RECOMMENDATIONS In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2 , the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX , EndoPredict , PAM50 , Breast Cancer Index , and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer .
No biomarker except for estrogen receptor , progesterone receptor , and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens .
PURPOSE To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer .
Molecular subtypes of breast cancer and amplification of topoisomerase IIα: predictive role in dose intensive adjuvant chemotherapy
Benefit from chemotherapy treatment in breast cancer patients is determined by the molecular make-up of the tumour . In a retrospective analysis , we determined the molecular subtypes of breast cancer originally defined by expression microarrays by immunohistochemistry in tumours of patients who took part in a r and omised study of adjuvant high-dose chemotherapy in breast cancer . In addition , the topoisomerase IIα ( TOP2A ) amplification status was determined by fluorescence in situ hybridisation and chromogenic in situ hybridisation . 411 of the 753 tumours ( 55 % ) were classified as luminal-like , 137 ( 18 % ) as basal-like and 205 ( 27 % ) as human epithelial receptor type 2 ( HER2 ) amplified . The basal-like tumours were defined as having no expression of ER and HER2 ; 98 of them did express epidermal growth factor receptor and /or cytokeratin 5/6 . The luminal-like tumours had a significantly better recurrence free and overall survival than the other two groups . From the 194 HER2-positive tumours , 47 ( 24 % ) were shown to harbour an amplification of TOP2A . Patients with an HER2-amplified tumour r and omised to the high-dose therapy arm did worse than those in the conventional treatment arm , possibly caused by the lower cumulative anthracycline dose in the high-dose arm . The tumours with a TOP2A amplification contributed hardly to this difference , suggesting that TOP2A amplification is not the cause of the steep dose – response curve for anthracyclines in breast cancer . Possibly , the difference of the cumulative dose of only 25 % between the treatment arms was insufficient to yield a survival difference
RECOMMENDATIONS In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2 , the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX , EndoPredict , PAM50 , Breast Cancer Index , and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer .
No biomarker except for estrogen receptor , progesterone receptor , and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens .
PURPOSE To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer .