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The effects of oncotype DX recurrence scores on chemotherapy utilization in a multi-institutional breast cancer cohort

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Abstract

The use of clinicopathologic features in decision-making in early stage estrogen receptor (ER)-positive breast cancer (BC) may lead to over or under treatment. We investigated the effect of the Oncotype Dx® (ODX) on chemotherapy (CTX) utilization in two cancer centers. 276 cases of node-negative ER-positive BC had ODX between 2005 and 2009. Age at diagnosis, tumor size, grade, and progesterone receptor (PR) status were abstracted from records and provided to two medical oncologists blinded to the ODX score. A recommendation for or against CTX was made based on clinicopathologic characteristics. Median age was 55 years. Mean tumor size was 1.6 cm. The median 10-year Adjuvant! Online (AO) mortality risk was 8. The median Nottingham Prognostic Index (NPI) was 3.3. The median ODX recurrence score was 17. Without knowledge of the ODX, oncologists were more likely to recommend CTX to younger women (P < 0.0001), women with negative PR status (P < 0.0001), higher NPI (P < 0.012), and tumors > 1 cm (P = 0.033). On average, CTX recommended patients had larger tumors (2.0 vs. 1.2 cm) and higher AO 10-year mortality (11.4 vs. 4.4%). ODX resulted in a change in management for 38% of women. Of 188 total patients who did not receive CTX, 71 had a recommendation favoring CTX by an oncologist blinded to the ODX score. In our multi-institutional cohort, the ODX score had a significant impact on the receipt of adjuvant CTX and altered management for 38% of women.

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Authors and Affiliations

  1. Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA

    Foluso O. Ademuyiwa, Austin Miller, Tracey O’Connor, Stephen B. Edge & Ellis Levine

  2. CRUK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

    Mangesh A. Thorat

  3. Indiana University School of Medicine, Indianapolis, IN, USA

    George W. Sledge & Sunil Badve

Authors
  1. Foluso O. Ademuyiwa
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  2. Austin Miller
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  3. Tracey O’Connor
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  4. Stephen B. Edge
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  5. Mangesh A. Thorat
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  6. George W. Sledge
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  7. Ellis Levine
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  8. Sunil Badve
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Correspondence to Foluso O. Ademuyiwa.

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Ademuyiwa, F.O., Miller, A., O’Connor, T. et al. The effects of oncotype DX recurrence scores on chemotherapy utilization in a multi-institutional breast cancer cohort. Breast Cancer Res Treat 126, 797–802 (2011). https://doi.org/10.1007/s10549-010-1329-6

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  • DOI: https://doi.org/10.1007/s10549-010-1329-6

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