Abstract P3-05-44: Genomic testing and Ki-67 Percentage: Two puzzle pieces being undervalued in breast cancer treatment
Authors: Wernecke Chloe , Ortega Krista , Bontempo Kelly , Bentley Brenna , Hoyer-Kimura Christina , Beitsch Peter , Patel Rakesh , Rosen Barry , Compagnoni Gia , Grady Ian , Brown Eric , Gold Lindsay , Whitworth Pat , Smith Linda Ann , Reitherman Richard , Wirga Mariusz , Cai Steven , Nguyen Toan , Traina Valerie , Holmes Dennis , Baron Paul , Krautheim Brittany , Peled Anne , Taylor Walt 
Published: March 2023

Abstract
Background: Genetic resources are underutilized when it comes to being incorporated into a breast cancer patient’s treatment, but that isn’t the only piece being overlooked. The Ki-67 proliferation index expressed (Ki-67%) is an established marker of tumor proliferation and aggressive behavior. We hypothesized that Ki-67% could have increased clinical utility when correlated with genomic testing results. Methods: Data was obtained from the Informed Genetics Annotated Patient Registry (iGAP), an IRB-approved, multi-center longitudinal registry designed to capture biomarker test results and their impact on treatment practices and outcomes. Tumor grades and Ki-67% were taken from patient pathology reports. The average Ki-67% was then calculated and compared for each tumor grade, MammaPrint genomic recurrence risk category (ultra low risk, low risk, and high risk), and Blueprint molecular subtype (Luminal type A, Luminal type B, Basal, and HER 2 type). ANOVA statistical analysis was performed for significance values. Results: Of 3102 patients enrolled in the iGAP Registry, 733 were diagnosed with breast cancer and had available tumor grade and Ki-67% data. Among these patients, 357 had genomic recurrence risk (MammaPrint) and 220 genomic molecular subtyping (BluePrint) reports. As expected, tumor grades were significantly positively correlated with Ki-67% (p&lt; 0.0001 between all 3 tumor grade groups). Average Ki-67% in each genomic recurrence risk revealed a significant difference between Low Risk (14%, range 1-70%) and High Risk (36%, range 1-95%, p&lt; 0.0001). Among the genomic molecular subtypes, there were significant differences in Ki-67% between Basal (avg 69%, 17-95%) and Luminal type A (avg 13%, 1-70%, p&lt; 0.0001)) and all other subtypes, while Luminal type B (avg 24%, 1-80%) and HER 2 (avg 38%, 29-45%) were not significantly different from each other (p=0.2817), but still significantly different to all other subtypes. Conclusion: From these results, we can deduce that molecular subtype correlates with, but is clinically distinct from, Ki-67 proliferation index. These results also indicate that molecular subtype correlates with higher tumor grades, possibly due to increased cell proliferation. Achieving truly personalized clinical decision making requires utilizing multiple modalities and biomarkers, integrating the results into management.
Citation Format: Chloe Wernecke, Krista Ortega, Kelly Bontempo, Brenna Bentley, Christina Hoyer-Kimura, Peter Beitsch, Rakesh Patel, Barry Rosen, Gia Compagnoni, Ian Grady, Eric Brown, Lindsay Gold, Pat Whitworth, Linda Ann Smith, Richard Reitherman, Mariusz Wirga, Steven Cai, Toan Nguyen, Valerie Traina, Dennis Holmes, Paul Baron, Brittany Krautheim, Anne Peled, Walt Taylor. Genomic testing and Ki-67 Percentage: Two puzzle pieces being undervalued in breast cancer treatment [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-44.