title: Breast medical oncologists' use of standard prognostic factors to predict a 21-gene recurrence score.
abstract: BACKGROUND
  Half of all breast cancers are early stage, lymph node negative, and hormone receptor positive. A 21-gene (Oncotype DX®; Genomic Health, Inc., Redwood City, CA) recurrence score (RS) is prognostic for recurrence and predictive of chemotherapy benefit. We explored the ability of oncologists to predict the RS using standard prognostic criteria.
  
  
  METHODS
  Standard demographic and tumor prognostic criteria were obtained from patients with an available RS. Two academic pathologists provided tumor grade, histologic type, and hormone receptor status. Six academic oncologists predicted the RS category (low, intermediate, or high) and provided a recommendation for therapy. The oncologists were then given the actual RS and provided recommendations for therapy. Analysis for agreement was performed.
  
  
  RESULTS
  Thirty-one cases, including nine additional cases with variant pathology reads, were presented. There was substantial agreement in oncologists' ability to discriminate between true low or true intermediate and true high (κ = 0.75; p < .0001). Predictions between low and intermediate were not consistent. The most common discrepancies were predictions of a low RS risk when cases were true intermediate and predictions of an intermediate RS risk when cases were true low. The actual RS resulted in a change in the treatment recommendations in 19% of cases. Of the 186 scenarios and six oncologists in aggregate, five fewer chemotherapy recommendations resulted with the actual RS.
  
  
  CONCLUSIONS
  Oncologists are able to differentiate between a low or intermediate RS and a high RS using standard prognostic criteria. However, provision of the actual RS changed the treatment recommendations in nearly 20% of cases, suggesting that the RS may reduce chemotherapy use. This effect was observed in particular in intermediate-risk cases. Prospective clinical trials are necessary to determine whether decisions based on the RS change outcomes.
authors.affiliation: Division of Medical Oncology, Duke Comprehensive Cancer Center, Durham, North Carolina, USA.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.forename: Charles L
authors.initials: CL
authors.lastname: Loprinzi
authors.forename: Carol
authors.initials: C
authors.lastname: Reynolds
authors.forename: Amylou C
authors.initials: AC
authors.lastname: Dueck
authors.forename: Xochiquetzal J
authors.initials: XJ
authors.lastname: Geiger
authors.forename: James N
authors.initials: JN
authors.lastname: Ingle
authors.forename: Robert W
authors.initials: RW
authors.lastname: Carlson
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Hobday
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Goetz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000235:genetics; D001943:Breast Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D048708:Cell Growth Processes / Q000235:genetics; D005260:Female; D020869:Gene Expression Profiling; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics* / Q000473:pathology; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics; D011960:Receptors, Estrogen / Q000235:genetics; D011980:Receptors, Progesterone / Q000235:genetics
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone