Role of clinical judgement in offering adjuvant chemotherapy for Breast Cancer patients
Published Date: 01st December 2020
Publication Authors: Patnam V, Pushdary KH
Aim
NICE recommends Oncotype Dx for patients with oestrogen receptor‐positive, human epidermal growth factor receptor 2 (HER2)‐negative and lymph node (LN)‐negative patients in the decision for adjuvant chemotherapy. Oncotype Dx predicts cancer recurrence and benefits from chemotherapy based on Recurrence Score (RS >26 significant chemotherapy benefit). We aimed to assess if clinical judgement coerces in offering chemotherapy in patients with RS less than 25.
Methods
Forty patients were identified in a period of one year, who were eligible and requested for Oncotype Dx as per NICE guidelines with Nottingham Prediction tool between 3.4‐5.4.
Results
Forty patients with a median age of 58 years (IQR 53.25 – 64.25). Surgery performed was mastectomy (20 patients) or wide local excision (20 patients). Nine patients had RS more than 25 and received chemotherapy, whereas two of 31 patients with RS less than 25 were offered chemotherapy due to lymphovascular invasion and tumour being pure mucinous carcinoma. Three patients who had lymph node metastasis and did not meet the criteria for Oncotype Dx still had the test done, although RS was less than 20 and not offered chemotherapy.
Conclusion
In selected clinical scenarios, tumour profiling test requests may be avoided where chemotherapy is a definitive indication or likely to offer benefit. This decreases financial burden (Oncotype Dx costs £3000) and avoids delay in opportune management. The decision in performing the test may be deferred until histopathology result, MDT recommendations, clinical and patient factors are assessed and guide for chemotherapy, regardless of Oncotype Dx result.
Patnam, V; Pushdary, K; Leaver, N. (2020). Role of clinical judgement in offering adjuvant chemotherapy for Breast Cancer patients in conjunction with tumour profiling test-Oncotype Dx: A single breast unit experience. British Journal of Surgery. 107 (S4), 59