Irish National Real-world Analysis of the Clinical and Economic Impact of 21-gene Oncotype DX® Testing in Early-stage, 1-3 Lymph Node-positive, Oestrogen Receptor-positive, HER2-negative, Breast Cancer

Overview

Journal Breast Cancer Res Treat

Specialty Oncology

Date 2024 Oct 4

PMID 39365509

Authors

I M Browne

R A McLaughlin

C S Weadick

S OSullivan

L M McSorley

D K Hadi

S J Millen

M J Higgins

J P Crown

R S Prichard

D P McCartan

A Dk Hill

R M Connolly

S A Noonan

D OMahony

C Murray

C OHanlon-Brown

B T Hennessy

C M Quinn

C M Kelly

S OReilly

P G Morris

J M Walshe

Affiliations

Soon will be listed here.

Abstract

Purpose: The treatment landscape of Oestrogen receptor-positive (ER-positive) breast cancer is evolving, with declining chemotherapy use as a result of Oncotype DX Breast Recurrence Score® testing. Results from the SWOG S1007 RxPONDER trial suggest that adjuvant chemotherapy may benefit some premenopausal women with ER-positive, HER2-negative disease with 1-3 positive lymph nodes (N1), and a Recurrence Score® (RS) of ≤ 25. Postmenopausal women with similar characteristics did not benefit from adjuvant chemotherapy. We examine the clinical and economic impact of Oncotype DX® testing on treatment decisions in patients with N1 disease in Ireland using real world data.

Methods: From March 2011 to October 2022, a retrospective, cross-sectional observational study was performed of patients with ER-positive, HER2-negative N1 breast cancer, who had Oncotype DX testing across 5 of Ireland's largest cancer centres. Patients were classified into low risk (RS 0-13), intermediate risk (RS 14-25) and high risk (RS > 25). Data were collected via electronic patient records. Information regarding costing was provided primarily by pre-published sources.

Results: A total of 828 N1 patients were included in this study. Post Oncotype DX testing, 480 patients (58%) were spared chemotherapy. Of the patients who had a change in chemotherapy recommendation based on Oncotype DX testing, 271 (56%), 205 (43%), 4 (1%) had a RS result of 0-13, 14-25 and > 25 respectively. Use of Oncotype DX testing was associated with a 58% reduction in chemotherapy administration overall. This resulted in estimated savings of over €6 million in treatment costs. Deducting the assay cost, estimated net savings of over €3.3 million were achieved. Changes in the ordering demographics of Oncotype DX tests were identified after RxPONDER data were presented, with increased testing in women ≥ 50 years and a reduction in proportion of tests ordered for women < 50 years.

Conclusion: Between 2011 and 2022, assay use resulted in a 58% reduction in chemotherapy administration and net savings of over €3.3 million.

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