Adjuvant chemotherapy in patients with invasive lobular carcinoma and use of the 21-gene recurrence score: A National Cancer Database analysis.
21-gene recurrence score
Oncotype
breast cancer
chemotherapy
estrogen receptor
hormone sensitive
invasive lobular carcinoma (ILC)
lobular
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
01 05 2022
01 05 2022
Historique:
revised:
04
12
2021
received:
26
07
2021
accepted:
22
12
2021
pubmed:
10
2
2022
medline:
13
4
2022
entrez:
9
2
2022
Statut:
ppublish
Résumé
Invasive lobular carcinoma (ILC) is traditionally considered less responsive to chemotherapy. Although the Oncotype recurrence score (RS) has been validated to identify high-risk patients who benefit from chemotherapy, some studies have questioned its relevance in patients with ILC. The objective of this study was to better characterize potential use of the RS in these patients. The National Cancer Database was used to identify women with stage I through III, T1 through T3, N0 or N1, hormone receptor-positive, HER2-negative ILC or invasive ductal carcinoma (IDC) who had an available RS between 2010 and 2016. Multivariable Cox regression was used to model the effect of variables on 5-year overall survival (OS). The Kaplan-Meier method was used to estimate OS according to the RS, nodal status, and chemotherapy. In total, 15,763 patients with ILC and 100,070 with IDC were identified. The mean age of patients with ILC and IDC was 59.2 ± 9.1 and 57.2 ± 9.8, respectively. A lower percentage of patients with ILC versus those with IDC had a high RS, defined as >25 (6.6% vs 16.0%; P < .0001). ILC patients with a high RS who had N0 or N1 disease received approximately 10% less chemotherapy compared with similar patients who had IDC. The results indicated that the RS had statistically significant prognostic value for patients with ILC. In addition, an absolute OS advantage was correlated with the receipt of chemotherapy by patients with ILC who had a high RS with N0 or N1 disease. Patients with ILC who have a high RS are treated less often with chemotherapy compared with similar patients who have IDC. Nevertheless, the RS has a prognostic as well as a predictive value in ILC, with an association between OS benefit and chemotherapy receipt in patients who have ILC with a high RS, especially if they have N1 disease. Invasive lobular carcinoma (ILC) is a subtype of breast cancer comprising about 15% of cases. The Oncotype recurrence score (RS) is a genetic test of breast tumors that helps predict which patients might benefit from chemotherapy. Some have doubted the relevance of the RS for patients with ILC. In this study, the authors show that the RS is relevant for patients who have ILC. The RS has the potential of predicting the risk of recurrence and identifying patients with ILC who might benefit from chemotherapy.
Sections du résumé
BACKGROUND
Invasive lobular carcinoma (ILC) is traditionally considered less responsive to chemotherapy. Although the Oncotype recurrence score (RS) has been validated to identify high-risk patients who benefit from chemotherapy, some studies have questioned its relevance in patients with ILC. The objective of this study was to better characterize potential use of the RS in these patients.
METHODS
The National Cancer Database was used to identify women with stage I through III, T1 through T3, N0 or N1, hormone receptor-positive, HER2-negative ILC or invasive ductal carcinoma (IDC) who had an available RS between 2010 and 2016. Multivariable Cox regression was used to model the effect of variables on 5-year overall survival (OS). The Kaplan-Meier method was used to estimate OS according to the RS, nodal status, and chemotherapy.
RESULTS
In total, 15,763 patients with ILC and 100,070 with IDC were identified. The mean age of patients with ILC and IDC was 59.2 ± 9.1 and 57.2 ± 9.8, respectively. A lower percentage of patients with ILC versus those with IDC had a high RS, defined as >25 (6.6% vs 16.0%; P < .0001). ILC patients with a high RS who had N0 or N1 disease received approximately 10% less chemotherapy compared with similar patients who had IDC. The results indicated that the RS had statistically significant prognostic value for patients with ILC. In addition, an absolute OS advantage was correlated with the receipt of chemotherapy by patients with ILC who had a high RS with N0 or N1 disease.
