Advertisement

Breast Cancer Research and Treatment

, Volume 165, Issue 3, pp 757–763 | Cite as

Impact of the 21-gene recurrence score on outcome in patients with invasive lobular carcinoma of the breast

  • Scott Kizy
  • Jing Li Huang
  • Schelomo Marmor
  • Todd M. Tuttle
  • Jane Yuet Ching HuiEmail author
Brief Report

Abstract

Purpose

Invasive lobular carcinoma (ILC) of the breast has unique clinicopathologic characteristics, compared to invasive ductal carcinoma. The role of the 21-gene Recurrence Score (RS) has not been clearly defined for ILC. We sought to determine the prognostic value of RS and the impact of adjuvant chemotherapy on long-term survival in patients with ILC.

Methods

Utilizing the Surveillance, Epidemiology and End Results database from 2004 to 2013, we identified records of women aged 18–74 years, diagnosed with estrogen receptor (ER)-positive ILC (stage I to III) with RS available. We categorized patients into risk groups based on the traditional RS cutoffs and into those of the Trial Assigning Individualized Options for Treatment (TAILORx). Five-year breast cancer-specific survival (BCSS) was analyzed using the Kaplan–Meier method and Cox proportional hazards models.

Results

Of the 7316 women included, 21% were in the low-risk; 71%, intermediate-risk; and 8%, high-risk groups as per TAILORx RS cutoffs. The 5-year BCSS was 99% in the low-risk, 99% in the intermediate-risk, and 96% in the high-risk groups. A high-risk RS as per TAILORx cutoff was independently associated with increased mortality (hazard ratio [HR] of death 2.37, 95% confidence interval [CI] 1.14–4.95) when compared to a low-risk RS. In both the high-risk and intermediate-risk groups, adjuvant chemotherapy was not significantly associated with the HR of death (high-risk, HR 1.14, 95% CI 0.55–2.38; intermediate-risk, HR 1.08, 95% CI 0.62–1.87).

Conclusion

For patients with ER-positive ILC, 8% were in the high-risk and 72% were in the intermediate-risk groups as per the TAILORx RS cutoffs. In the high-risk group, the RS predicted a lower 5-year BCSS. Adjuvant chemotherapy did not seem to confer a survival benefit for either the intermediate- or the high-risk cohorts.

Keywords

Breast cancer Recurrence score Oncotype DX Invasive lobular carcinoma 

Abbreviations

BCSS

Breast cancer-specific survival

CI

Confidence interval

ER

Estrogen receptor

HER

Human epidermal growth factor receptor

HR

Hazard ratio

IDC

Invasive ductal carcinoma

ILC

Invasive lobular carcinoma

OS

Overall survival

PR

Progesterone receptor

RS

Recurrence score

SEER

Surveillance, epidemiology, and end results

TAILORx

Trial assigning individualized options for treatment

Notes

Acknowledgments

The authors would like to thank Dr. Mary Knatterud for her assistance in editing this manuscript. Dr. Todd Tuttle reports a potential conflict of interest in holding an advisory board position for Genomic Health. There are no other conflicts of interest to disclose.

Supplementary material

10549_2017_4355_MOESM1_ESM.tiff (591 kb)
Supplementary material 1 (TIFF 590 kb)
10549_2017_4355_MOESM2_ESM.docx (79 kb)
Supplementary material 2 (DOCX 78 kb)

