Clinical Utility of Genomic Assay in Node-Positive Early-Stage Breast Cancer

Abstract

Breast cancer (BC) is the most common malignancy among women in Canada. Adjuvant treatment in early BC can reduce the risk of BC recurrence. Historically, the decision for adjuvant chemotherapy for early BC was made only based on clinical and tumour characteristics. In recent years, there has been an effort toward developing genomic assays as a predictive and prognostic tool to improve precision in estimating disease recurrence, sensitivity to systemic treatment and ultimately with clinical utility for guidance regarding adjuvant systemic treatment(s). There are various commercial genomic tests available for early-stage ER+/HER-2 negative BC. This paper will review the Oncotype DX 21-gene Recurrence Score (RS), MammaPrint, EndoPredict, Prosigna^®, and Breast Cancer Index (BCI) genomic assays. We will also focus on these genomic assays' clinical application and utility in node-positive early-stage BC based on the most recent evidence and guidance recommendations.

Keywords: Breast Cancer Index (BCI); EndoPredict; MammaPrint; Oncotype DX 21-gene Recurrence Score (RS); Prosigna®.

Figure 1

Algorithm on usage of biomarkers to guide decisions on adjuvant treatment among patients with node-positive early-stage ER+/HER2– BC as per ASCO updated guidelines 2022. Reprinted with permission from ASCO guidelines. Copyright year 2022, copyright owner’s Wolters Kluwer Health, INC [8].