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Genomic Tests Guiding the Adjuvant Systemic Therapy in Women with Breast Cancer

Siyana Gradanska, Maria Dzhinova, Vasil Yordanov, Miglena Balcheva

Abstract

Introduction: The decision to initiate adjuvant chemotherapy after surgery in patients with estrogen receptor-positive and lymph node-negative early stage breast cancer, has traditionally been guided by clinical and pathological factors (characteristics of the patient and the tumor), in conjunction with the clinician’s and the patient’s preferences. Many of these patients are exposed to adjuvant chemotherapy toxicity and cost with little or no clinical benefit, and identifying those who do benefit, remains a challenge. Gene-expression profiling is an emerging clinical strategy which evaluates cancer recurrence risk by using genomic information in order to support better decision-making about adjuvant chemotherapy.

Materials and Methods: In this research we analyzed three types of gene-expression-profiling tests of breast cancer. A multigene immunohistochemistry-based test, known as MammoStrat, classifies breast cancer patients into low-, moderate- or high-risk categories for disease recurrence. The MammaPrint assay is a seventy-gene signature developed using tumor tissue from young women (less than fifty-five years of age) with node-negative disease. OncotypeDX is a twenty-one-gene-expression profiling that provides a probability of recurrence score for women with early stage (Stage I or II), estrogen receptor-positive, node-negative breast cancer, and categorizes patients as low-, intermediate- , or high- risk for distant metastasis in the next five to ten years.

Results: A high-risk result is correlated with distant breast cancer recurrence rate, hormone therapy benefit, and chemotherapy benefit. A lower score is correlated with a lower risk of distant breast cancer recurrence, lower benefit of chemotherapy, and greater benefit of hormone therapy.

Conclusion: Use of gene-expression profiling along with clinical and pathological classification of early-stage breast cancer provides the physician with additional information about adjuvant systemic therapy in these patients in order to maximize efficacy and minimize adverse side effects.


Keywords

breast cancer, systemic therapy


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