Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative.
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Biomarkers, Tumor
/ genetics
Breast Neoplasms
/ drug therapy
Chemotherapy, Adjuvant
/ methods
Europe
Female
Gene Expression Profiling
Humans
Neoplasm Recurrence, Local
/ drug therapy
Practice Guidelines as Topic
/ standards
Prognosis
Receptor, ErbB-2
/ metabolism
Receptors, Estrogen
/ metabolism
Receptors, Progesterone
/ metabolism
Journal
British journal of cancer
ISSN: 1532-1827
Titre abrégé: Br J Cancer
Pays: England
ID NLM: 0370635
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
01
10
2020
accepted:
17
12
2020
revised:
10
12
2020
pubmed:
19
2
2021
medline:
28
9
2021
entrez:
18
2
2021
Statut:
ppublish
Résumé
Predicting the risk of recurrence and response to chemotherapy in women with early breast cancer is crucial to optimise adjuvant treatment. Despite the common practice of using multigene tests to predict recurrence, existing recommendations are inconsistent. Our aim was to formulate healthcare recommendations for the question "Should multigene tests be used in women who have early invasive breast cancer, hormone receptor-positive, HER2-negative, to guide the use of adjuvant chemotherapy?" The European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG), a multidisciplinary guideline panel including experts and three patients, developed recommendations informed by systematic reviews of the evidence. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision frameworks were used. Four multigene tests were evaluated: the 21-gene recurrence score (21-RS), the 70-gene signature (70-GS), the PAM50 risk of recurrence score (PAM50-RORS), and the 12-gene molecular score (12-MS). Five studies (2 marker-based design RCTs, two treatment interaction design RCTs and 1 pooled individual data analysis from observational studies) were included; no eligible studies on PAM50-RORS or 12-MS were identified and the GDG did not formulate recommendations for these tests. The ECIBC GDG suggests the use of the 21-RS for lymph node-negative women (conditional recommendation, very low certainty of evidence), recognising that benefits are probably larger in women at high risk of recurrence based on clinical characteristics. The ECIBC GDG suggests the use of the 70-GS for women at high clinical risk (conditional recommendation, low certainty of evidence), and recommends not using 70-GS in women at low clinical risk (strong recommendation, low certainty of evidence).
Sections du résumé
BACKGROUND
Predicting the risk of recurrence and response to chemotherapy in women with early breast cancer is crucial to optimise adjuvant treatment. Despite the common practice of using multigene tests to predict recurrence, existing recommendations are inconsistent. Our aim was to formulate healthcare recommendations for the question "Should multigene tests be used in women who have early invasive breast cancer, hormone receptor-positive, HER2-negative, to guide the use of adjuvant chemotherapy?"
METHODS
The European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG), a multidisciplinary guideline panel including experts and three patients, developed recommendations informed by systematic reviews of the evidence. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision frameworks were used. Four multigene tests were evaluated: the 21-gene recurrence score (21-RS), the 70-gene signature (70-GS), the PAM50 risk of recurrence score (PAM50-RORS), and the 12-gene molecular score (12-MS).
RESULTS
Five studies (2 marker-based design RCTs, two treatment interaction design RCTs and 1 pooled individual data analysis from observational studies) were included; no eligible studies on PAM50-RORS or 12-MS were identified and the GDG did not formulate recommendations for these tests.
CONCLUSIONS
The ECIBC GDG suggests the use of the 21-RS for lymph node-negative women (conditional recommendation, very low certainty of evidence), recognising that benefits are probably larger in women at high risk of recurrence based on clinical characteristics. The ECIBC GDG suggests the use of the 70-GS for women at high clinical risk (conditional recommendation, low certainty of evidence), and recommends not using 70-GS in women at low clinical risk (strong recommendation, low certainty of evidence).
Identifiants
pubmed: 33597715
doi: 10.1038/s41416-020-01247-z
pii: 10.1038/s41416-020-01247-z
pmc: PMC8076250
doi:
Substances chimiques
Biomarkers, Tumor
0
Receptors, Estrogen
0
Receptors, Progesterone
0
ERBB2 protein, human
EC 2.7.10.1
Receptor, ErbB-2
EC 2.7.10.1
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1503-1512Investigateurs
Mariangela Autelitano
(M)
Bettina Borisch
(B)
Xavier Castells
(X)
Edoardo Colzani
(E)
Jan Daneš
(J)
Patricia Fitzpatrick
(P)
Livia Giordano
(L)
Solveig Hofvind
(S)
Lydia Ioannidou-Mouzaka
(L)
Susan Knox
(S)
Lennarth Nystrom
(L)
Elena Parmelli
(E)
Elsa Perez
(E)
Alberto Torresin
(A)
Ruben Van Engen
(R)
Cary Van Landsveld-Verhoeven
(C)
Ken Young
(K)
Références
Ferlay, J. E. M., Lam, F., Colombet, M., Mery, L., Piñeros, M., Znaor, A. et al. Global Cancer Observatory: Cancer Today (International Agency for Research on Cancer, Lyon, France, 2018).
