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Breast Cancer Research and Treatment

, Volume 141, Issue 1, pp 13–22 | Cite as

The impact of the Oncotype Dx breast cancer assay in clinical practice: a systematic review and meta-analysis

  • Josh J. CarlsonEmail author
  • Joshua A. Roth
Review

Abstract

The impact of the Oncotype Dx (ODX) breast cancer assay on adjuvant chemotherapy (ACT) treatment decisions has been evaluated in many previous studies. However, it can be difficult to interpret the collective findings, which were conducted in diverse settings with limited sample sizes. We conducted a systematic review and meta-analysis to synthesize the results and provide insights about ODX utility. Studies, identified from PubMed, Embase, ASCO, and SABCS, were included if patients had ER+, node −, early-stage breast cancer, reported use of ODX to inform actual ACT decisions. Information was summarized and pooled according to: (1) distribution of ODX recurrence scores (RS), (2) impact of ODX on ACT recommendations, (3) impact of ODX on ACT use, and (4) proportion of patients following the treatment suggested by the ODX RS. A total of 23 studies met inclusion criteria. The distribution of RS categories was 48.8 % low, 39.0 % intermediate, and 12.2 % high (21 studies, 4,156 patients). ODX changed the clinical-pathological ACT recommendation in 33.4 % of patients (8 studies, 1,437 patients). In patients receiving ODX, receipt of ACT were: 28.2 % overall, 5.8 % low, 37.4 % intermediate, and 83.4 % high. High RS patients were significantly more likely to follow the treatment suggested by ODX versus low RS patients RR: 1.07 (1.01–1.14). The pooled results are consistent with most individual studies to date. The increased proportion of intermediate scores relative to original estimates may have implications for the clinical utility and cost impacts of testing. In addition, low versus high RS patients were significantly more likely to follow the ODX results, suggesting a tendency toward less aggressive treatment, despite a high ODX RS. Finally, there was a lack of studies on the impact of ODX on ACT use versus standard approaches, suggesting that additional studies are warranted.

Keywords

Gene expression Breast cancer Meta-analysis Adjuvant chemotherapy 

Notes

Acknowledgements

Carlson JJ is supported by the Agency for Healthcare Research and Quality Mentored Clinical Scientists Comparative Effectiveness Development Program (K12) at University of Washington (HS019482). Roth JA is supported by a National Institute on Aging T32 (AG027677).

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Pharmaceutical Outcomes Research and Policy ProgramUniversity of WashingtonSeattleUSA
  2. 2.Fred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.Group Health Research InstituteSeattleUSA

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