Breast cancer

ASCO Updates Breast Cancer Guideline to Include Genomic Test

The American Society of Clinical Oncology (ASCO) has recently updated its 2016 clinical guideline on biomarker use in patients with early invasive breast cancer. The guideline now includes the genomic test MammaPrint (Agendia, Irvine, CA) as a way to guide decisions on the use of adjuvant systemic therapy.

The update was based upon results of the phase III randomized MINDACT (Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy) study. In this study, the researchers assessed the effects of MammaPrint assay in 6693 women with early-stage breast cancer. Prior to the update, an expert panel reviewed the results of the MINDACT study and other published literature on the MammaPrint assay.
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ASCO has made the following recommendations for use of MammaPrint:

  • MammaPrint can be used to inform patients with high clinical risk regarding withholding adjuvant systemic chemotherapy due to its ability to identify a good-prognosis population with potentially limited chemotherapy benefit. This population includes patients with hormone receptor-positive, epidermal growth factor receptor 2 (HER2)-negative, node-negative breast cancer.
  • Women with low clinical risk should not receive a MammaPrint assay because they do not benefit from chemotherapy, regardless of genomic MammaPrint risk group.
  • Patients with hormone receptor-positive, HER2-negative, node-positive breast cancer, with 1 to 3 positive nodes and a high clinical risk may benefit from the MammaPrint assay in terms of informing decisions on withholding adjuvant systemic chemotherapy. However, patients should know chemotherapy may still be beneficial, especially in patients with more than 1 involved lymph node.
  • Due to lack of definitive evidence, MammaPrint assay should not be used to guide decisions on adjuvant systemic therapy in patients with hormone receptor-positive, HER2-negative, node-positive breast cancer at low clinical risk, nor should it be used in patients with HER2-positive or triple-negative breast cancer.

—Christina Vogt

Reference:

Krop I, Ismaila N, Andre F, et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American society of clinical oncology clinical practice guideline focused update [Published online July 10, 2017]. J Clin Oncol. doi:10.1200/JCO.2017.74.0472.