407 Requesting, Treatment and Outcomes Following Oncotype DX Testing in Breast Cancer

Abstract

Abstract Aim Oncotype DX (ODX) is a 21-gene assay for invasive breast cancer that yields a recurrence score (RS) value which indicates the risk of distant recurrence and the benefit from chemotherapy. NICE has laid down guidance regarding the criteria for test requesting which include having early breast cancer at an intermediate risk of distant recurrence that is ER-positive, HER2-negative and LN-negative. The aim of this study was to determine whether ODX was appropriately requested and followed. Treatment and outcomes were also observed. Method The study included all patients from The Countess of Chester Hospital who had undertaken ODX testing in the years 2015-2017. Patients were identified and clinicopathological data was obtained from clinic notes and pathology reports. NPI and PREDICT scores were calculated. The ODX original cut-off values were used. Results All 65 patients included in the study were ER-positive, 1 was HER2-positive and 1 was LN-positive. 9 patients had ODX requested inappropriately, all of which were low risk on both NPI and PREDICT. Chemotherapy was received by 1/32 low risk patients (RS 0-17), 6/24 intermediate risk patients (RS 18-30) and 5/5 high risk patients (RS 31-100). 57 patients had no recurrence, 2 patients had local recurrence (intermediate RS), 1 patient had distant recurrence (low RS) and 1 patient had metastasis (low RS). Chemotherapy was not received by any of the patients who experienced recurrence. Conclusions Adherence to NICE guidance regarding ODX requesting needs further emphasising. This would help reduce unnecessary patient investigation, costs, and pathology-lab workload.