EndoPredict improves the prognostic classification derived from common clinical guidelines in ER-positive, HER2-negative early breast cancer
P Dubsky, M Filipits, R Jakesz, M Rudas, C F Singer, R Greil, O Dietze, I Luisser, E Klug, R Sedivy, M Bachner, D Mayr, M Schmidt, M C Gehrmann, C Petry, K E Weber, R Kronenwett, J C Brase, M Gnant, Austrian Breast and Colorectal Cancer Study Group (ABCSG), P Dubsky, M Filipits, R Jakesz, M Rudas, C F Singer, R Greil, O Dietze, I Luisser, E Klug, R Sedivy, M Bachner, D Mayr, M Schmidt, M C Gehrmann, C Petry, K E Weber, R Kronenwett, J C Brase, M Gnant, Austrian Breast and Colorectal Cancer Study Group (ABCSG)
Abstract
Background: In early estrogen receptor (ER)-positive/HER2-negative breast cancer, the decision to administer chemotherapy is largely based on prognostic criteria. The combined molecular/clinical EndoPredict test (EPclin) has been validated to accurately assess prognosis in this population. In this study, the clinical relevance of EPclin in relation to well-established clinical guidelines is assessed.
Patients and methods: We assigned risk groups to 1702 ER-positive/HER2-negative postmenopausal women from two large phase III trials treated only with endocrine therapy. Prognosis was assigned according to National Comprehensive Cancer Center Network-, German S3-, St Gallen guidelines and the EPclin. Prognostic groups were compared using the Kaplan-Meier survival analysis.
Results: After 10 years, absolute risk reductions (ARR) between the high- and low-risk groups ranged from 6.9% to 11.2% if assigned according to guidelines. It was at 18.7% for EPclin. EPclin reassigned 58%-61% of women classified as high-/intermediate-risk (according to clinical guidelines) to low risk. Women reclassified to low risk showed a 5% rate of distant metastasis at 10 years.
Conclusion: The EPclin score is able to predict favorable prognosis in a majority of patients that clinical guidelines would assign to intermediate or high risk. EPclin may reduce the indications for chemotherapy in ER-positive postmenopausal women with a limited number of clinical risk factors.
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Source: PubMed