EndoPredict improves the prognostic classification derived from common clinical guidelines in ER-positive, HER2-negative early breast cancer
Open Access
- 3 October 2012
- journal article
- research article
- Published by Elsevier BV in Annals of Oncology
- Vol. 24 (3), 640-647
- https://doi.org/10.1093/annonc/mds334
Abstract
In early estrogen receptor (ER)-positive/HER2-negative breast cancer, the decision to administer chemotherapy is largely based on prognostic criteria. The combined molecular/clinical EndoPredict test (EPclin) has been validated to accurately assess prognosis in this population. In this study, the clinical relevance of EPclin in relation to well-established clinical guidelines is assessed. We assigned risk groups to 1702 ER-positive/HER2-negative postmenopausal women from two large phase III trials treated only with endocrine therapy. Prognosis was assigned according to National Comprehensive Cancer Center Network-, German S3-, St Gallen guidelines and the EPclin. Prognostic groups were compared using the Kaplan–Meier survival analysis. After 10 years, absolute risk reductions (ARR) between the high- and low-risk groups ranged from 6.9% to 11.2% if assigned according to guidelines. It was at 18.7% for EPclin. EPclin reassigned 58%–61% of women classified as high-/intermediate-risk (according to clinical guidelines) to low risk. Women reclassified to low risk showed a 5% rate of distant metastasis at 10 years. The EPclin score is able to predict favorable prognosis in a majority of patients that clinical guidelines would assign to intermediate or high risk. EPclin may reduce the indications for chemotherapy in ER-positive postmenopausal women with a limited number of clinical risk factors.This publication has 25 references indexed in Scilit:
- Decentral gene expression analysis for ER+/Her2− breast cancer: results of a proficiency testing program for the EndoPredict assayVirchows Archiv, 2012
- Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011Annals of Oncology, 2011
- A Comparison of PAM50 Intrinsic Subtyping with Immunohistochemistry and Clinical Prognostic Factors in Tamoxifen-Treated Estrogen Receptor–Positive Breast CancerClinical Cancer Research, 2010
- Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009Annals of Oncology, 2009
- Ki67 Index, HER2 Status, and Prognosis of Patients With Luminal B Breast CancerJNCI Journal of the National Cancer Institute, 2009
- Gene-Expression Signatures in Breast CancerThe New England Journal of Medicine, 2009
- Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trialsThe Lancet, 2005
- A Multigene Assay to Predict Recurrence of Tamoxifen-Treated, Node-Negative Breast CancerThe New England Journal of Medicine, 2004
- A Gene-Expression Signature as a Predictor of Survival in Breast CancerThe New England Journal of Medicine, 2002
- The utility of mitotic index, oestrogen receptor and Ki-67 measurements in the creation of novel prognostic indices fornode-negative breast cancerEuropean Journal of Surgical Oncology, 1999