Abstract
The use of Oncotype dx (Genomic Health, Redwood City, CA, U.S.A.) testing has been shown to change treatment decisions in approximately 30% of breast cancer (bca) cases, but research on how Recurrence Score testing has affected the type of chemotherapy offered is limited. We sought to determine if the availability of Oncotype dx testing resulted in a change to the type and duration of chemotherapy regimens used in the treatment of early-stage hormone receptor-positive bca. In a population-based cohort study, patients treated in the 2 years before the availability of Oncotype dx testing were compared with patients treated in the 2 years after testing availability. Charts were audited and divided into 2 groups: pre-Oncotype dx and post-Oncotype dx. The groups were compared for differences in duration of chemotherapy (12 weeks vs. >12 weeks), types of agents used (anthracycline vs. non-anthracycline), and myelosuppressive potential of the chosen regimen. Of 834 patients who fulfilled the enrolment criteria, 360 fell into the pre-Oncotype dx era, and 474, into the post-Oncotype dx era. An increase of 11.2 percentage points, to 69.5% from 58.3%, was observed in the proportion of patients receiving short-course compared with long-course chemotherapy (p = 0.068). The proportion of patients prescribed anthracycline-containing regimens declined in the post-Oncotype dx era (47.7% pre vs. 32.2% post, p = 0.016). The selection of more-myelosuppressive chemotherapy protocols increased in the post-Oncotype dx era (67.4% pre vs. 78.8% post, p = 0.044). In the present study, the availability of Oncotype dx testing was observed to influence the choice of chemotherapy type in the setting of early-stage bca.
Highlights
Recent classification by the International Association for the Study of Lung Cancer (IASLC) differentiates non-small cell lung cancer (NSCLC) with only one metastasis (M1b, stage IVA) from plurimetastatic (M1c)
The following are inclusion criteria for the study population: a pathologically proven diagnosis of NSCLC; an available Tumor Node and Metastasis (TNM) Staging; one synchronous metastasis based on the M1b staging of the 8th IASLC Classification [1]. or up to three cerebral metastases based on the methodology of the previous major phase II randomized study of Gomez et al [8]; a minimum follow-up period of 6 months; and no more than one contralateral lung metastasis
Of the 801 NSCLC patients reviewed from our databases, 643 of them had adequate documentation
Summary
Recent classification by the International Association for the Study of Lung Cancer (IASLC) differentiates non-small cell lung cancer (NSCLC) with only one metastasis (M1b, stage IVA) from plurimetastatic (M1c). “Oligometastatic disease” definition chosen is one synchronous metastasis based on the M1b staging of the eight IASLC (The International Association for the Study of Lung Cancer) Classification (within sixth months of diagnosis) or up to three cerebral metastasis based on the methodology of the previous major phase II randomized study of Gomez et al We compared the OS between patients receiving aggressive treatment at both metastatic and primary sites (Group A) and patients receiving non-aggressive treatment (Group B). Median progression-free survival (mPFS) of Group A was superior than Group B (17.5 months vs 3.4 months, p = 0.0001) This difference was still significant when controlled for primary tumor staging: stage I (p = 0.316), stage II (p = 0.024), and stage III (p = 0.001).
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