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Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

2741 - The Impact of the 21 Gene Recurrence Score (RS) on Chemotherapy (CHemoRx) Prescribing in Hormone Receptor (HR) Positive, Lymph Node Positive (LN+) Early-Stage Breast Cancer (BC) in Ireland: A National, Multi-centre, Prospective Study (CTRIAL-IE 15-34)

Date

22 Oct 2018

Session

Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

Presenters

Anees Hassan

Citation

Annals of Oncology (2018) 29 (suppl_8): viii58-viii86. 10.1093/annonc/mdy270

Authors

A. Hassan1, N. Keegan1, C. O'Leary1, L. McSorley1, T. Mahgoub1, S. O'Reilly2, J. Walshe3, M.J. Kennedy4, L. Coate5, M. O’connor6, M. Keane7, C.M. Kelly8, M. Milewski1, S. Molloy1, K. Eagan1, V. Murphy9, O.S. Breathnach1, L. Grogan1, B. Hennessy1, P.G. Morris1

Author affiliations

  • 1 Cancer Clinical Trials And Research Unit, Beaumont Hospital, Dublin 9, Ireland, Dublin 9 - Dublin/IE
  • 2 Department Of Medical Oncology, Cork University Hospital, Cork - Cork/IE
  • 3 Department Of Medical Oncology, St Vincent's University Hospital, Dublin 4 - Dublin/IE
  • 4 Oncology Directorate, St James's Hospital, Dublin/IE
  • 5 Department Of Medical Oncology, Mid-western Cancer Centre, Uhl, University Hospital Limerick, Dooradoyle/IE
  • 6 Department Of Medical Oncology, University Hospital Waterford, Waterford/IE
  • 7 Department Of Medical Oncology, University Hospital Galway, Galway/IE
  • 8 Department Of Medical Oncology, Mater Misericordiae University Hospital University College Dublin, 7 - Dublin/IE
  • 9 Translational Research Unit, Cancer Trials Ireland, Dublin/IE
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Resources

Abstract 2741

Background

The 21 gene RS has improved the selection of patients (pts) for ChemoRx in early BC. Internationally, the RS is used in LN+ disease, but has not been reimbursed for this indication in Ireland. We conducted a prospective study to determine the extent to which use of the RS could alter Oncologists’ ChemoRx recommendations in pts with LN+ BC.

Methods

Eligible patients had 1-3 LN+, HR+ HER2- BC. All pts gave written informed consent. Baseline demographics were collected. Questionnaires were completed by a Consultant Oncologist before and after the RS, which examined expectations of tumour chemo-sensitivity, strength of ChemoRx recommendation and type of planned ChemoRx. The primary endpoint was the % reduction in pts recommended ChemoRx (N = 75).

Results

RS was available on 74/75 pts; median age 54 (range 32-78) years. Most pts had T1 (43%) / T2 (47%), grade 2 (72%) tumours with 1 LN + (68%). The RS was <11 in 10 (13%), 11-25 in 56 (76%) and >25 in 8 (11%) pts. Access to the RS led to a 27% reduction in ChemoRx recommendations from 68 (92%) to 48 (65%) pts. This was most notable in pts with 1 LN + (46 vs 24) and 2 LN + (13 vs 7). Access to the RS led to a reduction in physician perception of tumour chemosensitivity and strength of ChemoRx recommendation (Table). Use of the RS led to a decrease in Anthracycline (A)-Taxane (T) ChemoRx (30 vs 17 pts) and T-based ChemoRx (30 vs 21 pts) with a resultant increase in non-A, non-T ChemoRx (8 vs 10 pts). The use of the RS did not impact on ChemoRx recommendations in women <40yrs (all got ChemoRx). The biggest reduction in ChemoRx occurred in women age 51-70 with 1LN + (28 vs 18 pts). Overall, in 47 (64%) cases, Oncologists thought the RS significantly changed their treatment recommendations.Table: 208P

Physician questionnaires before and after RS
1. How sensitive will the tumour be to ChemoRx?
12345
Not very sensitiveVery sensitive
Before RS
10 (13)32 (43)21 (28)10 (13)1 (1)
After RS
21 (28)26 (35)15 (20)11 (15)5 (7)
2. How strongly do you recommend ChemoRx?
12345
Not very stronglyVery strongly
Before RS
7 (9)22 (30)20 (27)20 (27)5 (7)
After RS
23 (31)16 (22)10 (13)21 (28)4 (5)

Conclusions

Broader access to the 21 gene RS could result in a reduction in the use of ChemoRx in Ireland.

Clinical trial identification

Legal entity responsible for the study

Cancer Trials Ireland.

Funding

Genomic Health Company.

Editorial Acknowledgement

Disclosure

P.G. Morris: Honoraria: Genomic Health Company. All other authors have declared no conflicts of interest.

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