References

  1. 1.
    Paik S, Shak S, Tang G et al (2004) A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 351:2817–2826. doi: 10.1056/NEJMoa041588 CrossRefPubMedGoogle Scholar
  2. 2.
    Győrffy B, Hatzis C, Sanft T et al (2015) Multigene prognostic tests in breast cancer: past, present, future. Breast Cancer Res Treat 17:11. doi: 10.1186/s13058-015-0514-2 CrossRefGoogle Scholar
  3. 3.
    Mamounas EP, Tang G, Fisher B et al (2010) Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J Clin Oncol 28:1677–1683. doi: 10.1200/JCO.2009.23.7610 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Sparano JA, Gray RJ, Makower DF et al (2015) Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med 373:150927220039001. doi: 10.1056/NEJMoa1510764 CrossRefGoogle Scholar
  5. 5.
    Gradishar W, Anderson B, Balassanian R et al (2016) Invasive breast cancer version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 14:324–354. doi: 10.1136/bmj.324.7334.410 CrossRefPubMedGoogle Scholar
  6. 6.
    Harris L, Fritsche H, Mennel R et al (2007) American society of clinical oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 25:5287–5312. doi: 10.1200/JCO.2007.14.2364 CrossRefPubMedGoogle Scholar
  7. 7.
    Rakha EA, El-Sayed ME, Powe DG et al (2008) Invasive lobular carcinoma of the breast: response to hormonal therapy and outcomes. Eur J Cancer 44:73–83. doi: 10.1016/j.ejca.2007.10.009 CrossRefPubMedGoogle Scholar
  8. 8.
    Rakha EA, Ellis IO (2010) Lobular breast carcinoma and its variants. Semin Diagn Pathol 27:49–61. doi: 10.1053/j.semdp.2009.12.009 CrossRefPubMedGoogle Scholar
  9. 9.
    Ciriello G, Gatza ML, Beck AH et al (2015) Comprehensive molecular portraits of invasive lobular breast cancer. Cell 163:506–519. doi: 10.1016/j.cell.2015.09.033 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Desmedt C, Zoppoli G, Gundem G et al (2016) Genomic characterization of primary invasive lobular breast cancer. J Clin Oncol 34:1872–1880. doi: 10.1200/JCO.2015.64.0334 CrossRefPubMedGoogle Scholar
  11. 11.
    Bertucci F, Orsetti B, Nègre V et al (2008) Lobular and ductal carcinomas of the breast have distinct genomic and expression profiles. Oncogene 27:5359–5372. doi: 10.1038/onc.2008.158 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Delpech Y, Coutant C, Hsu L et al (2013) Clinical benefit from neoadjuvant chemotherapy in oestrogen receptor-positive invasive ductal and lobular carcinomas. Br J Cancer 108:285–291CrossRefGoogle Scholar
  13. 13.
    Truin W, Vugts G, Roumen RMH et al (2016) Differences in response and surgical management with neoadjuvant chemotherapy in invasive lobular versus ductal breast cancer. Ann Surg Oncol 23:51–57. doi: 10.1245/s10434-015-4603-3 CrossRefPubMedGoogle Scholar
  14. 14.
    Marmor S, Hui JYC, Huang JL et al (2017) Relative effectiveness of adjuvant chemotherapy for invasive lobular compared with invasive ductal carcinoma of the breast. Cancer. doi: 10.1002/cncr.30699 CrossRefPubMedGoogle Scholar
  15. 15.
    Truin W, Voogd AC, Vreugdenhil G et al (2012) Effect of adjuvant chemotherapy in postmenopausal patients with invasive ductal versus lobular breast cancer. Ann Oncol 23:2859–2865. doi: 10.1093/annonc/mds180 CrossRefPubMedGoogle Scholar
  16. 16.
    Felts JL, Zhu J, Han B et al (2017) An analysis of Oncotype DX recurrence scores and clinicopathologic characteristics in invasive lobular breast cancer. Breast J 30. Accessed 2/21/2017. doi:  10.1111/tbj.12751
  17. 17.
    Tsai ML, Lillemoe TJ, Finkelstein MJ et al (2016) Utility of oncotype DX risk assessment in patients with invasive lobular carcinoma. Clin Breast Cancer 16:45–50. doi: 10.1016/j.clbc.2015.08.001 CrossRefPubMedGoogle Scholar
  18. 18.
    Siegelmann-Danieli N, Silverman B, Zick A et al (2013) The impact of the Oncotype DX recurrence score on treatment decisions and clinical outcomes in patients with early breast cancer: the Maccabi healthcare services experience with a unified testing policy. Ecancermedicalscience 7:1–10. doi: 10.3332/ecancer.2013.380 CrossRefGoogle Scholar
  19. 19.
    Kelly CM, Krishnamurthy S, Bianchini G et al (2010) Utility of oncotype DX risk estimates in clinically intermediate risk hormone receptor-positive, HER2-normal, grade II, lymph node-negative breast cancers. Cancer 116:5161–5167. doi: 10.1002/cncr.25269 CrossRefPubMedGoogle Scholar
  20. 20.
    Tsai ML, Lillemoe TJ, Finkelstein MJ et al (2016) Utility of oncotype DX risk assessment in patients with invasive lobular carcinoma. Clin Breast Cancer 16:45–50. doi: 10.1016/j.clbc.2015.08.001 CrossRefPubMedGoogle Scholar
  21. 21.
    Fisher B, Dignam J, Wolmark N et al (1997) Tamoxifen and chemotherapy for lymph node-negative, estrogen receptor-positive breast cancer. J Natl Cancer Inst 89:1673–1682. doi: 10.1093/jnci/89.22.1673 CrossRefPubMedGoogle Scholar
  22. 22.
    Barroso-Sousa R, Metzger-Filho O (2016) Differences between invasive lobular and invasive ductal carcinoma of the breast: results and therapeutic implications. Therap Adv Med Oncol 8:261–266. doi: 10.1177/1758834016644156 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of MinnesotaMinneapolisUSA

Personalised recommendations