiquetzal J. ; Ingle, James N. ; Carlson, Robert W. ; Hobday, Timothy James ; Winer, Eric P. ; Goetz, Matthew Philip. / Breast medical oncologists' use of standard prognostic factors to predict a 21-gene recurrence score. In: Oncologist. 2011 ; Vol. 16, No. 10. pp. 1359-1366.
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title = "Breast medical oncologists' use of standard prognostic factors to predict a 21-gene recurrence score",
abstract = "Background. Half of all breast cancers are early stage, lymph node negative, and hormone receptor positive. A 21-gene (Oncotype DX{\circledR}; Genomic Health, Inc., Redwood City, CA) recurrence score (RS) is prognostic for recurrence and predictive of chemotherapy benefit. We explored the ability of oncologists to predict the RS using standard prognostic criteria. Methods. Standard demographic and tumor prognostic criteria were obtained from patients with an available RS. Two academic pathologists provided tumor grade, histologic type, and hormone receptor status. Six academic oncologists predicted the RS category (low, intermediate, or high) and provided a recommendation for therapy. The oncologists were then given the actual RS and provided recommendations for therapy. Analysis for agreement was performed. Results. Thirty-one cases, including nine additional cases with variant pathology reads, were presented. There was substantial agreement in oncologists' ability to discriminate between true low or true intermediate and true high (κ = 0.75; p<.0001). Predictions between low and intermediate were not consistent. The most common discrepancies were predictions of a low RS risk when cases were true intermediate and predictions of an intermediate RS risk when cases were true low. The actual RS resulted in a change in the treatment recommendations in 19{\%} of cases. Of the 186 scenarios and six oncologists in aggregate, five fewer chemotherapy recommendations resulted with the actual RS. Conclusions. Oncologists are able to differentiate between a low or intermediate RS and a high RS using standard prognostic criteria. However, provision of the actual RS changed the treatment recommendations in nearly 20{\%} of cases, suggesting that the RS may reduce chemotherapy use. This effect was observed in particular in intermediate-risk cases. Prospective clinical trials are necessary to determine whether decisions based on the RS change outcomes.",
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T1 - Breast medical oncologists' use of standard prognostic factors to predict a 21-gene recurrence score

AU - Kamal, Arif H.

AU - Loprinzi, Charles Lawrence

AU - Reynolds, Carol

AU - Dueck, Amylou

AU - Geiger, Xochiquetzal J.

AU - Ingle, James N.

AU - Carlson, Robert W.

AU - Hobday, Timothy James

AU - Winer, Eric P.

AU - Goetz, Matthew Philip

PY - 2011

Y1 - 2011

N2 - Background. Half of all breast cancers are early stage, lymph node negative, and hormone receptor positive. A 21-gene (Oncotype DX®; Genomic Health, Inc., Redwood City, CA) recurrence score (RS) is prognostic for recurrence and predictive of chemotherapy benefit. We explored the ability of oncologists to predict the RS using standard prognostic criteria. Methods. Standard demographic and tumor prognostic criteria were obtained from patients with an available RS. Two academic pathologists provided tumor grade, histologic type, and hormone receptor status. Six academic oncologists predicted the RS category (low, intermediate, or high) and provided a recommendation for therapy. The oncologists were then given the actual RS and provided recommendations for therapy. Analysis for agreement was performed. Results. Thirty-one cases, including nine additional cases with variant pathology reads, were presented. There was substantial agreement in oncologists' ability to discriminate between true low or true intermediate and true high (κ = 0.75; p<.0001). Predictions between low and intermediate were not consistent. The most common discrepancies were predictions of a low RS risk when cases were true intermediate and predictions of an intermediate RS risk when cases were true low. The actual RS resulted in a change in the treatment recommendations in 19% of cases. Of the 186 scenarios and six oncologists in aggregate, five fewer chemotherapy recommendations resulted with the actual RS. Conclusions. Oncologists are able to differentiate between a low or intermediate RS and a high RS using standard prognostic criteria. However, provision of the actual RS changed the treatment recommendations in nearly 20% of cases, suggesting that the RS may reduce chemotherapy use. This effect was observed in particular in intermediate-risk cases. Prospective clinical trials are necessary to determine whether decisions based on the RS change outcomes.

AB - Background. Half of all breast cancers are early stage, lymph node negative, and hormone receptor positive. A 21-gene (Oncotype DX®; Genomic Health, Inc., Redwood City, CA) recurrence score (RS) is prognostic for recurrence and predictive of chemotherapy benefit. We explored the ability of oncologists to predict the RS using standard prognostic criteria. Methods. Standard demographic and tumor prognostic criteria were obtained from patients with an available RS. Two academic pathologists provided tumor grade, histologic type, and hormone receptor status. Six academic oncologists predicted the RS category (low, intermediate, or high) and provided a recommendation for therapy. The oncologists were then given the actual RS and provided recommendations for therapy. Analysis for agreement was performed. Results. Thirty-one cases, including nine additional cases with variant pathology reads, were presented. There was substantial agreement in oncologists' ability to discriminate between true low or true intermediate and true high (κ = 0.75; p<.0001). Predictions between low and intermediate were not consistent. The most common discrepancies were predictions of a low RS risk when cases were true intermediate and predictions of an intermediate RS risk when cases were true low. The actual RS resulted in a change in the treatment recommendations in 19% of cases. Of the 186 scenarios and six oncologists in aggregate, five fewer chemotherapy recommendations resulted with the actual RS. Conclusions. Oncologists are able to differentiate between a low or intermediate RS and a high RS using standard prognostic criteria. However, provision of the actual RS changed the treatment recommendations in nearly 20% of cases, suggesting that the RS may reduce chemotherapy use. This effect was observed in particular in intermediate-risk cases. Prospective clinical trials are necessary to determine whether decisions based on the RS change outcomes.

KW - Breast cancer

KW - Recurrence disease management

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U2 - 10.1634/theoncologist.2011-0048

DO - 10.1634/theoncologist.2011-0048

M3 - Article

C2 - 21934103

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