ECIS. European Cancer Information System From https://ecis.jrc.ec.europa.eu (2019).
Howlader, N., Altekruse, S. F., Li, C. I., Chen, V. W., Clarke, C. A., Ries, L. A. G. et al. US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J. Natl Cancer Inst. 28, 106 (2014).
Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365, 1687–1717 (2005).
Early Breast Cancer Trialists’ Collaborative Group. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378, 771–784 (2011).
Cardoso, F., van’t Veer, L. J., Bogaerts, J., Slaets, L., Viale, G., Delaloge, S. et al. 70-gene signature as an aid to treatment decisions in early-stage breast cancer. N. Engl. J. Med. 375, 717–729 (2016).
pubmed: 27557300
Goldhirsch, A., Wood, W. C., Coates, A. S., Gelber, R. D., Thurlimann, B., Senn, H. J. et al. 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 2011. Ann. Oncol. 22, 1736–1747 (2011).
pubmed: 21709140
pmcid: 3144634
Coates, A. S., Winer, E. P., Goldhirsch, A., Gelbert, R. D., Gnant, M., Piccart-Gebhart, M. et al. Tailoring therapies–improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann. Oncol. 26, 1533–1546 (2015)..
Petrelli, F., Viale, G., Cabiddu, M. & Barni, S. Prognostic value of different cut-off levels of Ki-67 in breast cancer: a systematic review and meta-analysis of 64,196 patients. Breast Cancer Res. Treat. 153, 477–491 (2015).
pubmed: 26341751
Early Breast Cancer Trialists’ Collaborative, Group. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379, 432–444 (2012).
Schünemann, H. J., Lerda, D., Dimitrova, N., Alonso-Coello, P., Gräwingholt, A., Quinn, C. et al. Methods for development of the European Commission Initiative on Breast Cancer Guidelines: Recommendations in the Era of Guideline Transparency. Ann. Intern. Med. https://doi.org/10.7326/M18-3445 (2019).
Knauer, M., Mook, S., Rutgers, E. J., Bender, R. A., Hauptmann, M., van de Vijver, M. J. et al. The predictive value of the 70-gene signature for adjuvant chemotherapy in early breast cancer. Breast Cancer Res. Treat. 120, 655–661 (2010).
pubmed: 20204499
Dowsett, M., Sestak, I., Lopez-Knowles, E., Sidhu, K., Dunbier, A. K., Cowens, J. W. et al. Comparison of PAM50 risk of recurrence score with oncotype DX and IHC4 for predicting risk of distant recurrence after endocrine therapy. J Clin Oncol. 31, 2783–90. (2013).
pubmed: 23816962
Gnant, M., Sestak, I., Filipits, M., Dowsett, M., Balic, M., Lopez-Knowles, E. et al. Identifying clinically relevant prognostic subgroups of postmenopausal women with node-positive hormone receptor-positive early-stage breast cancer treated with endocrine therapy: a combined analysis of ABCSG-8 and ATAC using the PAM50 risk of recurrence score and intrinsic subtype. Ann. Oncol. 26, 1685–1691 (2015).
pubmed: 25935792
Sestak, I., Cuzick, J., Dowsett, M., Lopez-Knowles, E., Filipits, M., Dubsky, P. et al. Prediction of late distant recurrence after 5 years of endocrine treatment: a combined analysis of patients from the Austrian breast and colorectal cancer study group 8 and arimidex, tamoxifen alone or in combination randomized trials using the PAM50 risk of recurrence score. J. Clin. Oncol. 33, 916–922 (2015).
pubmed: 25332252
Buus, R., Sestak, I., Kronenwett, R., Denkert, C., Dubsky, P., Krappmann, K. et al. Comparison of EndoPredict and EPclin with oncotype DX recurrence score for prediction of risk of distant recurrence after endocrine therapy. J. Natl Cancer Inst. 108, djw149 (2016).
