Adjuvant therapy for invasive breast cancer has been shown to improve survival post-surgery. For early-stage, hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) cancer, adjuvant therapy may consist of hormonal therapy, or a combination of chemotherapy and hormonal therapy. It is accepted that most patients with HR+, HER2− tumours should receive hormonal therapy; however, whether these patients should also receive chemontherapy is often a complex and difficult decision to make, based on a range of pathological and molecular factors.
The 21-gene Oncotype DX breast cancer assay (Genomic Health) has been developed over many years to assist with this type of clinical decision making. The Medical Journal of Australia has this week published a study undertaken in Melbourne to look at the impact of the Oncotype DX test results on adjuvant treatment recommendations when discussed at the multidisciplinary meeting (MDM). The multidisciplinay team includes the relevant clinical personnel responsible for the various aspects of treatment required following a diagnosis of breast cancer – the surgeons, medical oncologists, radiation oncologists, breast care nurses, radiologists and pathologists, to enable good cross-talk across the disciplines regarding each individual patient, in order to ensure the best and coordinated treatment recommendations for that person. In many countries, treatment recommendations are made by an individual practitioner. In Australia the MDM has become the standard forum for determining treatment recommendations. It is a national goal for all patients to have their treatment decisions discussed in an MDM before definitive treatment recommendations are made. In the study published this week, consideration of the Oncotype DX score in the MDM was assessed as to whether it would impact on treatment recommendation. The result of this study showed, ‘Yes’, the Oncotype DX test score plays an important role in formulating recommendations made by the multidisiplinary team for adjuvant therapy for early breast cancer. Unfortunately, to date the Oncotype DX test has only been validated in Australia for specific types of tumours (for example the molecular profile of tumours that are multifocal has not yet been validated, and therefore results for these types of tumours will not hold much weight for clinical decisions). However, for those patients whose breast cancer characteristics do meet the criteria for Oncotype DX testing, this study may have a profound impact on the adjuvant treatment recommended – it may mean not having to have chemotherapy, it may mean the best bet for avoiding disease recurrence will include chemotherapy along with hormone therapy, or it may simply mean that a patient can have confidence in the adjuvant therapy chosen. For patients faced with such important decisions, these are extremeley relevant points.
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