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The impact of EndoPredict ® on decision making with increasing oncological work experience: can overtreatment be avoided?

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Estimating distant recurrence risk in women with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer is still challenging. EndoPredict® is a gene expression-based test predicting the likelihood of recurrent disease. We analyzed the difference in oncological decision making with and without the knowledge of gene expression tests.

Patients and methods

This is a retrospective analysis including patients diagnosed with hormone-receptor positive, Her2 negative breast cancer between 2011 and 2015 at the Municipal Breast Cancer Centre Cologne, Germany. All patients received an evaluation by EndoPredict®. An oncological tumor board (TB) with knowledge of these results served as a baseline (control group). This baseline was compared to the treatment decision (adjuvant chemotherapy yes vs. no) made by oncologists with different experience levels (less than 5 years, between 5 and 15 years, and more than 15 years) who were not provided the EndoPredict® scores. All clinicians had access to clinical as well to histopathological data.

Results

There was no significant difference between control group and the oncologists with different experience levels concerning a chemotherapy indication. A trend could be shown in the subgroup of nodal negative patients between the treatment recommendation and physicians with more than 15 years of experience (p = 0.088). A further trend could be demonstrated in the subgroup of patients with a low Ki67 index (≤ 14%) (p = 0.063) between physician with 5–10 years of clinical experience and official treatment recommendation.

Conclusion

It seems that inexperienced physicians may profit from the use of EndoPredict® to avoid an overtreatment. In nodal negative patients and patients with a low Ki67 index, undertreatment can be avoided with the use of EndoPredict® (borderline significance). Further prospective studies with larger study cohorts are needed to further validate this tool.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University of Cologne, Medical Faculty, Cologne, Germany

    Fabinshy Thangarajah, Christian Eichler, Julia Fromme, Wolfram Malter, Sebastian Ludwig & Julian Puppe

  2. Breast Center, University of Cologne, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany

    Fabinshy Thangarajah, Christian Eichler & Wolfram Malter

  3. Breast Cancer Center, Municipal Hospital Holweide, Cologne, Germany

    Christian Eichler & Matthias Warm

  4. Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Germany

    Julia Caroline Radosa

  5. Breast Cancer Center, Technical University Munich, Munich, Germany

    Stefan Paepke

Authors
  1. Fabinshy Thangarajah
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  2. Christian Eichler
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  3. Julia Fromme
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  4. Wolfram Malter
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  5. Julia Caroline Radosa
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  6. Sebastian Ludwig
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  7. Julian Puppe
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  8. Stefan Paepke
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  9. Matthias Warm
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Contributions

FT: manuscript writing, project development, and data collection. CE: project development and data collection. JF: data collection and statistical analysis. WM: data collection and manuscript editing. JCR: data collection and manuscript editing. SL: data collection and manuscript editing. JP: data collection and manuscript editing. SP: data collection and manuscript editing. MW: manuscript writing, project development, and data collection.

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Correspondence to Fabinshy Thangarajah.

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Thangarajah, F., Eichler, C., Fromme, J. et al. The impact of EndoPredict ® on decision making with increasing oncological work experience: can overtreatment be avoided? . Arch Gynecol Obstet 299, 1437–1442 (2019). https://doi.org/10.1007/s00404-019-05097-w

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