CONCLUSIONS
Patients with ILC who have a high RS are treated less often with chemotherapy compared with similar patients who have IDC. Nevertheless, the RS has a prognostic as well as a predictive value in ILC, with an association between OS benefit and chemotherapy receipt in patients who have ILC with a high RS, especially if they have N1 disease.
LAY SUMMARY
Invasive lobular carcinoma (ILC) is a subtype of breast cancer comprising about 15% of cases. The Oncotype recurrence score (RS) is a genetic test of breast tumors that helps predict which patients might benefit from chemotherapy. Some have doubted the relevance of the RS for patients with ILC. In this study, the authors show that the RS is relevant for patients who have ILC. The RS has the potential of predicting the risk of recurrence and identifying patients with ILC who might benefit from chemotherapy.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1738-1747Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2022 American Cancer Society.
Références
McCart Reed AE, Kalinowski L, Simpson PT, Lakhani SR. Invasive lobular carcinoma of the breast: the increasing importance of this special subtype. Breast Cancer Res. 2021;23:6. doi:10.1186/s13058-020-01384-6
Thomas M, Kelly ED, Abraham J, Kruse M. Invasive lobular breast cancer: a review of pathogenesis, diagnosis, management, and future directions of early stage disease. Semin Oncol. 2019;46:121-132. doi:10.1053/j.seminoncol.2019.03.002
Desmedt C, Zoppoli G, Sotiriou C, Salgado R. Transcriptomic and genomic features of invasive lobular breast cancer. Semin Cancer Biol. 2017;44:98-105. doi:10.1016/j.semcancer.2017.03.007
Arpino G, Bardou VJ, Clark GM, Elledge RM. Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res. 2004;6:R149-R156. doi:10.1186/bcr767
Guiu S, Wolfer A, Jacot W, et al. Invasive lobular breast cancer and its variants: how special are they for systemic therapy decisions? Crit Rev Oncol Hematol. 2014;92:235-257. doi:10.1016/j.critrevonc.2014.07.003
Mamtani A, King TA. Lobular breast cancer: different disease, different algorithms? Surg Oncol Clin N Am. 2018;27:81-94. doi:10.1016/j.soc.2017.07.005
Delpech Y, Coutant C, Hsu L, et al. Clinical benefit from neoadjuvant chemotherapy in oestrogen receptor-positive invasive ductal and lobular carcinomas. Br J Cancer. 2013;108:285-291. doi:10.1038/bjc.2012.557
Truin W, Voogd AC, Vreugdenhil G, van der Heiden-van der Loo M, Siesling S, Roumen RM. Effect of adjuvant chemotherapy in postmenopausal patients with invasive ductal versus lobular breast cancer. Ann Oncol. 2012;23:2859-2865. doi:10.1093/annonc/mds180
Marmor S, Hui JYC, Huang JL, et al. Relative effectiveness of adjuvant chemotherapy for invasive lobular compared with invasive ductal carcinoma of the breast. Cancer. 2017;123:3015-3021. doi:10.1002/cncr.30699
Paik S, Tang G, Shak S, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006;24:3726-3734. doi:10.1200/JCO.2005.04.7985
Albain KS, Barlow WE, Gralow JR, Shak S, et al. Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial. Lancet Oncol. 2010;11:55-65. doi:10.1016/S1470-2045(09)70314-6
Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, et al. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer. N Engl J Med. 2021;385:2336-2347. doi:10.1056/NEJMoa2108873
Sparano JA, Gray RJ, Makower DF, et al. Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med. 2015;373:2005-2014. doi:10.1056/NEJMoa1510764
Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379:111-121. doi:10.1056/NEJMoa1804710
Siegelmann-Danieli N, Silverman B, Zick A, Beit-Or A, Katzir I, Porath A. The impact of the Oncotype DX recurrence score on treatment decisions and clinical outcomes in patients with early breast cancer: the Maccabi Healthcare Services experience with a unified testing policy. Ecancermedicalscience. 2013;7:380. doi:10.3332/ecancer.2013.380
