2012, Number 2
Next >>
Gac Med Mex 2012; 148 (2)
Características clinicopatológicas, pronóstico e influencia en el tratamiento adyuvante en los grupos de riesgo de recurrencia determinados por el perfil de expresión de 21 genes, Oncotype Dx®, en cáncer de mama temprano
Gerson CR, Alban TLF, Villalobos PA, Serrano OJA
Language: Spanish
References: 39
Page: 117-124
PDF size: 92.96 Kb.
ABSTRACT
Background: Adjuvant chemotherapy (ACT) reduces recurrence and mortality in breast cancer (BC); however, not all patients require ACT. Oncotype Dx
® (ODX) explores the expression of 21 genes and the risk of recurrence BC.
Objectives: To determine the clinicopathologic characteristics, prognosis, and the prescription for ACT in early BC according to ODX risk groups.
Methods: 36 patients with resected stage I-IIA BC, axillary lymph node-negative or 1-3
+, hormonal receptor (HR)-positive, HER2 negative. Three groups were designed by ODX: low (LG), medium (MG) and high-risk groups (HG).
Results: LG 23 patients (63.9%), MG eight (22.2%) and HG five (13.9%). We detected high expression of Ki-67 in MG and HG in relation to LG, 21.1 and 32.5 versus 10.1%, respectively (p = 0.007) and lower ER-positive, 85.3, 85.4 and 56.9%, respectively (p = 0.005). Recurrence score: LG 12 (0-18), MG 23 (19-27) and HG 47 (36-57); p ‹ 0.000. Pre-ODX, we planned ACT in 21/36 patients (58.3%) and post-ODX only 9/36 patients (25%) received it. No recurrences or deaths were observed in all groups.
Conclusions: In early BC, 64% have low recurrence risk. High-risk cases presented elevated Ki-67 and lower ER expression. ODX modifies the therapeutic recommendation in 57.2% of cases.
REFERENCES
Globocan 2008. International Agency for Research on Cancer. [Internet] Disponible en: http://www.dep.iarc.fr
García M, Jemal A, Ward EM, et al. Global Cancer Facts & Figures 2007. Atlanta, GA: American Cancer Society; 2007.
Cianfrocca M, Goldstein LJ. Prognostic and predictive factors in earlystage breast cancer. Oncologist. 2004;9:606-16.
Early Breast Cancer Trialist’s Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of randomized trials. Lancet. 2005;365:1687-717.
National Comprehensive Cancer Network. Breast cancer. NCCN Clinical practice guidelines in oncology 2011 v.2. [Internet] Disponible en: www.nccn.org
Lønning PE. Breast cancer prognostication and prediction: are we progress? Ann Oncol. 2007;18(suppl 8):viii3-7.
Mizra AN, Mizra NQ, Vlastos G, Singletary SE. Prognostic factors in node negative breast cancer. A review of studies with sample size more than 200 and follow-up more than 5 years. Ann Surg. 2002;235:10-26.
López-Tarruela S, Martín M. Advances in adjuvant systemic chemotherapy of early breast cancer. Breast Cancer Res. 2009;11:204-19.
Soerjomataram I, Louman MW, Ribot JG, Roukema JA, Willem J, Coebergh JW. An overview of prognostic factors for long-term survivors of breast cancer. Breast Cancer Res Treat. 2008;107:309-30.
Olivotto IA, Bajdik CD, Ravdin PM, et al. Population-based validation of the prognostic model ADJUVANT! For early breast cancer. J Clin Oncol. 2005;23:2716-25.
Perou CM, Jeffrey SS, Van de Rijn M, et al. Distinctive gene expression patterns in human mammary epithelial cells and breast cancers. Nature. 2000;96:9212-7.
Ross JS, Hatzis C, Symmans WF, Pusztai L, Hortobágyi GN. Commercialized multigene predictors of clinical outcome for breast cancer. Oncologist. 2008;13:477-93.
Marchionni L, Wilson RF, Wolff AC, et al. Systematic review: gene expression profiling assays in early stage breast cancer. Ann Intern Med. 2008;148:358-69.
Sotiriou C, Pusztai L. Gene-expression signatures in breast cancer. N Engl J Med. 2009;360:790-800.
Sparano JA, Paik S. Development of the 21-gene assay and its application in clinical practice and clinical trials. J Clin Oncol. 2008;26:721-8.
Paik S. Development and clinical utility of a 21-gene recurrence score prognostic assay in patients with early breast cancer treated with tamoxifen. Oncologist. 2007;12:631-5.
Oakman C, Bessi S, Zafarana E, Galardi F, Biganzoli L, Di Leo A. Recent advanced in systemic therapy: new diagnostic and biological predictors of outcome in early breast cancer. Breast Cancer Res. 2009;11:205.
Paik S, Shak S, Tang G, et al. A multigene assay to predict recurrence of tamoxifen-treated, node negative breast cancer. N Engl J Med. 2004;351:2817-26.
