Use of the 21-gene recurrence score (RS) assay is helping clinicians and patients decide which treatments are best for them, according to a large-scale survey of more than 3000 women treated for breast cancer.
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The RS test is used to stratify early-stage, estrogen receptor-positive patients with breast cancer by recurrence risk and to see whether chemotherapy would be an effective means of reducing that risk. This helps patients who are very low risk avoid the potentially toxic effects of chemotherapy and makes sure that patients who are high risk receive chemotherapy so that they are less likely to recur.
To see how the RS test was being utilized in clinical practice, researchers led by Christopher Friese, PhD, RN, University of Michigan School of Nursing (Ann Arbor, MI), surveyed 3880 women treated for breast cancer between 2013 and 2014. Women were identified using the Los Angeles County and Georgia Surveillance, Epidemiology, and End Results registries. Respondents reported on their chemotherapy recommendations, receipt of chemotherapy, testing experiences, and decision satisfaction.
Among the respondents, there were 1527 patients with stage I/II, estrogen receptor/progesterone receptor–positive, human epidermal growth factor 2–negative disease. A total of 778 received a RS; 62.5% of these patients had node-negative, unfavorable disease, 24.3% had node-negative, favorable disease, and 13% had node-positive disease. Overall, 47.2% of the patients received a recommendation against chemotherapy, and 40.5% received a recommendation for it.
Further, clinician recommendations tended to correlate with RSs, as patients with high scores (31-100) typically received a chemotherapy recommendation (86.9%-96.5% across clinical subgroups) and patients with low scores (0-18) received a recommendation against it (65.9%-78.2% across subgroups). Additionally, based on the diverse sample of patients, researchers found that race or ethnicity did not play a role in how RS tests were used nor whether or not chemotherapy was recommended.
Researchers concluded that clinicians are using the RS test to personalize treatment for patients with breast cancer, even those with node-negative disease. Still, Dr Friese cautioned that some patients may still be left behind as treatment practices advance.
"Only 60 percent of patients accurately recalled their test result," he said in a press statement. "This suggests that while precision medicine for breast cancer has left the station, we have left a few women behind. There's opportunity in the oncology community to improve how we explain to women the purpose of these tests, how to interpret the results, and what the results mean for their breast cancer treatment."
