Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
AI Summary:
The study evaluated the impact of the Oncotype DX Breast Recurrence Score (RS) test on chemotherapy administration in patients with breast cancer. The results showed that the RS test had a significant impact on chemotherapy administration, particularly in patients with high-risk PREDICT scores who returned low-risk RS results.AI Topics:
Introduction:
The Oncotype DX Breast RS test has been adopted in Scotland and has been the subject of a large population-based study by a Scottish Consensus Group to assess the uptake of the recurrence score (RS), evaluate co-variates associated with the RS and to analyse the effect it may have had on clinical practice.
Materials & Methods: Pan-Scotland study between August 2018–August 2021 evaluating 833 patients who had a RS test performed as part of their diagnostic pathway. Data was extracted retrospectively from electronic records and analysis conducted to describe change in chemotherapy administration (by direct comparison with conventional risk assessment tools), and univariate/multivariate analysis to assess relationship between covariates and the RS.
Results:
Chemotherapy treatment was strongly influenced by the RS (p < 0.001). Only 30 % of patients received chemotherapy treatment in the intermediate and high risk PREDICT groups, where chemotherapy is considered. Additionally, 55.5 % of patients with a high risk PREDICT had a low RS and did not receive chemotherapy. There were 17 % of patients with a low risk PREDICT but high RS who received chemotherapy.
Multivariate regression analysis showed the progesterone receptor Allred score (PR score) to be a strong independent predictor of the RS, with a negative PR score being associated with high RS (OR 4.49, p < 0.001). Increasing grade was also associated with high RS (OR 3.81, p < 0.001). Classic lobular pathology was associated with a low RS in comparison to other tumour pathology (p < 0.01). Nodal disease was associated with a lower RS (p = 0.012) on univariate analysis, with menopausal status (p = 0.43) not influencing the RS on univariate or multivariate analysis.
Conclusions:
Genomic assays offer the potential for risk-stratified decision making regarding the use of chemotherapy. They can help reduce unnecessary chemotherapy treatment and identify a subgroup of patients with more adverse genomic tumour biology. A recent publication by Health Improvement Scotland (HIS) has updated guidance on use of the RS test for NHS Scotland [1].It suggests to limit its use to the intermediate risk PREDICT group. Our study shows the impact of the RS test in the low and high risk PREDICT groups. The implementation across Scotland has resulted in a notable shift in practice, leading to a significant reduction in chemotherapy administration in the setting of high risk PREDICT scores returning low risk RS. There has also been utility for the test in the low risk PREDICT group to detect a small subgroup with a high RS.
We have found the PR score to have a strong independent association with high risk RS. This finding was not evaluated by the key RS test papers, and the potential prognostic information provided by the PR score as a surrogate biomarker is an outstanding question that requires more research to validate.
Peters, A.L.
Author
Mactier, Karen and Baxter, Mark and Peters, Adam and Fair, Katherine and Hannington, Laura and Robertson, James and Wood, Georgina and Sarwar, Asma and Bishr, Mai and Webb, Rebekah and Al-Zubaidi, Mohammed and Eastlake, Leonie and Lankester, Kate and McInerney, Samuel and Creedon, Helen and Stillie, Alison and Purshouse, Karin (2024) TOURISM study (Treatment Outcomes in UteRIne SarcoMa): a 10-year retrospective evaluation of practice in the UK. BMJ Open, 14 (12): e094838. ISSN 2044-6055
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
Malviya, Gaurav and Lannagan, Tamsin R.M. and Johnson, Emma and Mackintosh, Agata and Bielik, Robert and Peters, Adam and Soloviev, Dmitry and Brown, Gavin and Jackstadt, Rene and Nixon, Colin and Gilroy, Kathryn and Campbell, Andrew and Sansom, Owen J. and Lewis, David Y. (2024) Noninvasive stratification of colon cancer by multiplex PET imaging. Clinical Cancer Research, 30 (8). pp. 1518-1529. ISSN 1078-0432
See full publications listHall, P.S.
Author
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listJordan, L.B.
Author
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listSoh, F.Y.
Author
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listHannington, L.
Author
Mactier, Karen and Baxter, Mark and Peters, Adam and Fair, Katherine and Hannington, Laura and Robertson, James and Wood, Georgina and Sarwar, Asma and Bishr, Mai and Webb, Rebekah and Al-Zubaidi, Mohammed and Eastlake, Leonie and Lankester, Kate and McInerney, Samuel and Creedon, Helen and Stillie, Alison and Purshouse, Karin (2024) TOURISM study (Treatment Outcomes in UteRIne SarcoMa): a 10-year retrospective evaluation of practice in the UK. BMJ Open, 14 (12): e094838. ISSN 2044-6055
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listMakaranka, S.
Author
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listUrquhart, G.
Author
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listVallet, M.
Author
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listCartwright, D.
Author
Cartwright, Douglas and Kidd, Andrew C. and Ansel, Sonam and Ascierto, Maria Libera and Spiliopoulou, Pavlina (2025) Oncogenic signalling pathways in cancer immunotherapy: leader or follower in this delicate dance? International Journal of Molecular Sciences, 26 (9): 4393. ISSN 1661-6596
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
Neilson, Lisa J. and Cartwright, Douglas and Risteli, Maija and Jokinen, Elina M. and McGarry, Lynn and Sandvik, Toni and Nikolatou, Konstantina and Hodge, Kelly and Atkinson, Samuel and Vias, Maria and Kay, Emily J. and Brenton, James D. and Carlin, Leo M. and Bryant, David M. and Salo, Tuula and Zanivan, Sara (2023) Omentum-derived matrix enables the study of metastatic ovarian cancer and stromal cell functions in a physiologically relevant environment. Matrix Biology Plus, 19-20: 100136. ISSN 2590-0285
See full publications listMarashi, H.
Author
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listElsberger, B.
Author
Peters, A.L. and Hall, P.S. and Jordan, L.B. and Soh, F.Y. and Hannington, L. and Makaranka, S. and Urquhart, G. and Vallet, M. and Cartwright, D. and Marashi, H. and Elsberger, B. (2024) Enhancing clinical decision support with genomic tools in breast cancer: a Scottish perspective. Breast, 75: 103728. ISSN 0960-9776
See full publications listAvailable under License Creative Commons Attribution.
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