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Commercially Available Gene Expression Assays as Predictive Tools for Adjuvant Radiotherapy? A Critical Review.

David Krug1, René Baumann1,2, Wilfried Budach3

  • 1Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.

Breast Care (Basel, Switzerland)
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Summary

Gene expression assays show potential for predicting breast cancer recurrence but are not yet recommended for guiding adjuvant radiation decisions. Further research is needed to validate their role in radiotherapy selection.

Keywords:
Breast cancerGene expression assayOncotype DXPredictive markerRadiotherapy

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Area of Science:

  • Oncology
  • Genomics
  • Radiotherapy

Background:

  • Gene expression assays are vital for adjuvant chemotherapy decisions in hormone receptor-positive, HER2-negative breast cancer.
  • Clinical need exists for improved prognostic and predictive markers to guide adjuvant radiotherapy.
  • The increasing use of gene expression analysis raises questions about its utility in adjuvant radiation decision-making.

Purpose of the Study:

  • To evaluate the potential of gene expression assays in guiding adjuvant radiation decisions.
  • To assess the correlation between gene expression assay results and locoregional recurrence rates.
  • To review the predictive value of gene expression analysis for radiotherapy in various clinical settings.

Main Methods:

  • Review of multiple studies correlating gene expression assays with clinical outcomes.
  • Analysis of publications addressing the predictive value of gene expression for radiotherapy.
  • Assessment of methodological limitations and evidence for radiotherapy indication.

Main Results:

  • Multiple studies indicate a correlation between gene expression assay results and locoregional recurrence rates.
  • Few studies have specifically addressed the predictive value of gene expression analysis for adjuvant radiotherapy.
  • Current evidence is insufficient to support the use of gene expression assays for radiotherapy decisions.

Conclusions:

  • Methodological weaknesses, patient selection issues, non-randomized designs, and limited tissue availability hinder the use of gene expression assays for radiotherapy guidance.
  • The available evidence does not support incorporating gene expression assays into adjuvant radiation decision-making.
  • Cautious utilization of current knowledge is advised for clinical radiotherapy indications.