TY - JOUR
T1 - Oncotype DX results increase concordance in adjuvant chemotherapy recommendations for early-stage breast cancer
AU - Licata, Luca
AU - Viale, Giulia
AU - Giuliano, Mario
AU - Curigliano, Giuseppe
AU - Chavez-MacGregor, Mariana
AU - Foldi, Julia
AU - Oke, Oluchi
AU - Collins, Joseph
AU - Del Mastro, Lucia
AU - Puglisi, Fabio
AU - Montemurro, Filippo
AU - Vernieri, Claudio
AU - Gerratana, Lorenzo
AU - Giordano, Sara
AU - Rognone, Alessia
AU - Sica, Lorenzo
AU - Gentilini, Oreste Davide
AU - Cascinu, Stefano
AU - Pusztai, Lajos
AU - Giordano, Antonio
AU - Criscitiello, Carmen
AU - Bianchini, Giampaolo
N1 - Funding Information:
The authors received support from the Associazione Italiana per la Ricerca sul Cancro (IG2018eID21787 project grant to G.B.) and Fondazione Michelangelo (grants to G.B.).
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - Adjuvant chemotherapy recommendations for ER+/HER2− early-stage breast cancers (eBC) involve integrating prognostic and predictive information which rely on physician judgment; this can lead to discordant recommendations. In this study we aim to evaluate whether Oncotype DX improves confidence and agreement among oncologists in adjuvant chemotherapy recommendations. We randomly select 30 patients with ER+/HER2− eBC and recurrence score (RS) available from an institutional database. We ask 16 breast oncologists with varying years of clinical practice in Italy and the US to provide recommendation for the addition of chemotherapy to endocrine therapy and their degree of confidence in the recommendation twice; first, based on clinicopathologic features only (pre-RS), and then with RS result (post-RS). Pre-RS, the average rate of chemotherapy recommendation is 50.8% and is higher among junior (62% vs 44%; p < 0.001), but similar by country. Oncologists are uncertain in 39% of cases and recommendations are discordant in 27% of cases (interobserver agreement K 0.47). Post-RS, 30% of physicians change recommendation, uncertainty in recommendation decreases to 5.6%, and discordance decreases to 7% (interobserver agreement K 0.85). Interpretation of clinicopathologic features alone to recommend adjuvant chemotherapy results in 1 out of 4 discordant recommendations and relatively high physician uncertainty. Oncotype DX results decrease discordancy to 1 out of 15, and reduce physician uncertainty. Genomic assay results reduce subjectivity in adjuvant chemotherapy recommendations for ER +/HER2− eBC.
AB - Adjuvant chemotherapy recommendations for ER+/HER2− early-stage breast cancers (eBC) involve integrating prognostic and predictive information which rely on physician judgment; this can lead to discordant recommendations. In this study we aim to evaluate whether Oncotype DX improves confidence and agreement among oncologists in adjuvant chemotherapy recommendations. We randomly select 30 patients with ER+/HER2− eBC and recurrence score (RS) available from an institutional database. We ask 16 breast oncologists with varying years of clinical practice in Italy and the US to provide recommendation for the addition of chemotherapy to endocrine therapy and their degree of confidence in the recommendation twice; first, based on clinicopathologic features only (pre-RS), and then with RS result (post-RS). Pre-RS, the average rate of chemotherapy recommendation is 50.8% and is higher among junior (62% vs 44%; p < 0.001), but similar by country. Oncologists are uncertain in 39% of cases and recommendations are discordant in 27% of cases (interobserver agreement K 0.47). Post-RS, 30% of physicians change recommendation, uncertainty in recommendation decreases to 5.6%, and discordance decreases to 7% (interobserver agreement K 0.85). Interpretation of clinicopathologic features alone to recommend adjuvant chemotherapy results in 1 out of 4 discordant recommendations and relatively high physician uncertainty. Oncotype DX results decrease discordancy to 1 out of 15, and reduce physician uncertainty. Genomic assay results reduce subjectivity in adjuvant chemotherapy recommendations for ER +/HER2− eBC.
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U2 - 10.1038/s41523-023-00559-6
DO - 10.1038/s41523-023-00559-6
M3 - Article
C2 - 37291235
AN - SCOPUS:85161275643
SN - 2374-4677
VL - 9
JO - npj Breast Cancer
JF - npj Breast Cancer
IS - 1
M1 - 51
ER -