scholarly journals Molecular Profiling for Breast Cancer: A Comprehensive Review

2013 ◽  
Vol 5 ◽  
pp. BIC.S9455 ◽  
Author(s):  
Muaiad Kittaneh ◽  
Alberto J. Montero ◽  
Stefan Glück
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Recurrence Risk ◽  
Cancer Diagnostics ◽  
Breast Cancer Patients ◽  
Breast Cancer Diagnostics ◽  
Molecular Tests ◽  
Standard Clinical Practice ◽  
Medical Oncologists ◽  
Polymerase Chain

In recent years advances in molecular biology have launched disruptive innovations in breast cancer diagnostics and therapeutics. The advent of genomics has revolutionized our understanding of breast cancer as several different biologically and molecularly distinct diseases. This research has led to commercially available polymerase chain reaction (PCR) and microarray tests that have begun to fundamentally change the way medical oncologists quantify recurrence risk in early stage breast cancer patients. The Genomics era has altered the clinicopathologic paradigm of selecting patients for adjuvant cytotoxic chemotherapy. Sufficiently powered prospective studies are underway that may establish these molecular assays as elements of standard clinical practice in breast cancer treatment. In this article, we review the strengths and limitations of currently available breast cancer-specific molecular tests.

scholarly journals Genomic Assays in Node Positive Breast Cancer Patients: A Review

2021 ◽  
Vol 10 ◽  
Author(s):  
Maroun Bou Zerdan ◽  
Maryam Ibrahim ◽  
Clara El Nakib ◽  
Rayan Hajjar ◽  
Hazem I. Assi
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Individualized Medicine ◽  
Recurrence Risk ◽  
Breast Cancer Patients ◽  
Node Positive ◽  
Genomic Assays ◽  
Standard Clinical Practice ◽  
Node Positive Disease

In recent years, developments in breast cancer have allowed yet another realization of individualized medicine in the field of oncology. One of these advances is genomic assays, which are considered elements of standard clinical practice in the management of breast cancer. These assays are widely used today not only to measure recurrence risk in breast cancer patients at an early stage but also to tailor treatment as well and minimize avoidable treatment side effects. At present, genomic tests are applied extensively in node negative disease. In this article, we review the use of these tests in node positive disease, explore their ramifications on neoadjuvant chemotherapy decisions, highlight sufficiently powered recent studies emphasizing their use and review the most recent guidelines.

scholarly journals Genomic Signatures in Luminal Breast Cancer

Breast Care ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. 355-365
Author(s):  
Julian Puppe ◽  
Tabea Seifert ◽  
Christian Eichler ◽  
Henryk Pilch ◽  
Peter Mallmann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Throughput Sequencing ◽  
Early Stage ◽  
Intrinsic Subtype ◽  
Luminal Breast Cancer ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Cancer Subtypes ◽  
Molecular Tests ◽  
Immunohistochemical Markers

Background: Breast cancer is a very heterogeneous disease and luminal breast carcinomas represent the hormone receptor-positive tumors among all breast cancer subtypes. In this context, multigene signatures were developed to gain further prognostic and predictive information beyond clinical parameters and traditional immunohistochemical markers. Summary: For early breast cancer patients these molecular tools can guide clinicians to decide on the extension of endocrine therapy to avoid over- and undertreatment by adjuvant chemotherapy. Beside the predictive and prognostic value, a few genomic tests are also able to provide intrinsic subtype classification. In this review, we compare the most frequently used and commercially available molecular tests (OncotypeDX®, MammaPrint®, Prosigna®, EndoPredict®, and Breast Cancer IndexSM). Moreover, we discuss the clinical utility of molecular profiling for advanced breast cancer of the luminal subtype. Key Messages: Multigene assays can help to de-escalate systemic therapy in early-stage breast cancer. Only the Oncotype DX® and MammaPrint®test are validated by entirely prospective and randomized phase 3 trials. More clinical evidence is needed to support the use of genomic tests in node-positive disease. Recent developments in high-throughput sequencing technology will provide further insights to understand the heterogeneity of luminal breast cancers in early-stage and metastatic disease.

