https://cdr.lib.unc.edu/downloads/nz8061892

Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013

https://dash.harvard.edu/bitstream/handle/1/17820849/4511219.pdf?sequence=1

Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

Currently, breast cancer affects approximately 12% of women worldwide. While the incidence of breast cancer rises with age, a younger age at diagnosis is linked to increased mortality. We discuss age related factors affecting breast cancer diagnosis, management and treatment, exploring key concepts and identifying critical areas requiring further research. We examine age as a factor in breast cancer diagnosis and treatment relating it to factors such as genetic status, breast cancer subtype, hormone factors and nodal status. We examine the effects of age as seen through the adoption of population wide breast cancer screening programs. Assessing the incidence rates of each breast cancer subtype, in the context of age, we examine the observed correlations. We explore how age affects patient's prognosis, exploring the effects of age on stage and subtype incidence. Finally we discuss the future of breast cancer diagnosis and treatment, examining the potential of emerging tests and technologies (such as microRNA) and how novel research findings are being translated into clinically relevant practices.

/pdf/effects-of-age-on-the-detection-and-management-of-breast-3x0o4jc76i.pdf

Effects of Age on the Detection and Management of Breast Cancer

Breast cancer affects approximately 12 % women worldwide and results in 14 % of all cancer-related fatalities. Breast cancer is commonly categorized into one of four main subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) positive and basal), indicating molecular characteristics and informing treatment regimes. The most severe form of breast cancer is metastasis, when the tumour spreads from the breast tissue to other parts of the body. Significantly, the primary tumour subtype affects rates and sites of metastasis. Currently, up to 5 % of patients present with incurable metastasis, with an additional 10–15 % of patients going on to develop metastasis within 3 years of diagnosis. MicroRNAs (miRNAs) are short 21–25 long nucleotides that have been shown to significantly affect gene expression. Currently, >2000 miRNAs have been identified and significantly, specific miRNAs have been found associated with diseases states. Importantly, miRNAs are found circulating in the blood, presenting an opportunity to use these circulating disease-related miRNAs as biomarkers. Clearly, the identification of circulating miRNA specific to metastatic breast cancer presents a unique opportunity for early disease identification and for monitoring disease burden. Currently however, few groups have identified miRNA associated with metastatic breast cancer. Here, we review the literature surrounding the identification of metastatic miRNA in breast cancer patients, highlighting key areas where miRNA biomarker discovery could be beneficial, identifying key concepts, recognizing critical areas requiring further research and discussing potential problems.

/pdf/metastatic-breast-cancer-the-potential-of-mirna-for-p9b6cr6pb6.pdf

Metastatic breast cancer: the potential of miRNA for diagnosis and treatment monitoring

Tumour gene expression analysis is useful in predicting adjuvant chemotherapy benefit in early breast cancer patients. This study aims to examine the implications of routine Oncotype DX testing in the UK. Women with oestrogen receptor positive (ER+), pNO or pN1mi breast cancer were assessed for adjuvant chemotherapy and subsequently offered Oncotype DX testing, with changes in chemotherapy decisions recorded. A subset of patients completed questionnaires about their uncertainties regarding chemotherapy decisions pre- and post-testing. All patients were asked to complete a diary of medical interactions over the next 6 months, from which economic data were extracted to model the cost-effectiveness of testing. Oncotype DX testing resulted in changes in chemotherapy decisions in 38 of 142 (26.8%) women, with 26 of 57 (45.6%) spared chemotherapy and 12 of 85 (14.1%) requiring chemotherapy when not initially recommended (9.9% reduction overall). Decision conflict analysis showed that Oncotype DX testing increased patients’ confidence in treatment decision making. Economic analysis showed that routine Oncotype DX testing costs £6232 per quality-adjusted life year gained. Oncotype DX decreased chemotherapy use and increased confidence in treatment decision making in patients with ER+ early-stage breast cancer. Based on these findings, Oncotype DX is cost-effective in the UK setting.

