Clinical Utility of Gene Expression Profiling Data for Clinical Decision-Making Regarding Adjuvant Therapy in Early Stage, Node-Negative Breast Cancer: A Case Report
Breast cancer is the most common malignancy among women in the United States with the second highest incidence of cancer-related death following lung cancer. The decision-making process regarding adjuvant therapy is a time intensive dialogue between the patient and her oncologist. There are multiple tools that help individualize the treatment options for a patient. Population-based analysis with Adjuvant! Online and genomic profiling with Oncotype DX are two commonly used tools in patients with early stage, node-negative breast cancer. This case report illustrates a situation in which the population-based prognostic and predictive information differed dramatically from that obtained from genomic profiling and affected the patient’s decision. In light of this case, we discuss the benefits and limitations of these tools.
References
[1]
Jemal, A.; Slegal, R.; Ward, E.; Hao, Y.; Xu, J.; Thun, M.J. Cancer statistics, 2009. CA Cancer J. Clin. 2009, 59, 225–249, doi:10.3322/caac.20006.
[2]
Adjuvant! Breast Cancer Help Files. Available online: http://www.adjuvantonline.com/breasthelp0306/breastindex.html (accessed on 25 March 2010).
[3]
Cronin, M.; Sangli, C.; Liu, M.-L.; Pho, M.; Dutta, D.; Nguyen, A.; Jeong, J.; Wu, J.; Langone, K.C.; Watson, D. Analytical Validation of the Oncotype DX genomic diagnostic test for recurrence prognosis and therapeutic response prediction in node-negative, estrogen-receptor-positive breast cancer. Clin. Chem. 2007, 53, 1084–1091.
[4]
Adjuvant! Online 2012. Available online: http://www.adjuvantonline.com/ (accessed on 01 August 2012).
[5]
Paik, S.; Shak, S.; Tang, G.; Kim, C.; Baker, J.; Cronin, M.; Baehner, F.L.; Walker, M.G.; Watson, D.; Park, T.; et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N. Engl. J. Med. 2004, 351, 2817–2826.
[6]
Paik, S.; Tang, G.; Shak, S.; Kim, C.; Baker, J.; Kim, W.; Cronin, M.; Baehner, F.L.; Watson, D.; Bryant, J.; et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J. Clin. Oncol. 2006, 24, 3726–3734.
[7]
Habel, L.A.; Shak, S.; Jacobs, M.K.; Capra, A.; Alexander, C.; Pho, M.; Baker, J.; Walker, M.; Watson, D.; Hackett, J.; 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, R25.
[8]
Henry, L.R.; Stojadinovic, A.; Swain, S.M.; Prindiville, S.; Cordes, R.; Soballe, P.W. The influence of a gene expression profile on breast cancer decisions. J. Surg. Oncol. 2009, 99, 319–323, doi:10.1002/jso.21244.
[9]
Asad, J.; Jacobson, A.F.; Estabrook, A.; Smith, S.R.; Boolbol, S.K.; Feldman, S.M.; Osborne, M.P.; Boachie-Adjei, K.; Twardzik, W.; Tartter, P.I. Does oncotype DX recurrence score affect the management of patients with early-stage breast cancer? Am. J. Surg. 2008, 196, 527–529.
[10]
Sparano, J.A. The TAILORx trial: Individualized options for treatment. Commun. Oncol. 2006, 3, 494–496, doi:10.1016/S1548-5315(11)70741-0.
[11]
Whelan, T.J.; Loprinzi, C. Physician/patient decision aids for adjuvant therapy. J. Clin. Oncol. 2005, 23, 1627–1630, doi:10.1200/JCO.2005.10.072.
