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. 2021 Apr;12(Suppl 1):21-29.
doi: 10.1007/s13193-019-01014-4. Epub 2019 Dec 9.

CanAssist Breast Impacting Clinical Treatment Decisions in Early-Stage HR+ Breast Cancer Patients: Indian Scenario

Satish Sankaran  1 , Jyoti Bajpai Dikshit  1 , Chandra Prakash Sv  1 , S E Mallikarjuna  1 , S P Somashekhar  2 , Shekhar Patil  3   4 , Rajeev Kumar  5 , Krishna Prasad  6 , Dinesh Shet  7 , Manjiri M Bakre  1
Affiliations

CanAssist Breast Impacting Clinical Treatment Decisions in Early-Stage HR+ Breast Cancer Patients: Indian Scenario

Satish Sankaran et al. Indian J Surg Oncol. 2021 Apr.

Abstract

CanAssist Breast (CAB) has thus far been validated on a retrospective cohort of 1123 patients who are mostly Indians. Distant metastasis-free survival (DMFS) of more than 95% was observed with significant separation (P < 0.0001) between low-risk and high-risk groups. In this study, we demonstrate the usefulness of CAB in guiding physicians to assess risk of cancer recurrence and to make informed treatment decisions for patients. Of more than 500 patients who have undergone CAB test, detailed analysis of 455 patients who were treated based on CAB-based risk predictions by more than 140 doctors across India is presented here. Majority of patients tested had node negative, T2, and grade 2 disease. Age and luminal subtypes did not affect the performance of CAB. On comparison with Adjuvant! Online (AOL), CAB categorized twice the number of patients into low risk indicating potential of overtreatment by AOL-based risk categorization. We assessed the impact of CAB testing on treatment decisions for 254 patients and observed that 92% low-risk patients were not given chemotherapy. Overall, we observed that 88% patients were either given or not given chemotherapy based on whether they were stratified as high risk or low risk for distant recurrence respectively. Based on these results, we conclude that CAB has been accepted by physicians to make treatment planning and provides a cost-effective alternative to other similar multigene prognostic tests currently available.

Keywords: CanAssist-Breast; Decision impact; Early-stage breast cancer; Indian patients; Prognostic.

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Conflict of interest statement

Conflict of InterestAll authors except SPS, SP, RK, KP, and DS are employees of OncoStem Diagnostics Pvt. Ltd which developed CanAssist-Breast. MMB is a co-inventor on a patent application related to this article. Authors do not have any other competing interest to declare.

Figures

Fig. 1
Fig. 1
Performance of CAB. a Survival (KM) curve using CAB-based risk categorization on a retrospective mixed cohort of chemotherapy-treated and chemotherapy-naïve (endocrine therapy alone treated) patients. b Survival analysis using CAB-based categorization with chemotherapy-naïve patient cohort
Fig. 2
Fig. 2
Comparison of risk categorization by CAB vs Adjuvant! Online. a Proportions of high- and low-risk categorization by the two tests. b Differential risk categorization by CAB vs Adjuvant! Online irrespective of node status. c Differential risk categorization by CAB vs Adjuvant! Online based on node status
Fig. 3
Fig. 3
Physician prescriptions. a Geographical distribution of prescribers of CAB in India and outside India (n = 440). b Percentage of physician prescriptions across based on number of cases prescribed
See this image and copyright information in PMC

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