Sestak, I., Buus, R., Cuzick, J., Dubsky, P., Kronenwett, R., Denkert, C. et al. Comparison of the performance of 6 prognostic signatures for estrogen receptor-positive breast cancer: a secondary analysis of a randomized clinical trial. JAMA Oncol. 4, 545–553 (2018).
pubmed: 29450494
pmcid: 5885222
Guyatt, G. H., Oxman, A. D., Kunz, R., Atkins, D., Brozek, J., Vist, G. et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J. Clin. Epidemiol. 64, 395–400 (2011).
pubmed: 21194891
Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D. et al. The cochrane collaboration’s tool for assessing risk of bias inrandomised trials. BMJ 343, d5928 (2011).
pubmed: 22008217
pmcid: 3196245
Sterne, J. A., Hernán, M. A., Reeves, B. C., Savovic, J., Berkman, N. D., Viswanathan, M. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355, i4919 (2016).
pubmed: 27733354
pmcid: 5062054
NICE (National Institute for Health and Care Excellence). The guidelines manual: appendix G. NICE methodology checklist for economic evaluations. https://www.nice.org.uk/process/pmg6/resources/the-guidelines-manual-appendices-bi-2549703709/chapter/appendix-g-methodology-checklist-economic-evaluations (2012).
Alonso-Coello, P., Oxman, A. D., Moberg, J., Brignardello-Petersen, R., Akl, E. A., Davoli, M. et al. GRADE evidence to decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: clinical practice guidelines. BMJ 353, i2089 (2016).
pubmed: 27365494
Sparano, J. A., Gray, R. J., Makower, D. F., Pritchard, K. I., Albain, K. S., Hayes, D. F. et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N. Engl. J. Med. 379, 111–121 (2018).
pubmed: 29860917
pmcid: 6172658
Ravdin, P. M., Siminoff, L. A., Davis, G. J., Mercer, M. B., Hewlett, J., Gerson, N. et al. Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J. Clin. Oncol. 19, 980–991 (2001).
pubmed: 11181660
Olivotto, I. A., Bajdik, C. D., Ravdin, P. M., Speers, C. H., Coldman, A. J., Norris, B. D. et al. Population-based validation of the prognostic model ADJUVANT! for early breast cancer. J. Clin. Oncol. 23, 2716–2725 (2005).
pubmed: 15837986
Paik, S., Tang, G., Shak, S., Kim, C., Baker, J., Kim, W. et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J. Clin. Oncol. 24, 3726–3734 (2006).
pubmed: 16720680
Albain, K. S., Barlow, W. E., Shak, S., Hortobagyi, G. N., Livingston, R. B., Yeh, I. T. et al. Breast cancer intergroup of north america. prognostic and predictive value of the 21-gene recurrence score assay in a randomized trial of chemotherapy for postmenopausal, node-positive, estrogen receptor-positive breast cancer. Lancet Oncol. 11, 55–65 (2010).
pubmed: 20005174
van de Vijver, M. J., He, Y. D., van’t Veer, L. J., Dai, H., Hart, A. A. M., Voskuil, D. W. et al. A gene-expression signature as a predictor of survival in breast cancer. N. Engl. J. Med. 347, 1999–2009 (2002).
pubmed: 12490681
Bueno-de-Mesquita, J. M., Linn, S. C., Keijzer, R., Wesseling, J., Nuyten, D. S. A., van Krimpen, C. et al. Validation of 70-gene prognosis signature in node-negative breast cancer. Breast Cancer Res. Treat. 117, 483–495 (2009).
pubmed: 18819002
Mook, S., Schmidt, M. K., Viale, G., Pruneri, G., Eekhout, I., Floore, A. et al. The 70-gene prognosis-signature predicts disease outcome in breast cancer patients with 1–3 positive lymph nodes in an independent validation study. Breast Cancer Res. Treat. 116, 295–302 (2009).
pubmed: 18661261
Blok, E. J., Bastiaanet, E., van den Hout, W. B., Liefers, G. J., Smit, V. T. H. B. M., Kroep, J. R. et al. Systematic review of the clinical and economic value of gene expression profiles for invasive early breast cancer available in Europe. Cancer Treat. Rev. 62, 74–90 (2018).
pubmed: 29175678
Wang, S. Y., Dang, W., Richman, I., Mougalian, S. S., Evans, S. B. & Gross, C. P. Cost-effectiveness analyses of the 21-gene assay in breast cancer: systematic review and critical appraisal. J. Clin. Oncol. 36, 1619–1627 (2018).
pubmed: 29659329
pmcid: 5978470
Davidson, J. A., Cromwell, I., Ellard, S. L., Lohrisch, C., Gelmon, K. A., Shenkier, T. et al. A prospective clinical utility and pharmacoeconomic study of the impact of the 21-gene Recurrence Score(R) assay in oestrogen receptor positive node negative breast cancer. Eur. J. Cancer 49, 2469–2475 (2013).
pubmed: 23611660
Jahn, B., Rochau, U., Kurzthaler, C., Hubalek, M., Miksad, R., Sroczynski, G. et al. Personalized treatment of women with early breast cancer: a risk-group specific cost-effectiveness analysis of adjuvant chemotherapy accounting for companion prognostic tests OncotypeDX and Adjuvant!Online. BMC Cancer 17, 685 (2017).
pubmed: 29037213
pmcid: 5644100
Katz, G., Romano, O., Foa, C., Vataire, A. L., Chantelard, J. V., Hervé, R. et al. Economic impact of gene expression profiling in patients with early-stage breast cancer in France. PLoS ONE 10, e0128880 (2018).
