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Treatment Resistant Cancers02:56

Treatment Resistant Cancers

Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
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Testing Targeted Therapies in Cancer using Structural DNA Alteration Analysis and Patient-Derived Xenografts
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Why does Oncotype DX recurrence score reduce adjuvant chemotherapy use?

Jeffrey G Schneider1, Danny N Khalil

  • 1Winthrop-University Hospital Campus of SUNY Health Sciences Center at Stony Brook, 200 Old Country Rd, Room #450, Mineola, NY 11501, USA. jschneid@winthrop.org

Breast Cancer Research and Treatment
|June 23, 2012
PubMed
Summary

The Oncotype DX recurrence score (RS) significantly reduced breast cancer adjuvant chemotherapy use. However, this score influenced treatment decisions even when it predicted a worse outcome than other methods, suggesting complex factors at play.

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Area of Science:

  • Oncology
  • Genomics
  • Clinical Decision-Making

Background:

  • The Oncotype DX recurrence score (RS) is used to guide adjuvant treatment decisions in early-stage breast cancer.
  • The precise mechanisms by which RS influences treatment utilization are not fully understood.

Purpose of the Study:

  • To investigate the impact of the Oncotype DX recurrence score on adjuvant chemotherapy decisions in node-negative breast cancer patients.
  • To explore the relationship between the RS, a calculated "prognostic delta" (P∆), and actual treatment choices.

Main Methods:

  • Retrospective chart review of 89 node-negative breast cancer patients who underwent Oncotype DX testing.
  • Calculation of a prognostic delta (P∆) by comparing RS-predicted relapse rates with Adjuvant! Online (AOL) predictions.
  • Clinician interviews to assess the influence of RS and P∆ on treatment decisions.

Main Results:

  • Adjuvant chemotherapy use decreased significantly from 61% to 26% following RS results (p < 0.0001).
  • RS was the sole significant factor associated with final adjuvant treatment choices in multivariate analysis.
  • Chemotherapy was withheld even in cases where RS indicated a less favorable prognosis compared to AOL predictions (negative P∆).

Conclusions:

  • The Oncotype DX recurrence score substantially reduces adjuvant chemotherapy use in early breast cancer.
  • The prognostic and predictive utilities of RS alone do not fully explain its impact on treatment decisions.
  • Additional factors, potentially including unintended influences, may contribute to the observed reduction in chemotherapy utilization.