Habel LA, Shak S, Jacobs MK, et al. A population-based study of tumor gene expression and risk of breast cancer death among lymph node negative patients. Breast Cancer Res. 2006;8(3):R25.
Paik S, Tang G, Kim C, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006;24:3726-34.
Dowsett M, Cuzick J, Wale C, et al. Prediction of risk and distant recurrence using the 21-gene recurrence score in node-negative and nodepositive postmenopausal patients with breast cancer treated with anastrazol or tamoxifen: a TansATAC study. J Clin Oncol. 2010;28:1829-34.
Albain K, Barlow WE, Shak S, et al. Prognostic and predictive value of the 21-gene recurrence score assay in the randomized trial of chemotherapy for postmenopausal, node-positive, estrogen-receptor positive breast cancer. Lancet Oncol. 2010;11:55-65.
Wolf I, Ben-Baruch N, Shapira-Frommer R, et al. Association between standard clinical and pathologic characteristics and the 21-gene recurrence score in breast cancer patients: a population-based study. Cancer. 2008;112:731-6.
Ademuyiwa FO, Miller A, O´Connor T, et al. The effects of Oncotype Dx recurrence scores on chemotherapy receipt in a multi-institutional breast cancer cohort. Breast Cancer Res Treat. 2011;126:797-802.
Amwar K, Edmiston K, Khan A, Walsh W. To compare the results of adjuvant online and Oncotype Dx in estimating risk of relapse in hormone receptor positive stage I breast cancer patients. J Clin Oncol. 2008;26(supl 20):A22069.
Patel H, Hook K, Kaplan C, et al. Utilization of Oncotype Dx in nodenegative, ER-positive breast cancer patients. J Clin Oncol. 2007;25(supl 18):A11067.
Gwin K, Pinto M, Tavassoli FA. Complementary value of the Ki-67 proliferation index to the Oncotype Dx recurrence score. Int J Surg Pathol. 2009;17:303-10.
Toi M, Iwata H, Yamanaka T, et al. Clinical significance of the 21-gene signature (Oncotype Dx) in hormone receptor-positive early stage breast cancer in the Japanese population. Cancer. 2010;116: 3112-8.
Auerbach J, Kim S, Fineberg S. Can features evaluated in the routine pathologic assessment of lymph node-negative, estrogen receptor-positive, stage I or II invasive breast cancer be used to predict the Oncotype Dx recurrence score? Arch Pathol Lab Med. 2010;134:1697-701.
Asad J, Jacobson AF, Estabrook A, et al. Does oncotype Dx recurrence score affect the management in patients with early-stage breast cancer? Am J Surg. 2008;196:527-9.
Kelly CM, Krishnamurthy S, Bianchini G, et al. Utility of Oncotype Dx risk estimates in clinically intermediate risk, hormone receptor-positive, HER2 normal, grade II, lymph node-negative breast cancer. Cancer. 2010; 116:5161-7.
Geradts J, Bean SM, Bentley RC, Barry WT. The Oncotype Dx recurrence score is correlated with a composite index including routinely reported pathobiologic features. Cancer Invest. 2010;28:969-77.
Albanell J, González A, Ruiz-Borrego M, et al. Prospective transGEICAM study of the impact of the 21-gene recurrence score assay and traditional clinicopathological factor on adjuvant clinical decision making in women with estrogen receptor-positive (ER+) node-negative breast cancer. Ann Oncol. 2011 Jun 6. [Epub ahead of print].
Jung SY, Han W, Lee JW, et al. Ki-67 expression gives additional prognostic information on St. Gallen 2007 and Adjuvant! Online risk categories in early breast cancer. Ann Surg Oncol. 2009;16: 1112-21.
O´Connor SM, Beriwal S, Dabbs DJ, Bhargava R. Concordance between semiquantitative immunohistochemical assay and Oncotype Dx RT-PCR assay for estrogen and progesterone receptors. Appl Immunohistochem Mol Morphol. 2010;18:268-72.
Kamal AH, Loprinzi CL, Reynolds C, et al. How well do standard prognostic criteria predict Oncotype Dx (ODx) score? J Clin Oncol. 2007;25(supl 18s):A576.
Hanrahan EO, González-Angulo AM, Giordano SH, et al. Overall survival and cause-specific mortality of patients with stage T1a,b N0M0 breast carcinoma. J Clin Oncol. 2007;25:4952-60.
Kondo M, Hoshi SL, Yamanaka T, Ishiguro H, Toi M. Economic evaluation of the 21-gene signature (Oncotype Dx) in lymph node-negative/positive, hormone receptor-positive early stage breast cancer based on Japanese validation study (JBCRG-TR03). Breast Cancer Res Treat. 2011; 127:739-49.
Hornberger J, Cosler LE, Lymann GH. Economic analysis of targeting chemotherapy using a 21-gene RT-PCR assay in lymph node-negative, estrogen receptor-positive, early stage breast cancer. Am J Manag Care. 2005;11:313-24.