The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer

R. Exner; Z. Bago-Horvath; R. Bartsch; M. Mittlboeck; V.P. Retèl; F. Fitzal; M. Rudas; C. Singer; G. Pfeiler; M. Gnant; R. Jakesz; P. Dubsky

doi:10.1038/bjc.2014.339

The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer

R. Exner, Z. Bago-Horvath, R. Bartsch, M. Mittlboeck, V.P. Retèl, F. Fitzal, M. Rudas, C. Singer, G. Pfeiler, M. Gnant, R. Jakesz, P. Dubsky^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Validated multigene signatures (MGS) provide additional prognostic information when evaluating clinical features of ER⁺, HER2^- early breast cancer. We have studied the quantitative and qualitative impact of MGS on multidisciplinary team (MDT) recommendations.

Methods: We prospectively recruited 75 ER⁺, HER2^- breast cancer patients. Inclusion was based on biopsy assessment of grade, hormone receptor status, HER2, clinical tumour and nodal status. A fresh tissue sample was sent for MammaPrint (MP), TargetPrint analysis at surgery. Clinical risk was decided by the MDT in the absence of MP results and repeated following the collection of MP results. Decision changes were recorded and a health technology assessment was undertaken to compare cost effectiveness.

Results: The majority of patients were assigned low to intermediate clinical risk by the MDT. According to MP, 76% were low risk. A very high correlation between local IHC and the TargetPrint assessment was shown. In over a third of patients, discordance between clinical and molecular risk was observed. Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy. The use of MP was also found to be more cost effective.

Conclusions: The multigene signature MP revealed clinical and molecular risk discordance in a third of patients. The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy. The use of MGS is unlikely to have an impact in either clinically low-risk women or in patients with more than one relative indication for chemotherapy.

Original language	English
Pages (from-to)	837-842
Number of pages	6
Journal	British journal of cancer
Volume	111
Issue number	5
DOIs	https://doi.org/10.1038/bjc.2014.339
Publication status	Published - 1 Jan 2014
Externally published	Yes

Keywords

Adjuvant systemic treatment
Breast cancer (BC)
Gene expression profiling
Tumour board recommendation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/bjc.2014.339

multigeneFinal published version, 195 KB

Cite this

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title = "The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer",

abstract = "Background: Validated multigene signatures (MGS) provide additional prognostic information when evaluating clinical features of ER+, HER2- early breast cancer. We have studied the quantitative and qualitative impact of MGS on multidisciplinary team (MDT) recommendations.Methods: We prospectively recruited 75 ER+, HER2- breast cancer patients. Inclusion was based on biopsy assessment of grade, hormone receptor status, HER2, clinical tumour and nodal status. A fresh tissue sample was sent for MammaPrint (MP), TargetPrint analysis at surgery. Clinical risk was decided by the MDT in the absence of MP results and repeated following the collection of MP results. Decision changes were recorded and a health technology assessment was undertaken to compare cost effectiveness.Results: The majority of patients were assigned low to intermediate clinical risk by the MDT. According to MP, 76% were low risk. A very high correlation between local IHC and the TargetPrint assessment was shown. In over a third of patients, discordance between clinical and molecular risk was observed. Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy. The use of MP was also found to be more cost effective.Conclusions: The multigene signature MP revealed clinical and molecular risk discordance in a third of patients. The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy. The use of MGS is unlikely to have an impact in either clinically low-risk women or in patients with more than one relative indication for chemotherapy.",

keywords = "Adjuvant systemic treatment, Breast cancer (BC), Gene expression profiling, Tumour board recommendation",

author = "R. Exner and Z. Bago-Horvath and R. Bartsch and M. Mittlboeck and V.P. Ret{\`e}l and F. Fitzal and M. Rudas and C. Singer and G. Pfeiler and M. Gnant and R. Jakesz and P. Dubsky",

year = "2014",

month = jan,

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doi = "10.1038/bjc.2014.339",

language = "English",

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T1 - The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer

AU - Exner, R.

AU - Bago-Horvath, Z.

AU - Bartsch, R.

AU - Mittlboeck, M.

AU - Retèl, V.P.

AU - Fitzal, F.

AU - Rudas, M.

AU - Singer, C.

AU - Pfeiler, G.

AU - Gnant, M.

AU - Jakesz, R.

AU - Dubsky, P.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Validated multigene signatures (MGS) provide additional prognostic information when evaluating clinical features of ER+, HER2- early breast cancer. We have studied the quantitative and qualitative impact of MGS on multidisciplinary team (MDT) recommendations.Methods: We prospectively recruited 75 ER+, HER2- breast cancer patients. Inclusion was based on biopsy assessment of grade, hormone receptor status, HER2, clinical tumour and nodal status. A fresh tissue sample was sent for MammaPrint (MP), TargetPrint analysis at surgery. Clinical risk was decided by the MDT in the absence of MP results and repeated following the collection of MP results. Decision changes were recorded and a health technology assessment was undertaken to compare cost effectiveness.Results: The majority of patients were assigned low to intermediate clinical risk by the MDT. According to MP, 76% were low risk. A very high correlation between local IHC and the TargetPrint assessment was shown. In over a third of patients, discordance between clinical and molecular risk was observed. Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy. The use of MP was also found to be more cost effective.Conclusions: The multigene signature MP revealed clinical and molecular risk discordance in a third of patients. The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy. The use of MGS is unlikely to have an impact in either clinically low-risk women or in patients with more than one relative indication for chemotherapy.

AB - Background: Validated multigene signatures (MGS) provide additional prognostic information when evaluating clinical features of ER+, HER2- early breast cancer. We have studied the quantitative and qualitative impact of MGS on multidisciplinary team (MDT) recommendations.Methods: We prospectively recruited 75 ER+, HER2- breast cancer patients. Inclusion was based on biopsy assessment of grade, hormone receptor status, HER2, clinical tumour and nodal status. A fresh tissue sample was sent for MammaPrint (MP), TargetPrint analysis at surgery. Clinical risk was decided by the MDT in the absence of MP results and repeated following the collection of MP results. Decision changes were recorded and a health technology assessment was undertaken to compare cost effectiveness.Results: The majority of patients were assigned low to intermediate clinical risk by the MDT. According to MP, 76% were low risk. A very high correlation between local IHC and the TargetPrint assessment was shown. In over a third of patients, discordance between clinical and molecular risk was observed. Decision changes were recorded in half of these cases (18.6%) and resulted in two out of three patients not requiring chemotherapy. The use of MP was also found to be more cost effective.Conclusions: The multigene signature MP revealed clinical and molecular risk discordance in a third of patients. The impact of this on MDT recommendations was most profound in cases where few clinical risk factors were observed and enabled some women to forgo chemotherapy. The use of MGS is unlikely to have an impact in either clinically low-risk women or in patients with more than one relative indication for chemotherapy.

KW - Adjuvant systemic treatment

KW - Breast cancer (BC)

KW - Gene expression profiling

KW - Tumour board recommendation

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AN - SCOPUS:84906934415

SN - 0007-0920

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EP - 842

JO - British journal of cancer

JF - British journal of cancer

IS - 5

ER -

The multigene signature MammaPrint impacts on multidisciplinary team decisions in ER+, HER2- early breast cancer

Abstract

Keywords

UN SDGs

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