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Breast cancer, early stage

4208 - 10 years follow up of the RASTER study; implementing a genomic signature in daily practice.

Date

09 Sep 2017

Session

Breast cancer, early stage

Topics

Targeted Therapy;  Breast Cancer

Presenters

Sonja Vliek

Citation

Annals of Oncology (2017) 28 (suppl_5): v43-v67. 10.1093/annonc/mdx362

Authors

S.B. Vliek1, V. Retel2, C. Drukker3, E. Rutgers3, H. van Tinteren4, M.J. van de Vijver5, J.M. Bueno-De-Mesquita1, J. Wesseling6, W. van Harten2, S.C. Linn7

Author affiliations

  • 1 Molecular Pathology, The Netherlands Cancer Institute, 1066 CX - Amsterdam/NL
  • 2 Health Technology Assessment, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 3 Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 4 Biometrics, The Netherlands Cancer Institute, 1066 CX - Amsterdam/NL
  • 5 Pathology, Academic Medical Center, 1100 DD - Amsterdam/NL
  • 6 Pathology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 7 Medical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
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Resources

Abstract 4208

Background

In 2004 the 70-gene signature, MammaPrint® (MP), developed to predict High or Low Risk of distant breast cancer (BC) recurrence, was introduced in the observational RASTER trial. Patients (cT1–3N0M0) and their doctors took the clinical Dutch guideline and MP in to account to decide on adjuvant systemic treatment (AST). Five years follow-up data confirmed the prognostic value of the MP (Drukker, Int J Cancer, 2013). In this analysis we report the outcome at 10 years.

Methods

Ten year survival data was available for all 427 Raster patients, age < 61. For the current analysis, clinical high (C-high) or low (C-low) risk was scored according to the modified version of Adjuvant! Online (Cardoso, N Engl J Med, 2016). 10-year distant-recurrence-free-interval (DRFI) probabilities were compared between risk groups based on the 70-gene signature and clinical assessment.

Results

The 70-gene signature identified 51.4% (219/427) patients with a genomic Low Risk of BC recurrence (G-low). 10-year DRFI in patients with G-low or genomic High Risk (G-high) was 93.7% and 86.8% respectively (HR 1.4; 95% confidence interval{CI] 1.0-1.9). Clinical assessment identified 57% as C-low. The 10-year DRFI was 91.7% in C-low and 88.2% in C-high (HR 1.4; 95%CI 0.8-2.6). The 10-year DRFI in the combined genomic and clinical riskgroups was 94.4% in patients with a C-low/G-Low profile, only 11.6% of them received AST. In the C-low/G-High group 10-years DRFI was 88.5%, over 90% of them received AST. For C-high risk patients 10-year DRFI was 90.9% if G-Low (n = 46) and 87.3% if G-High (n = 137). In ER-positive BC (ER+) (N = 342) 10-years DRFI was 93.6% (G-Low) versus 88.8% (G-High) (HR 1.6; 95%CI 0.8-3.3). With clinical risk assessment, 10-years DRFI in ER+ was 91.6% (C-low) versus 91.9% (C-high).

Conclusions

Patients who omitted chemotherapy based on MammaPrint Low Risk had an excellent 10 year DRFI, confirming the prognostic value of the MP. When C-high, the MP identified another 10.8% (46/426) of patients as G-Low who might forego adjuvant chemotherapy if ER+. In contrast to genomic risk stratification, the clinical risk assessment was unable to differentiate for survival between ER+ C-high and C-low risk patients.

Clinical trial identification

not applicable

Legal entity responsible for the study

S. Linn

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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