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February 17, 2018 – In a new study, published in JAMA Oncology online on February 15, 2018, a comparison of the performance of 6 prognostic signatures for estrogen receptor (ER) –positive breast cancer was performed in a secondary analysis of a randomized clinical trial.
Almost all women with estrogen receptor (ER)–positive primary breast cancer are offered adjuvant endocrine therapy, and a highly relevant clinical question is who remains at high risk for distant recurrence despite completion of primary adjuvant therapy. Multigene expression profiles have significantly increased the ability to estimate distant recurrence in ER-positive breast cancer after surgery and endocrine treatment. These signatures are used in combination with different clinical characteristics to aid the selection of patients for whom chemotherapy may be appropriate based on prognosis. Several of these signatures are commercially available, including the Oncotype Dx recurrence score (RS) (Genomic Health), PAM50-based Prosigna risk of recurrence (ROR) (NanoString), Breast Cancer Index (BCI) (bioTheranostics), EndoPredict (EPclin) (Myriad Genetics), and MammaPrint Netherland Kanker Institute 70-gene signature (Agendia BV), are endorsed by several guidelines and are routinely used by clinicians.
In the present study, a within-patient comparison of the prognostic value of 6 multigene signatures in women with early ER-positive breast cancer who received endocrine therapy for 5 years was conducted. The retrospective biomarker analysis included 774 postmenopausal women with ER-positive ERBB2 (formerly HER2)–negative breast cancer. This analysis was performed as a preplanned secondary study of data from the Anastrozole or Tamoxifen Alone or Combined randomized clinical trial comparing 5-year treatment with anastrozole vs tamoxifen with 10-year follow-up data (see the study protocol and trial registration ISRCTN18233230). The analysed signatures included the Oncotype Dx recurrence score, PAM50-based Prosigna risk of recurrence (ROR), Breast Cancer Index (BCI), EndoPredict (EPclin), Clinical Treatment Score, and 4-Marker Immunohistochemical Score. Data were collected from January 2009, through April 2015.
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