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Background. Oncotype DX
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1. Recurrence Risk of Node-Negative and ER-Positive Early Stage Breast Cancer Patients by Combining Recurrence Score, Pathologic, and Clinical Information: A Meta Analysis Approach
3. Objectives Develop an integrated risk estimate
RS-Pathology-Clinical (RSPC) assessment.
Compare this new tool with RS alone and with pathology and clinical features alone
Expected that among ER+/N- breast cancer, RSPC will
Decrease number of patients classified as intermediate risk by RS
Refine assessments of DR risk when RS and standard measures are discordant
5. Measures Included in Meta-Analysis
6. Distribution of RS, Tumor Grade, Tumor Size and Age1735 Patients from B-14 and TransATAC
7. Statistical Methods
8. Pre-Defined Risk Groups RS (standard definition)
Low: RS < 18
Intermediate: 18 = RS < 31
High: RS = 31
9. Meta-Analysis Likelihood Ratio Tests (All Patients)
10. Proportion of Node-Negative Patients Classified asLow, Intermediate and High Risk by RS and RSPC
11. Cross Classification by Risk Group: RSPC vs. RS
12. RSPC is for Recurrence Risk,Not Prediction of Chemotherapy Benefit RS is Predictive of Chemotherapy Benefit in ER(+) Patients
Node(-): NSABP B-20 [4]
Node(+): SWOG 8814 [5]
Work is ongoing to assess the use of RS with RSPC in prediction of chemotherapy benefit
Currently, RS used alone is the recommended method to predict chemotherapy benefit.
13. Summary and Conclusions RSPC recurrence risk assessment combining RS with age, tumor grade and tumor size significantly improves prognostic power over RS alone
RSPC recurrence risk assessment decreases number of patients classified as intermediate risk
RSPC refines assessment of recurrence risk when RS and standard measures are discordant
As a meta-analysis, this analysis reflects all of the currently available evidence; it can be updated as new relevant datasets become available
RSPC will be made available by Genomic Health as a free online tool after acceptance for publication
14. Acknowledgements Women who participated in breast cancer clinical trials.
NSABP:
Funding from CTEP, National Cancer Institute, USA
TransATAC:
Janine Salter, Emma Quinn, Liz Mallon
the ATAC trialists and pathologists
ATAC Pathology sub-committee
ATAC Steering Committee
Funding from Breakthrough Breast Cancer and AstraZeneca
Cancer Research UK
GHI:
Joff Baker, Maureen Cronin, Drew Watson, Carl Yoshizawa, Frederick L. Baehner, Audrey Goddard, Angela Chen, Meike Labusch, Jackie Brooks, Lauren Intagliata
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Breast Cancer Res 2006.8(3):R25.
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