Abstract
Magee Equations™ are multivariable models that can estimate oncotype DX® Recurrence Score, and Magee Equation 3 has been shown to have chemopredictive value in the neoadjuvant setting as a standalone test. The current study tests the accuracy of Magee Decision Algorithm™ using a large in-house database. According to the algorithm, if all Magee Equation scores are <18, or 18–25 with a mitosis score of 1, then oncotype testing is not required as the actual oncotype recurrence score is expected to be ≤25 (labeled “do not send”). If all Magee Equation scores are 31 or higher, then also oncotype testing is not required as the actual score is expected to be >25 (also “do not send”). All other cases could be considered for testing (labeled “send”). Of the 2196 ER+, HER2-negative cases sent for oncotype testing, 1538 (70%) were classified as “do not send” and 658 (30%) as “send”. The classification accuracy in the “do not send” group was 95.1%. Of the 75 (4.9%) discordant cases (expected score ≤25 by decision algorithm but the actual oncotype score >25), 26 received endocrine therapy alone. None of these 26 patients experienced distant recurrence (average follow-up of 73 months). The Magee Decision Algorithm accurately identifies cases that will not benefit from oncotype testing. Such cases constitute ~70% of the routine clinical oncotype requests, an estimated saving of $300,000 per 100 test requests. The occasional discordant cases (expected ≤25, but actual oncotype score >25) appears to have an excellent outcome on endocrine therapy alone.
Highlights
Several molecular tests are regularly used in the management of breast cancer in routine clinical practice.This study was presented at San Antonio Breast Cancer Symposium, December 10–14, 2019, and to be presented more completely at the United States and Canadian Academy of Pathology, February 29–March 5, 2020
Based on earlier studies that utilized tissue blocks from National Surgical Adjuvant Breast and Bowel Project B-14 and B-20 clinical trials, oncotype clinical risk categories were defined as low-risk, intermediate-risk, and high-risk [1, 2]
According to the algorithm (Fig. 1), if all Magee EquationsTM (ME) scores are
Summary
Several molecular tests are regularly used in the management of breast cancer in routine clinical practice.
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