Oncotype DX test
As cancer care moves increasingly towards individualized medicine and treatments, one test continues to be useful for many women caught in the gray area of a chemotherapy decision. Sometimes it is very clear that a woman does not need chemo and often it is very clear that she does. There are times, however, when a woman has an early breast cancer with some features that may be worrisome, but others that seem good, that the choice is not so clear.
This is where the Oncotype DX test comes in. For women with hormone positive (ER positive) breast cancers and negative lymph nodes, the chemo decision is often uncertain. For about six years now, this test has existed to help determine those tumors that are at a high risk of recurring--and should, therefore, be treated with chemotherapy in addition to hormonal therapy. A sample of the tumor is sent to Myriad Labs in California where a gene screen is done. The answer comes back quickly: high, medium, or low risk of recurrence. Note that there still may be a gray area--those with an intermmediate score--where a woman and her doctor will still have to puzzle out what makes the most sense medically and psychologically.
Here is an article from Komen about this test:
Oncotype DX Influences Breast Cancer Treatment Decisions
Among women with early breast cancer, use of the Oncotype DX® test changed oncologist treatment recommendations in approximately 32% of cases. Use of the test also increased oncologist confidence in the treatment recommendation and decreased patient anxiety. These results were published in the Journal of Clinical Oncology.
The Oncotype DX test measures the expression of 21 genes in a sample of tumor tissue and generates a Recurrence Score. The Recurrence Score predicts the magnitude of chemotherapy benefit and the likelihood of breast cancer recurrence for women with early-stage, estrogen receptor-positive breast cancer.
To explore how use of the Oncotype DX test influences oncologist and patient treatment decisions and satisfaction, researchers collected information from 89 patients treated by 17 medical oncologists. Information about adjuvant treatment plan was collected before and after obtaining the Oncotype DX Recurrence Score.
Based on the Recurrence Score, the oncologist's treatment recommendation changed for 31.5% of patients. The most common change was from chemotherapy plus hormonal therapy to hormonal therapy alone.
Recurrence Score results increased oncologist confidence in the treatment plan in 76% of the cases.
27% of patients changed their treatment decision based on the Recurrence Score.
Patient anxiety was lower after receipt of the Recurrence Score results.
These results provide additional evidence that Recurrence Score results can influence treatment recommendations and treatment decisions for women with early breast cancer, and can help relieve patient anxiety.
Reference: Lo SS, Mumby PB, Norton J et al. Prospective multicenter study of the impact of the 21-gene recurrence score assay on medical oncologist and patient adjuvant breast cancer treatment selection. Journal of Clinical Oncology [early online publication]. January 11,