Abstract 186P
Background
21-gene Recurrence Score Assay (OncotypeDx®, RSA) testing is strongly recommended to guide adjuvant chemotherapy in HR+/HER2- early breast cancer (eBC). However, it is not available for all patients. At our site, RSA has been offered since 2012, initially according to a set of regionally defined criteria and with a limited number of tests. Following TAILORx reports, criteria broadened and the number of tests expanded. Here, we investigated whether a high agreement between oncologists might overcome the added value of RSA testing in a real-world scenario.
Methods
Six staff oncologists of the Breast Cancer Section independently completed a survey on a retrospective series of consecutive patients with HR+/HER2- eBC. Patients had been surgically treated at Hospital del Mar between 2016 and 2019. We addressed three questions: 1) The degree of agreement between oncologists (based on patient age, pTNM, histology, grade, ER/PR levels, and Ki67) on whether chemotherapy (CHT) should have been discussed with the patient besides hormone therapy (HT). High agreement (HiA) was considered if ≥ 5 oncologists agreed either for CHT or for HT, and the rest was considered low agreement (LoA); 2) The proportion of RSA testing in HiA compared to LoA cases; and 3) In patients with HiA that had undergone RSA testing, the rate of change in adjuvant therapy recommendation.
Results
We included 291 patients, of which 44% had undergone RSA testing. Mean age was 61 (range 35-91), 75% had stage I and 18% N1 disease. HiA was reached in 80% of cases (234/291): 72% for HT and 28% for CHT. RSA was ordered for 35% (82/234) of HiA cases (49% for HT and 51% for CHT) compared with 82% (47/57) of LoA cases (p<0.001). In the HiA subgroup that had undergone RSA testing, 79% (33/42) of cases with HiA for CHT received HT alone, while 13% (5/40) with HiA for HT received CHT, leading to an overall rate of change of 46% in therapy recommendation after RSA.
Conclusions
Oncologists highly agreed on adjuvant therapy recommendations in 80% of cases. RSA testing was more frequent in LoA cases. High agreement between oncologists was not sufficient to overcome the need for RSA testing in driving adjuvant treatment in eBC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
Funding
Has not received any funding.
Disclosure
M. Castro-Henriques: Advisory/Consultancy, Non-remunerated activity/ies: Roche; Speaker Bureau/Expert testimony: MSD; Travel/Accommodation/Expenses: Sanofi. D. Casadevall Aguilar: Travel/Accommodation/Expenses: Roche; Travel/Accommodation/Expenses: Pfizer. M. Martinez-Garcia: Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche; Travel/Accommodation/Expenses: Pfizer; Advisory/Consultancy, Travel/Accommodation/Expenses: Celgene; Speaker Bureau/Expert testimony: Pierre Fabre. I. Tusquets Trias Bes: Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche; Advisory/Consultancy, Speaker Bureau/Expert testimony: Roche Diagnostics; Advisory/Consultancy: Pfizer; Advisory/Consultancy: Celgene; Speaker Bureau/Expert testimony: AstraZeneca. J. Albanell: Advisory/Consultancy: Roche; Advisory/Consultancy: Amgen; Advisory/Consultancy: Pfizer; Advisory/Consultancy: MSD; Advisory/Consultancy: Genomic Health; Advisory/Consultancy: Palex. S. Servitja: Advisory/Consultancy, Travel/Accommodation/Expenses: Roche; Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca; Advisory/Consultancy, Travel/Accommodation/Expenses: Pfizer; Advisory/Consultancy: MSD; Advisory/Consultancy: Genomic Health. All other authors have declared no conflicts of interest.