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Why does Oncotype DX recurrence score reduce adjuvant chemotherapy use?

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Abstract

The Oncotype DX recurrence score (RS) reduces breast cancer adjuvant treatment utilization, but the reasons for this effect are not straightforward. We performed a retrospective chart review of 89 consecutive node-negative breast cancer patients for whom RS was ordered to facilitate adjuvant treatment decisions. By subtracting the relapse rate predicted by RS from that calculated using the Adjuvant! Online (AOL) web-based instrument, a “prognostic delta” (P∆) was determined, reflecting the difference between prognoses predicted by these two indices. Clinician interviews were conducted to evaluate the actual effect of RS on treatment decisions and its relation to P∆. Adjuvant chemotherapy use decreased from 61 to 26 % as a consequence of RS results (p < 0.0001). In multivariate analysis, RS was the only factor significantly associated with the final adjuvant treatment choice. Surprisingly, RS caused chemotherapy to be withheld even when P∆ was negative (i.e., cases in which RS predicted a less favorable outcome than AOL). The prognostic and chemotherapy predictive utilities of the RS do not fully account for its effect in reducing adjuvant chemotherapy use. Further studies are required to more fully elucidate other factors that may be responsible for this effect, including the possibility of unintended influence.

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Acknowledgments

We thank biostatistician Martin Feuerman, MS for providing his insightful review of our data. Special thanks also to the medical oncologists who generously gave their time as interviewees so that we could best understand the factors essential to the decision-making process for each of their patients in this study—Nina D’Abreo MD, Michael Garrison MD, Alexander Hindenburg MD FACP, and Harry Staszewski, MD FACP. Finally, we thank Julie Mischo RN MBA for her organizational assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Winthrop-University Hospital Campus of SUNY Health Sciences Center at Stony Brook, 200 Old Country Rd, Room #450, Mineola, NY, 11501, USA

    Jeffrey G. Schneider

  2. Department of Internal Medicine, Weill Cornell Medical College of Cornell University, 1300 York Ave, New York, NY, 100021, USA

    Danny N. Khalil

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  1. Jeffrey G. Schneider
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  2. Danny N. Khalil
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Correspondence to Jeffrey G. Schneider.

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Schneider, J.G., Khalil, D.N. Why does Oncotype DX recurrence score reduce adjuvant chemotherapy use?. Breast Cancer Res Treat 134, 1125–1132 (2012). https://doi.org/10.1007/s10549-012-2134-1

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  • DOI: https://doi.org/10.1007/s10549-012-2134-1

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