The impact of age and nodal status on variations in oncotype DX testing and adjuvant treatment

Kathleen Iles,Paula D. Strassle,Kristalyn Gallagher,Mya L. Roberson,Philip Spanheimer,David W. Ollila,Stephanie Downs-Canner

doi:10.1038/s41523-022-00394-1

Abstract

Oncotype DX (ODX) recurrence score (RS) is a validated tool to guide the use of adjuvant chemotherapy (AC) in hormone receptor+/HER2- breast cancer. In this analysis, we examine (1) characteristics associated with ODX testing and (2) the association between ODX RS and receipt of AC across age and nodal status. Women with HR+/HER2–, early-stage (T1-2, N0-1) breast cancers from 2010–2017 in the National Cancer Database were included. 530,125 met inclusion and 255,971 received ODX testing. Older women were less likely to receive testing; however, nodal positivity increased use of testing. High ODX RS was associated with increased mortality, though the association was not consistent across age and was most strongly associated with mortality among younger, node-negative women. Older women with high ODX RS, regardless of nodal status, were less likely to receive AC. Clinicians may be employing ODX RS to support treatment decisions against the receipt of AC.

Highlights

Unprecedented advances in science and technology, such as multigene expression analysis of tumors, have rapidly changed treatment paradigms for many cancers
530,125 women were diagnosed with early-stage, hormone receptor (HR)+/HER2– breast cancer were included and 255,971 (48%) of these women received an oncotype DX (ODX) recurrence score (RS) test
Our study highlights the current landscape of oncotype DX RS testing; that is, older women are less likely to receive an Oncotype DX recurrence score (ODX RS) test than their younger counterparts, but when RS testing is used in in women ≥70 years of age, it is more often performed in those with nodal positivity

Summary

Introduction

Unprecedented advances in science and technology, such as multigene expression analysis of tumors, have rapidly changed treatment paradigms for many cancers. Recurrence score (RS) (Exact Sciences., Madison, WI) is a validated prognostic and predictive tool to estimate patient risk of distant breast-cancer recurrence and guide the use of adjuvant chemotherapy in hormone receptor-positive (HR+) human epidermal growth factor receptor-2 negative (HER2–), earlystage breast cancer[1,2]. ODX RS enables personalized treatment approaches and has reduced the use of chemotherapy, which is associated with both negative short- and long-term sequela that can severely affect quality of life[12,13]. Prospective randomized control trials have shown that axillary staging and radiation therapy do not improve overall or disease-specific survival in select older women with early-stage breast cancer[14–18]. Tumor biology of older breast-cancer patients is distinct, and deimplementation of practices such as adjuvant radiation and sentinel node biopsy in low-risk patients has been slow[19–22].

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