Adoption of Gene Expression Profile Testing and Association With Use of Chemotherapy Among Women With Breast Cancer
Adoption of Gene Expression Profile Testing and Association With Use of Chemotherapy Among Women With Breast Cancer
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DOI：
10.1200/jco.2011.38.5740
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发表时间：
2012-06-20
影响因子：
45.3
通讯作者：
Weeks, Jane C.
中科院分区：
文献类型：
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作者：
Hassett, Michael J.;Silver, Samuel M.;Weeks, Jane C.
目的基因表达谱（GEP）检测是一项相对较新的技术，它为患者提供了个性化治疗的潜力，但对其常规应用知之甚少。第一个商业化的GEP测试之一，一个21个基因的档案，被开发来评估激素受体阳性乳腺癌辅助化疗的好处（HR阳性BC）.患者和方法通过使用一个前瞻性登记数据集，该数据集概述了在17个综合性和基于社区的癌症中心从2006年到2008年向诊断为HR阳性BC的妇女提供的常规护理，我们评估了GEP测试的采用以及测试与化疗使用之间的关联。结果在7，375名女性中，20.4%接受了GEP测试，50.2%接受了化疗。随着时间的推移，检测增加（2006年为14.7%，2008年为27.5%; P <0.01），化疗的使用减少（2006年为53.9%，2008年为47.0%; P <0.01）。与检测几率较低独立相关的特征包括非裔美国人与白色种族（比值比[OR]，0.70; 95%CI，0.54至0.92）以及高中或以下与高中以上教育程度（OR，0.63; 95%CI，0.52至0.76）。总体而言，检测与化疗使用的几率较低相关（OR，0.70; 95% CI，0.62至0.80）。分层分析表明，对于小的，淋巴结阴性的癌症，检测与化疗使用的几率较高相关（OR，11.13; 95%CI，5.39至22.99），而对于淋巴结阳性和大淋巴结阴性癌症，检测与化疗使用的几率较低相关（OR，0.11; 95%CI，0.07至0.17）.ConclusionThere一直是一个渐进的增加，在使用这种GEP测试和相关的转变的特点和整体减少的比例与HR阳性BC接受辅助化疗的妇女。J Clin Oncol 30：2218-2226. (c)2012年美国临床肿瘤学会
PurposeGene expression profile (GEP) testing is a relatively new technology that offers the potential of personalized medicine to patients, yet little is known about its adoption into routine practice. One of the first commercially available GEP tests, a 21-gene profile, was developed to estimate the benefit of adjuvant chemotherapy for hormone receptor-positive breast cancer (HR-positive BC).Patients and MethodsBy using a prospective registry data set outlining the routine care provided to women diagnosed from 2006 to 2008 with HR-positive BC at 17 comprehensive and community-based cancer centers, we assessed GEP test adoption and the association between testing and chemotherapy use.ResultsOf 7,375 women, 20.4% had GEP testing and 50.2% received chemotherapy. Over time, testing increased (14.7% in 2006 to 27.5% in 2008; P < .01) and use of chemotherapy decreased (53.9% in 2006 to 47.0% in 2008; P < .01). Characteristics independently associated with lower odds of testing included African American versus white race (odds ratio [OR], 0.70; 95% CI, 0.54 to 0.92) and high school or less versus more than high school education (OR, 0.63; 95% CI, 0.52 to 0.76). Overall, testing was associated with lower odds of chemotherapy use (OR, 0.70; 95% CI, 0.62 to 0.80). Stratified analyses demonstrated that for small, node-negative cancers, testing was associated with higher odds of chemotherapy use (OR, 11.13; 95% CI, 5.39 to 22.99), whereas for node-positive and large node-negative cancers, testing was associated with lower odds of chemotherapy use (OR, 0.11; 95% CI, 0.07 to 0.17).ConclusionThere has been a progressive increase in use of this GEP test and an associated shift in the characteristics of and overall reduction in the proportion of women with HR-positive BC receiving adjuvant chemotherapy. J Clin Oncol 30:2218-2226. (c) 2012 by American Society of Clinical Oncology