Lyman, G. H., Cosler, L. E., Kuderer, N. M. & Homberger, J. Impact of a 21-gene RT-PCR assay on treatment decisions in early-stage breast cancer: An economic analysis based on prognostic and predictive validation studies. Cancer 109, 1011–1018 (2007).
pubmed: 17311307
Ontario Health Technology Advisory Committee, Medical Advisory Secretariat. Gene expression profiling for guiding adjuvant chemotherapy decisions in women with early breast cancer: an evidence- based and economic analysis. Ont. Health Technol. Assess Ser 10, 1–57 (2010).
Paulden, M., Franek, J., Pham, B., Bedard, P. L., Trudeau, M. & Krahn, M. Cost-effectiveness of the 21-gene assay for guiding adjuvant chemotherapy decisions in early breast cancer. Value Health 16, 729–739 (2013).
pubmed: 23947965
Vataire, A. L., Laas, E., Aballea, S., Gligorov, J., Rouzier, R. & Chéreau, E. Cost-effectiveness of a chemotherapy predictive test. Bull Cancer 99, 907–914 (2012).
pubmed: 23041366
Kondo, M., Hoshi, S. L., Ishiguro, H. & Toi, M. Economic evaluation of the 70-gene prognosis-signature (MammaPrint) in hormone receptor-positive, lymph node-negative, human epidermal growth factor receptor type 2-negative early stage breast cancer in Japan. Breast Cancer Res. Treat. 133, 759–68. (2012).
pubmed: 22315134
Ward, S., Scope, A., Rafia, R., Pandor, A., Harnan, S., Evans, P. et al. Gene expression profiling and expanded immunohistochemistry tests to guide the use of adjuvant chemotherapy in breast cancer management: a systematic review and cost-effectiveness analysis. Health Technol. Assess 17, 1–302 (2013).
pubmed: 24088296
pmcid: 4780957
Blohmer, J. U., Rezai, M., Kummel, S., Kühn, T., Warm, M., Friedrich, K. et al. Using the 21-gene assay to guide adjuvant chemotherapy decision-making in early- stage breast cancer: a cost-effectiveness evaluation in the German setting. J. Med. Econ. 16, 30–40 (2013).
pubmed: 22966753
Nerich, V., Curtit, E., Bazan, F., Montcuquet, P., Villanueva, C., Chaigneau, L. et al. Economic assessment of the routine use of Oncotype DX assay for early breast cancer in Franche-Comte region. Bull Cancer 101, 681–689 (2014).
pubmed: 25091650
Vanderlaan, B. F., Broder, M. S., Chang, E. Y., Oratz, R. & Bentley, T. G. K. Cost-effectiveness of 21-gene assay in node-positive, early-stage breast cancer. Am. J. Manag. Care 17, 455–464 (2011).
pubmed: 21819166
Sparano, J. A., Gray, R. J., Makower, D. F., Albain, K. S., Saphner, T. J., Badve, S. S. et al. Clinical outcomes in early breast cancer with a high 21-gene recurrence score of 26 to 100 assigned to adjuvant chemotherapy plus endocrine therapy: a secondary analysis of the TAILORx randomized clinical trial. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2019.4794 (in press).
Sparano, J. A., Gray, R. J., Ravdin, P. M., Makower, D. F., Pritchard, K. I., Albain, K. S. et al. Clinical and genomic risk to guide the use of adjuvant therapy for breast cancer. N. Engl. J. Med. 380, 2395–2405 (2019).
pubmed: 31157962
pmcid: 6709671
Giorgi Rossi, P., Lebeau, A. & Schünemann, H. J. Clinical and genomic risk in adjuvant therapy for breast cancer. N. Engl. J. Med. 381, 1289–1290 (2019).
pubmed: 31553845
Dowsett, M. & Turner, N. Estimating risk of recurrence for early breast cancer: integrating clinical and genomic risk. J. Clin. Oncol. 37, 689–692 (2019).
pubmed: 30742561
Mariotto, A., Jayasekerea, J., Petkov, V., Schechter, C. B., Enewold, L., Helzlsouer, K. J. et al. Expected monetary impact of oncotype DX score-concordant systemic breast cancer therapy based on the TAILORx trial. J. Natl Cancer Inst. 112, 154–160 (2020).
pubmed: 31165854
Giorgi Rossi, P. & Paci, E. Re: expected monetary impact of oncotype DX score-concordant systemic breast cancer therapy based on the TAILORx trial. J. Natl Cancer Inst. https://doi.org/10.1093/jnci/djz125 , in press (2021).
