Authors' recommendations: Nearly 200,000 new cases of breast cancer are identified in the United States every year, which lead to approximately 40,000 deaths annually. While common, breast cancer is highly treatable when identified early and has a 98% 5-year survival rate for women. However, once spread to the lymph nodes (disease is node positive, or N+), the 5-year survival rate drops to 83.6%, and to 23.4% if the cancer has metastasized. To reduce the risk of recurrence of breast cancer following surgical resection, adjuvant chemotherapy is commonly used, which has resulted in improvements in both disease-free survival and overall survival. However, a dilemma exists in that it is not currently possible to use clinical or pathologic variables to predict in which women the cancer will recur. Therefore, many women need to be treated and exposed to the risks of adjuvant chemotherapy for a few to benefit in avoiding cancer recurrence. Adjuvant chemotherapies, depending on the individual agents and regimens, are associated with a variety of common toxicities, including nausea and vomiting, myelosuppression, hair loss, cognitive decline, and mucositis, as well as less common toxicities that are often more severe, such as heart failure, thromboembolic events, premature menopause, and leukemia. The antiestrogen hormonal agent tamoxifen is often used as an adjuvant therapy to reduce the risk of breast cancer recurrence in women with estrogen receptor (ER) positive (ER+) breast cancer. Recently, the aromatase inhibitors anastrozole, letrozole, and exemestane have also been used as an option for adjuvant antiestrogen therapy. Adjuvant chemotherapy is offered on the basis of risk factors that have been shown to be associated with greater disease-specific mortality or greater chance of distant recurrence (metastasis). These risk factors often include patient age, menopause status, disease stage and location, histologic and nuclear tumor grade, ER status, progesterone receptor (PR) status, whether the tumor expresses the oncogene human epidermal growth factor receptor 2 (HER2 or ERBB2), and measures of proliferation of the tumor. Because of the complexity of making these decisions, several guidelines and prognostic models are used to identify patients at high risk for disease-specific mortality or greater chance of distant recurrence. The most common of these are the St. Gallen guidelines, the National Comprehensive Cancer Network (NCCN) guidelines, and the Adjuvant! Online model. The focus of this review is to assess the evidence that supports use of the Oncotype DX assay to predict breast cancer recurrence or response to treatment with adjuvant chemotherapy.

Project Status: Completed

Year Published: 2010

URL for published report: http://www.hayesinc.com/hayes/crd/?crd=11163

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: HAYES, Inc.

Contact Address: 157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215 855 0615; Fax: 215 855 5218

Contact Name: saleinfo@hayesinc.com

Contact Email: saleinfo@hayesinc.com

Copyright: 2010 Winifred S. Hayes, Inc