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move over ONCODX--Harvard utilizing poor man's version
Dr. Slamon has said that OncoDx does not tell much more than well-performed testing for ER, PR, her2 and Ki-67. Now it seems Harvard has
tried to see if just the first three are about as good as gene expression profiling to classify tumors into the four main subtypes and classify them by prognosis. Interestingly these results preceed herceptin.
The study was based on lumpectomy with radiation therapy treated patients and the good news was that there was less than 10% local recurrence in all subgroups of patients. (good margins had been obtained) These figures may be useful in counselling, they say. Would love for them to look at larger numbers of patients and include Ki-67. Interestingly in their study her2+er+ metastasized more often than her2+er- probably because chemo without herceptin worked less well for the her2+er+s than for the her2+er-s, something which is no longer the case when herceptin is added according to the North American and HERA adjuvant herceptin trials.
This seems to show that less expensive testing can still give lots of useful
information
J Clin Oncol. 2008 Apr 14 [Epub ahead of print]
Breast Cancer Subtype Approximated by Estrogen Receptor, Progesterone Receptor, and HER-2 Is Associated With Local and Distant Recurrence After Breast-Conserving Therapy.
Nguyen PL, Taghian AG, Katz MS, Niemierko A, Abi Raad RF, Boon WL, Bellon JR, Wong JS, Smith BL, Harris JR.
Harvard Radiation Oncology Program, Departments of Radiation Oncology and Surgery, Massachusetts General Hospital, Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, and Harvard Medical School, Boston, MA.
PURPOSE: To determine whether breast cancer subtype is associated with outcome after breast-conserving therapy (BCT) consisting of lumpectomy and radiation therapy. PATIENTS AND METHODS: We studied 793 consecutive patients with invasive breast cancer who received BCT from July 1998 to December 2001. Among them, 97% had pathologically negative margins of resection, and 90% received adjuvant systemic therapy. No patient received adjuvant trastuzumab. Receptor status was used to approximate subtype: estrogen receptor (ER) or progesterone receptor (PR) positive and human epidermal growth factor receptor 2 negative = luminal A; ER+ or PR+ and HER-2+ = luminal B; ER- and PR - and HER-2+ = HER-2; and ER- and PR - and HER-2- = basal. Competing risks methodology was used to analyze time to local recurrence and distant metastases. RESULTS: Median follow-up was 70 months. The overall 5-year cumulative incidence of local recurrence was 1.8% (95% CI, 1.0 to 3.1); 0.8% (0.3, 2.2) for luminal A, 1.5% (0.2, 10) for luminal B, 8.4% (2.2, 30) for HER-2, and 7.1% (3.0, 16) for basal. On multivariable analysis (MVA) with luminal A as baseline, HER-2 (adjusted hazard ratio [AHR] = 9.2; 95% CI, 1.6 to 51; P = .012) and basal (AHR = 7.1; 95% CI, 1.6 to 31; P = .009) subtypes were associated with increased local recurrence. On MVA, luminal B (AHR = 2.9; 95% CI, 1.3 to 6.5; P = .007) and basal (AHR = 2.3; 95% CI, 1.1 to 5.2; P = .035) were associated with increased distant metastases. CONCLUSION: Overall, the 5-year local recurrence rate after BCT was low, but varied by subtype as approximated using ER, PR, and HER-2 status. Local recurrence was particularly low for the luminal A subtype, but was less than 10% at 5 years for all subtypes. Although further follow-up is needed, these results may be useful in counseling patients about their anticipated outcome after BCT.
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