The Impact of the Oncotype DX Breast Cancer Assay on Treatment Decisions for Women With Estrogen Receptor-Positive, Node-Negative Breast Carcinoma in Hong Kong.
The Oncotype DX Breast Cancer Assay is validated to assess risk of distant recurrence and likelihood of chemotherapy (CT) benefit in estrogen receptor-positive ESBC in various populations. In Hong Kong, > 80% of breast cancers are early stage breast cancer (ESBC) and > 60% of these women receive CT. This prospective study measured changes in CT type and recommendations, as well as physician impression of assay impact in a homogenous Chinese population.



Consecutive patients with estrogen receptor-positive, T1-3 N0-1mi M0 ESBC were offered enrollment. After surgery, physicians discussed treatment options with patients, then ordered the assay, then reassessed treatment recommendation considering assay results. Changes in treatment recommendation, CT utilization, physician confidence, and physician rating of influence on their treatment recommendations were measured.



A total of 146 evaluable patients received pre- and post-testing treatment recommendations. CT recommendations (including changes in intensity of CT) were changed for 34 of 146 patients (23.3%; 95% confidence interval, 16.7%-31.0%); change in intensity occurred in 7 of 146 (4.8%). There were 27 changes in treatment recommendations of adding or removing CT altogether (18.5% change; 95% confidence interval, 12.6%-25.8%). CT recommendations decreased from 52.1% to 37.7%, a net absolute reduction of 14.4% (P < .001; 27.6% net relative reduction). Pre-assay, 96% of physicians agreed/strongly agreed that they were confident in their treatment recommendation; post-assay, 90% of physicians agreed/strongly agreed with the same statement. Thirty percent of physicians agreed/strongly agreed that the test had influenced their recommendation, similar to the proportion of changed recommendations.



The Oncotype DX Assay appears to influence physician ESBC adjuvant treatment recommendations in Hong Kong.
Division of Medical Oncology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Roland C Y
RC
Leung
Division of Medical Oncology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Thomas C C
TC
Yau
Breast Centre, Kwong Wah Hospital, Hong Kong.
Miranda C M
MC
Chan
Kowloon East Cluster Breast Centre, United Christian Hospital, Hong Kong.
Sharon W W
SW
Chan
New Territories Cluster Breast Centre, Northern District Hospital, Hong Kong.
Terence W C
TW
Chan
St. Paul's Hospital, Hong Kong.
Yvonne Y Y
YY
Tsang
St. Paul's Hospital, Hong Kong.
Ting Ting
TT
Wong
Genomic Health, Inc, Redwood City, CA.
Calvin
C
Chao
Genomic Health, Inc, Redwood City, CA.
Carl
C
Yoshizawa
Pamela Youde Nether Sole Eastern Hospital, Hong Kong.
Inda S
IS
Soong
Hong Kong Sanatorium and Hospital, Hong Kong.
Wing-Hong
WH
Kwan
Princess Margaret Hospital, Hong Kong.
Carol C H
CC
Kwok
Prince of Wales Hospital, Hong Kong.
Joyce S J
JS
Suen
Queen Elizabeth Hospital, Hong Kong.
Roger K C
RK
Ngan
Breast Care Centre, Hong Kong Sanatorium and Hospital, Hong Kong Breast Cancer Foundation, Hong Kong. Electronic address: pollyc@pca.hk.
Polly S Y
PS
Cheung
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D020869:Gene Expression Profiling / Q000379:methods; D006723:Hong Kong; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000235:genetics*; D009367:Neoplasm Staging; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000378:metabolism; D018570:Risk Assessment / Q000379:methods; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D011960:Receptors, Estrogen
Adjuvant drug therapy; Decision support techniques; Molecular diagnostic techniques; Neoplasms; Risk assessment