Oxman, A. D., Fretheim, A. & Schünemann, H. J. SURE. Improving the use of research evidence in guideline development: introduction. Health Res. Policy Syst. 4, 12 (2006).
pubmed: 17116254
pmcid: 1684247
Schünemann, H. J., Wiercioch, W., Etxeandia, I., Falavigna, M., Santesso, N., Mustafa, R. et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ 186, E123–E142 (2014).
pmcid: 3928232
Woolf, S., Schünemann, H. J., Eccles, M. P., Grimshaw, J. M. & Shekelle, P. Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations. Implement Sci. 7, 61 (2012).
pubmed: 22762158
pmcid: 3436711
Schünemann, H. J., Lerda, D., Quinn, C., Follmann, M., Alonso-Coello, P., Giorgi Rossi P. et al. Breast cancer screening and diagnosis: a synopsis of the European breast guidelines. Ann. Intern. Med. https://doi.org/10.7326/M19-2125 , in press (2021).
NICE National Institute for Health Care and Excellence (2018). Tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer. Diagnostic Guidance DG34. https://www.nice.org.uk/guidance/dg34/resources/tumour-profiling-tests-to-guide-adjuvant-chemotherapy-decisions-in-early-breast-cancer-pdf-1053750722245 (2020).
Cuzick, J., Dowsett, M., Pineda, S., Wale, C., Salter, J., Quinn, E. et al. Prognostic value of a combined estrogen receptor, progesterone receptor, Ki-67, and human epidermal growth factor receptor 2 immunohistochemical score and comparison with the Genomic Health recurrence score in early breast cancer. J. Clin. Oncol. 29, 4273–4278 (2011).
pubmed: 21990413
Barton, S., Zabaglo, L., A’Hern, R., Turner, N., Ferguson, T., O´Neill, S. et al. Assessment of the contribution of the IHC4 + C score to decision making in clinical practice in early breast cancer. Br. J. Cancer 106, 1760–1765 (2012).
pubmed: 22531639
pmcid: 3364112
Candido Dos Reis, F. J., Wishart, G. C., Dicks, E. M., Greenberg, D., Rashbass, J., Schmidt, M. K. et al. An updated PREDICT breast cancer prognostication and treatment benefit prediction model with independent validation. Breast Cancer Res. 19, 58 (2017).
pubmed: 28532503
pmcid: 5440946
Harris, L. N., Ismaila, N., McShane, L. M., Andre, F., Collyar, D. E., Gonzalez-Angulo, A. M. et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline. J. Clin. Oncol. 34, 1134–1150 (2016).
pubmed: 26858339
pmcid: 4933134
Krop, I., Ismaila, N., Andre, F., Bast, R. C., Barlow, W., Collyar, D. E. et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update. J. Clin. Oncol. 35, 2838–2847 (2017).
pubmed: 28692382
Andre, F., Ismaila, N., Henry, N. L., Somerfield, M. R., Bast, R. C., Barlow, W. et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: ASCO Clinical Practice Guideline Update-Integration of Results From TAILORx. J. Clin. Oncol. 37, 1956–1964 (2019).
pubmed: 31150316
Harnan, S., Tappenden, P., Cooper, K., Stevens, J., Bessey, A., Rafia, R. et al. Tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer: a systematic review and economic analysis. Health Technol Assess 23, 1–328 (2019).
pubmed: 31264581
pmcid: 6627008
Schildgen, V., Warm, M., Brockmann, M. & Schildgen, O. Oncotype DX breast cancer recurrence score resists inter-assay reproducibility with RT(2)-profiler multiplex RT-PCR. Sci. Rep. 9, 20266 (2019).
pubmed: 31889145
pmcid: 6937305
Sestak, I., Martín, M., Dubsky, P., Kronenwett, R., Rojo, F., Cuzick, J. et al. Prediction of chemotherapy benefit by EndoPredict in patients with breast cancer who received adjuvant endocrine therapy plus chemotherapy or endocrine therapy alone. Breast Cancer Res Treat. 176, 377–386 (2019).
pubmed: 31041683
pmcid: 6555778