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? | ||||
| 1 | 2 | 3 | 4 | 5 |
| Not very sensitive | Very 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? | ||||
| 1 | 2 | 3 | 4 | 5 |
| Not very strongly | Very 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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