Felts JL, Zhu J, Han B, Smith SJ, Truica CI. An analysis of Oncotype DX recurrence scores and clinicopathologic characteristics in invasive lobular breast cancer. Breast J. 2017;23:677-686. doi:10.1111/tbj.12751
Tadros AB, Wen HY, Morrow M. Breast cancers of special histologic subtypes are biologically diverse. Ann Surg Oncol. 2018;25:3158-3164. doi:10.1245/s10434-018-6687-z
Christgen M, Gluz O, Harbeck N, et al. Differential impact of prognostic parameters in hormone receptor-positive lobular breast cancer. Cancer. 2020;126:4847-4858. doi:10.1002/cncr.33104
Kizy S, Huang JL, Marmor S, Tuttle TM, Hui JYC. Impact of the 21-gene recurrence score on outcome in patients with invasive lobular carcinoma of the breast. Breast Cancer Res Treat. 2017;165:757-763. doi:10.1007/s10549-017-4355-9
Chen XH, Zhang WW, Wang J, et al. 21-gene recurrence score and adjuvant chemotherapy decisions in patients with invasive lobular breast cancer. Biomark Med. 2019;13:83-93. doi:10.2217/bmm-2018-0396
Ashok Kumar P, Paulraj S, Wang D, Huang D, Sivapiragasam A. Associated factors and outcomes of delaying adjuvant chemotherapy in breast cancer by biologic subtypes: a National Cancer Database study. J Cancer Res Clin Oncol. 2021;147:2447-2458. doi:10.1007/s00432-021-03525-6
Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2:322-329. doi:10.1001/jamaoncol.2015.3856
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613-619. doi:10.1016/0895-4356(92)90133-8
Pestalozzi BC, Zahrieh D, Mallon E, et al. Distinct clinical and prognostic features of infiltrating lobular carcinoma of the breast: combined results of 15 International Breast Cancer Study Group clinical trials. J Clin Oncol. 2008;26:3006-3014. doi:10.1200/JCO.2007.14.9336
Jacobs C, Ibrahim MFK, Clemons M, et al. Treatment choices for patients with invasive lobular breast cancer: a doctor survey. J Eval Clin Pract. 2015;21:740-748. doi:10.1111/jep.12379
Hu G, Hu G, Zhang C, et al. Adjuvant chemotherapy could not bring survival benefit to HR-positive, HER2-negative, pT1b-c/N0-1/M0 invasive lobular carcinoma of the breast: a propensity score matching study based on SEER database. BMC Cancer. 2020;20:136. doi:10.1186/s12885-020-6614-0
Trapani D, Gandini S, Corti C, et al. Benefit of adjuvant chemotherapy in patients with lobular breast cancer: a systematic review of the literature and metanalysis. Cancer Treat Rev. 2021;97:102205. doi:10.1016/j.ctrv.2021.102205
Bomeisl PE, Thompson CL, Harris LN, Gilmore HL. Comparison of Oncotype DX recurrence score by histologic types of breast carcinoma. Arch Pathol Lab Med. 2015;139:1546-1549. doi:10.5858/arpa.2014-0557-OA
Kalife ET, Sung CJ, Singh K. To Oncotype or not: knowledge of histologic grade and subtype may help. Arch Pathol Lab Med. 2016;140:1184-1185. doi:10.5858/arpa.2016-0195-LE
Wilson PC, Chagpar AB, Cicek AF, et al. Breast cancer histopathology is predictive of low-risk Oncotype Dx recurrence score. Breast J. 2018;24:976-980. doi:10.1111/tbj.13117
Conlon N, Ross DS, Howard J, Catalano JP, Dickler MN, Tan LK. Is there a role for Oncotype Dx testing in invasive lobular carcinoma? Breast J. 2015;21:514-519. doi:10.1111/tbj.12445
Tsai ML, Lillemoe TJ, Finkelstein MJ, et al. Utility of Oncotype DX risk assessment in patients with invasive lobular carcinoma. Clin Breast Cancer. 2016;16:45-50. doi:10.1016/j.clbc.2015.08.001
Makower D, Qin J, Lin J, Xue X, Sparano JA. The 21-gene recurrence score in early nonductal breast cancer: a National Cancer Database analysis [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, Texas; AARC. Cancer Res. 2021;84(4 suppl);PS6-20. doi:10.1158/1538-7445.SABCS20-PS6-20