/pdf/a-decision-impact-decision-conflict-and-economic-assessment-31342egw10.pdf

A decision impact, decision conflict and economic assessment of routine Oncotype DX testing of 146 women with node-negative or pNImi, ER-positive breast cancer in the UK

The 21-gene recurrence score assay impacts adjuvant therapy recommendations for ER-positive, node-negative and node-positive early breast cancer resulting in a risk-adapted change in chemotherapy use

Background Oncotype DX® has become part of clinical routine in the diagnosis and decision-making progress in early breast cancer (EBC). Prospective data on its clinical use and impact on treatment decisions in ER-positive (ER+) node negative (N0) disease from various controlled clinical trials in different countries have been published recently. The Recurrence Score® (RS) has also been validated as a prognostic and predictive marker for patients with ER+ node positive (N+) disease. As of today no prospective data have been reported on its impact on decision making in these patients. We performed a large prospective study to evaluate RS-guided adjuvant therapy in N0 and N+ ER+ EBC. Material and Methods : Patients (pts) with ER+, HER2−negative N0 and N+ (1-3 positive lymph nodes) EBC and no contraindication for adjuvant chemotherapy were included in the study. Physicians’ adjuvant treatment recommendations and their confidence in these as well as patients’ decisional conflicts were assessed before and after knowledge of the results of the test using standardized questionnaires. Actual treatment data were collected to perform pharmacoeconomic analyses. Analyses were performed on the per-protocol population for whom a Recurrence Score result and treatment recommendations pre and post-test were available. Results : Overall 379 pts were recruited. In 11 pts Oncotype DX could not be performed and 2 pts dropped out leaving 366 pts in the per protocol population. Of these, 244 (66.7%) were N0 and 122 (33.3%) N+. Median age was 56 years (Range 25–85). Overall, 54.1% had low, 38.0% intermediate and 7.9% high RS values. For N0 disease, the distribution of RSs was 53.7%, 38.9%, 7.4% and for N+ disease 54.9%, 36.9% and 9.0%, respectively. Initial treatment recommendation changed in 33.1% of all cases; 30.3% in N0 and 38.5% in N+ disease, and in 36.4% for pts with low, 30.9% with intermediate and 20.7% with high RSs. In 21.6% of all pts a recommendation for adjuvant chemoendocrine therapy (CHT) was changed to endocrine therapy (HT), 10.7% of recommendations changed from HT to CHT. For N0 disease change rates were 18.4% from CHT to HT and 11.5% from HT to CHT. For N+ disease 27.9% of recommendations changed from CHT to HT and 9.0% of recommendations changed from HT to CHT. In 25% of all, 22% of N0 and 39% of N+ pts initially recommended HT the post-RS recommendation changed to CHT; in 38% of all, 39% of N0 and 37% of N+ pts initially recommended CHT the recommendation changed to HT. Overall, physicians’ confidence increased in 45.1% of all (p=0.047) and 44.7 of N0 and 45.9% of N+ cases, respectively. There was a moderate decrease of the decisional conflict score in all pts and subgroups that reached statistical significance for all pts (p=0.029) and the low RS subgroup (p=0.003). Conclusions : Results of this large prospective study show an impact of the RS on adjuvant treatment decision making in German clinical practice for patients with ER+ EBC. Recommendations were predominantly changed from chemoendocrine to endocrine adjuvant therapy resulting in a net reduction of chemotherapy usage. This effect was more pronounced for patients with 1–3 positive nodes. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-26.

P2-12-26: Impact of the Recurrence Score on Adjuvant Decision-Making in ER-Positive Early Breast Cancer – Results of a Large Prospective Multicentre Decision Impact Study in Node Negative and Node Positive Disease.

Endokrine Therapielandschaft bei prämenopausalen Patientinnen mit HR+ HER2- frühem Mammakarzinom vor Einführung der CDK4/6-Inhibitor-Behandlung in Deutschland – eine Real-World-Analyse

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Papers

The 21-gene recurrence score assay impacts adjuvant therapy recommendations for ER-positive, node-negative and node-positive early breast cancer resulting in a risk-adapted change in chemotherapy use

P2-12-26: Impact of the Recurrence Score on Adjuvant Decision-Making in ER-Positive Early Breast Cancer – Results of a Large Prospective Multicentre Decision Impact Study in Node Negative and Node Positive Disease.

Endokrine Therapielandschaft bei prämenopausalen Patientinnen mit HR+ HER2- frühem Mammakarzinom vor Einführung der CDK4/6-Inhibitor-Behandlung in Deutschland – eine Real-World-Analyse