A physician engagement learning strategy to reduce care variation in breast cancer across a clinically integrated network.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 30-30
Author(s):  
Trever Bradley Burgon ◽  
Jon M. Richards ◽  
Carrie E. Nelson ◽  
David R. Paculdo ◽  
Diana Tamondong-Lachica ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Claims Data ◽  
Learning Strategy ◽  
Clinical Performance ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Evidence Based ◽  
Breast Cancer Patients ◽  
Integrated Network ◽  
Medical Oncologists

30 Background: Advocate Physician Partners (APP) is a 5,000+ physician CIN associated with Advocate Aurora Health. APP wanted to standardize care among their 100+ medical oncologists who work in 20+ independent and employed practices. We approached standardization as a learning opportunity that could be best done through active engagement. Methods: From January 2016 to November 2017, we utilized the Clinical Performance and Value (CPVÒ) simulated patient platform to measure clinical practice and provide feedback across APP. Over six rounds, a total of 119 APP medical oncologists were scored against evidence-based work-up and treatment criteria. To determine if any of the learnings found on the CPVs translated into practice, we used registry and claims data on unnecessary imaging for early stage breast cancer. Results: In the simulated breast cancer patients, we found an overall improvement of 13.3% in primary diagnosis accuracy and 15.3% in treatment (p<0.001 for both). Preferred guideline-based hormonal therapy and chemotherapy similarly improved by 15.1% (p=0.018). To compare the CPV improvements with patient-level improvements, we looked specifically at unnecessary imaging and testing which declined overall by 35.7% (p=0.006); the associated costs fell by 31.3%. In early stage breast cancer, the CPV-measured use rates for CT or PET/CT (p=0.026) and other scans (p=0.012) decreased, showing better alignment with guidelines (see Table). When we analyzed the patient claims data, we found these showed similar declines in potentially unneeded breast cancer testing. Conclusions: Active learning, using CPV simulations, increased adherence to evidence-based practices, which translated into practice as evidenced by registry/claims data showing fewer unnecessary imaging in early stage breast cancer. [Table: see text]

High levels of proliferation regulators and an impaired senescence response pathway to identify early-stage breast tumors with a poor prognosis.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 43-43
Author(s):  
Fiona T. Lanigan ◽  
Eiseart J. Dunne ◽  
Gerard L. Brien ◽  
Fatima Al Oraifi ◽  
Yue Fan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Primary Cultures ◽  
Cancer Recurrence ◽  
Recurrence Risk ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Cancer Proliferation ◽  
Protein Levels ◽  
Clinical Biomarkers

43 Background: Predicting the risk of tumour recurrence, and thus the need for chemotherapy, for lymph node-negative breast cancer patients is a significant problem for clinicians and patients. Methods: We have identified a ‘core proliferation signature,’ which is consistently high in proliferating primary cultures, and is downregulated during cellular senescence. Using a reverse engineering approach on a breast cancer-specific regulatory network, and confirmed by ChIP-seq analysis, we have identified a hierarchy of several highly interconnected Master Transcriptional Regulators upstream of these core proliferation genes. Results: Further analysis of the expression of these factors in breast cancer cohorts at the mRNA and protein levels reveals a remarkable ability to reliably predict recurrence risk for early-stage breast cancer. Strikingly, in our analyses, a combination of just two of these factors outperforms the currently used clinical biomarkers for breast cancer recurrence risk, as well as recently developed multi-gene prognostic assays. Moreover, the addition of the senescence regulator p16INK4A to this panel further increases its prognostic capability. Conclusions: We propose that this novel approach has succeeded in identifying ‘drivers’ of breast cancer proliferation which, when combined with a marker of senescence such as p16INK4A, successfully identify actively proliferating tumours with an impaired senescence response pathway. Furthermore, we suggest that this gene combination has the potential to become an improved prognostic assay for early-stage breast cancer.

scholarly journals Machine learning radiomics for predicting recurrence risk in patients with early-stage invasive breast cancer

