SEP 03, 2015 11:55 PM PDT

Cancer Risk and Chemotherapy Usage

WRITTEN BY: Ilene Schneider
A genetic test can predict whether some women’s breast cancer will recur, and that could influence how chemotherapy is used. A study from Duke University Medicine determined that low-risk patients who took the test seemed to decide on more treatment, and high-risk patients who took it chose less.
Genetic test predicts cancer recurrence and affects therapy selection.
The findings show that the 21-gene recurrence test score, approved for Medicare coverage in 2006, is being used to help direct clinical decisions in what is among the first widespread applications of personalized medicine. The Duke-led study was published in JAMA Oncology and reported in Drug Discovery & Development

As lead author Michaela A. Dinan, Ph.D., of the Duke Cancer Institute and the Duke Clinical Research Institute explained, “The decision to get chemotherapy is very complex and personal, and it needs to be made between patients and physicians. This shows that the risk score test provides information that appears to affect to patients’ selection of treatment options in general clinical practice.”

Dinan and colleagues did a retrospective study, in which they analyzed data for 44,044 Medicare patients who had early-stage, estrogen receptor-positive breast cancer. They are patients for whom the RS assay is recommended. Of those patients, 24 percent were described as low-risk using National Comprehensive Cancer Network (NCCN) guidelines; 51.3 percent were classified as intermediate risk; and 24.6 percent were called high risk because of lymph node involvement. 

In toto, 14.3 percent of patients had chemotherapy within 12 months after diagnosis. The researchers saw no overall association between having the RS assay and using chemotherapy.

However, among the different NCCN categories, there were surprising differences. RS testing was associated with decreased chemotherapy use among patients who were designated under NCCN definitions as high-risk – especially the younger Medicare patients who were between the ages of 66 and 70. Increased chemotherapy treatment was associated with test use among NCCN-designated low-risk patients.

The authors were unaware of what the RS scores were for the patients. Therefore, they were not able to ascertain whether patients in the NCCN risk categories coincided with RS risk.

Dinan concluded, “This limitation of the study affected the extent to which we could determine how the RS results were being used to guide chemotherapy within individual patients, and remains an area of ongoing research.”

About the Author
Bachelor's (BA/BS/Other)
Ilene Schneider is the owner of Schneider the Writer, a firm that provides communications for health care, high technology and service enterprises. Her specialties include public relations, media relations, advertising, journalistic writing, editing, grant writing and corporate creativity consulting services. Prior to starting her own business in 1985, Ilene was editor of the Cleveland edition of TV Guide, associate editor of School Product News (Penton Publishing) and senior public relations representative at Beckman Instruments, Inc. She was profiled in a book, How to Open and Operate a Home-Based Writing Business and listed in Who's Who of American Women, Who's Who in Advertising and Who's Who in Media and Communications. She was the recipient of the Women in Communications, Inc. Clarion Award in advertising. A graduate of the University of Pennsylvania, Ilene and her family have lived in Irvine, California, since 1978.
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