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Breast Cancer Res Treat. 2019 Apr 30. doi: 10.1007/s10549-019-05226-8. [Epub ahead of print]

Prediction of chemotherapy benefit by EndoPredict in patients with breast cancer who received adjuvant endocrine therapy plus chemotherapy or endocrine therapy alone.

Author information

1
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. i.sestak@qmul.ac.uk.
2
Instituto de Investigacion Sanitaria Gregorio Marañon, CIBERONC, Universidad Complutense, Madrid, Spain.
3
Spanish Breast Cancer Group, GEICAM, Madrid, Spain.
4
Hirslanden Klinik St. Anna, Lucerne, Switzerland.
5
Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
6
Myriad International GmbH, Cologne, Germany.
7
Fundacion Jimenez Diaz, Madrid, Spain.
8
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
9
Austrian Breast and Colorectal Study Group, ABCSG, Vienna, Austria.
10
Instituto Valenciano de Oncologia, Valencia, Spain.
11
Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, USA.
12
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
13
West Cancer Center, Germantown, USA.
14
The Breast Cancer Now Research Centre, Institute of Cancer, London, UK.
15
Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
16
Hospital Universitario de Elche, Valencia, Spain.

Abstract

PURPOSE:

EndoPredict (EPclin) is a prognostic test validated to inform decisions on adjuvant chemotherapy to endocrine therapy alone for patients with oestrogen receptor-positive, HER2-negative breast cancer. Here, we determine the performance of EPclin for estimating 10-year distant recurrence-free interval (DRFI) rates for those who received adjuvant endocrine therapy (ET) alone compared to those with chemotherapy plus endocrine therapy (ET + C).

METHODS:

A total of 3746 women were included in this joint analysis. 2630 patients received 5 years of ET alone (ABCSG-6/8, TransATAC) and 1116 patients received ET + C (GEICAM 2003-02/9906). The primary objective was to evaluate the ability of EPclin to provide an estimate of the 10-year DR rate as a continuous function of EPclin separately for ET alone and ET + C. Cox proportional hazard models were used for these analyses.

RESULTS:

EPclin was highly prognostic for DR in women who received ET alone (HR 2.79 (2.49-3.13), P < 0.0001) as well as in those who received ET + C (HR 2.27 (1.99-2.59), P < 0.0001). Women who received ET + C had significantly smaller increases in 10-year DR rates with the increasing EPclin score than those receiving ET alone (EPclin = 5; 12% ET + C vs. 20% ET alone). We observed a significant positive interaction between EPclin and treatment groups (P-interaction = 0.022).

CONCLUSIONS:

In this comparative non-randomised analysis, the rate of increase in DR with EPclin score was significantly reduced in women who received ET + C versus ET alone. Our indirect comparisons suggest that a high EPclin score can predict chemotherapy benefit in women with ER-positive, HER2-negative disease.

KEYWORDS:

Breast cancer; Chemotherapy; EndoPredict; Prediction

PMID:
31041683
DOI:
10.1007/s10549-019-05226-8

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