2020 ◽  
Author(s):  
Herui Yao ◽  
Yunfang Yu ◽  
Wei Ren ◽  
Zifan He ◽  
Yongjian Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Machine Learning ◽  
Invasive Breast Cancer ◽  
Clinical Decision Making ◽  
Molecular Subtype ◽  
Early Stage ◽  
Recurrence Risk ◽  
Low Risk ◽  
Breast Cancer Patients ◽  
Risk Recurrence

Abstract There are no satisfying approaches to identify high- and low-risk recurrence patients with early-stage breast cancer in current clinical practice. Patients might be overtreated or undertreated due to the inaccurate prediction of recurrence risk. Herein, machine learning magnetic resonance imaging radiomic-based signature that integrates the intratumoral and peritumoral radiomic signatures, and clinicopathological characteristics was developed to classify high- and low-risk recurrence patients and predict recurrence within multicentre cohorts. The radiomic-clinical signature could also discriminate high- from low-risk recurrence patients among different breast cancer molecular subtype, and HR+/Her2-, T1N0M0 stage patients. Furthermore, it was observed that the neoadjuvant chemotherapy improved survival in high-risk Luminal subtype patients compared with the adjuvant chemotherapy. The survival-associated radiomic features also showed the correlation with the immune microenvironment. The radiomic-clinical signature presented the feasibility of predicting recurrence risk and assisting clinical decision-making in early-stage invasive breast cancer patients.

scholarly journals Ten-year clinical outcomes in N0 ER+ breast cancer patients with Recurrence Score-guided therapy

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Salomon M. Stemmer ◽  
Mariana Steiner ◽  
Shulamith Rizel ◽  
Noa Ben-Baruch ◽  
Beatrice Uziely ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Early Stage ◽  
Real Life ◽  
Recurrence Score ◽  
Recurrence Risk ◽  
Distant Recurrence ◽  
Breast Cancer Patients ◽  
Recurrence Rates ◽  
Node Negative

Abstract The 21-gene Recurrence Score (RS) assay is a validated prognosticator/predictor of chemotherapy (CT) benefit in early-stage estrogen receptor (ER)-positive breast cancer (BC). Long-term data from real-life clinical practice where treatment was guided by the RS result are lacking. We performed exploratory analysis of the Clalit Health Services (CHS) registry, which included all CHS patients with node-negative ER+ HER2-negative BC who underwent RS testing between 1/2006 and 12/2009 to determine 10-year Kaplan–Meier estimates for distant recurrence/BC-specific mortality (BCSM) in this cohort. The analysis included 1365 patients. Distribution of RS results: RS 0–10, 17.8%; RS 11–25, 62.5%; RS 26–100, 19.7%. Corresponding CT use: 0, 9.4, and 69.9%. Ten-year distant recurrence rates in patients with RS 0–10, 11–25, and 26–100: 2.6% (95% confidence interval [CI], 1.1–6.2%), 6.1% (95% CI, 4.4–8.6%), and 13.1% (95% CI, 9.4–18.3%), respectively (P < 0.001); corresponding BCSM rates: 0.7% (95% CI 0.1–5.1%), 2.2% (95% CI, 1.3–3.7%), and 9.5% (95% CI, 6.0–14.9%) (P < 0.001). When the analysis included patients treated with endocrine therapy alone (95.5/87.5% of patients with RS 0–10/11–25), 10-year distant recurrence and BCSM rates for RS 0–10 patients were 2.7% (95% CI, 1.1–6.5%) and 0.8% (95% CI, 0.1–5.3%), respectively, and for RS 11–25 patients, 5.7% (95% CI, 3.9–8.3%) and 2.0% (95% CI, 1.1–3.7%), respectively. For RS 11–25 patients, no statistically significant differences were observed in 10-year distant recurrence/BCSM rates between CT-treated and untreated patients; however, this should be interpreted cautiously since the number of events was low and patients were not randomized. In conclusion, in node-negative ER+ HER2-negative BC patients, where treatment decisions in real-life clinical practice incorporated the RS, patients with RS 0–25 (~80% of patients, <10% CT use) had excellent outcomes at 10 years. Patients with RS 26–100 had high distant recurrence risk despite CT use and are candidates for new treatment approaches.

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