TY - JOUR
T1 - The impact and indications for Oncotype DX on adjuvant treatment recommendations when third-party funding is unavailable
AU - Chin-Lenn, L.
AU - De, Boer
AU - Segelov, E.
AU - Marx, G.M.
AU - Hughes, T.M.
AU - McCarthy, N.J.
AU - White, S.C.
AU - Foo, S.S.
AU - Rutovitz, J.J.
AU - Della-Fiorentina, S.
AU - Jennens, R.
AU - Antill, Y.C.
AU - Tsoi, D.
AU - Cronk, M.F.
AU - Lombard, J.M.
AU - Kiely, B.E.
AU - Chirgwin, J.H.
AU - Gorelik, A.
AU - Mann, G.B.
PY - 2018
Y1 - 2018
N2 - Objectives: Industry-supported decision impact studies demonstrate that Oncotype Dx (ODX) changes treatment recommendations (TR) in 24–40% of hormone receptor+/HER2− patients. ODX is not reimbursed by third-party payers in Australia, potentially resulting in more selective use. We sought to evaluate the impact of self-funded ODX on TRs. Methods: Data collected included demographics, tumor characteristics, indication for ODX and pre- and post-recurrence score (RS) TR. Primary endpoint was frequency of TR change and associations with TR change were sought. Results: Eighteen physicians contributed 382 patients (median age 54). A total of 232 (61%) of tumors were T1 and were grade 1, 2 and 3 in 49 (13%), 252 (66%) and 79 (21%). A total of 257 (67%) were node negative. Assay indications were: confirm need for chemotherapy (CT) (36%), confirm omission of CT (40%) and genuine equipoise (24%). RS was low (≤17) in 55%, intermediate (18-31) in 36% and high (≥32) in 9%.ÃÂ Thirty-eight percent of patients had TR change post-ODX. Sixty-five percent of patients recommended CT pre-ODX changed to hormone therapy alone (HT)—more likely if lower grade and if ER and/or PRÃÂ >ÃÂ 10%. Fourteen percent of patients with pre-ODX TR for HT added CT—more likely if ER and/or PR ≤10% and if Ki67ÃÂ >ÃÂ 15% Overall, TR for CT decreased from 47% to 24%. Conclusion: Patient-funded ODX changed TRs in 38% of patients, de-escalating 65% from CT to HT and adding CT to 14% of those recommended HT. These changes were greater than an industry-funded study suggesting that physicians can identify situations where the assay may influence decisions.
AB - Objectives: Industry-supported decision impact studies demonstrate that Oncotype Dx (ODX) changes treatment recommendations (TR) in 24–40% of hormone receptor+/HER2− patients. ODX is not reimbursed by third-party payers in Australia, potentially resulting in more selective use. We sought to evaluate the impact of self-funded ODX on TRs. Methods: Data collected included demographics, tumor characteristics, indication for ODX and pre- and post-recurrence score (RS) TR. Primary endpoint was frequency of TR change and associations with TR change were sought. Results: Eighteen physicians contributed 382 patients (median age 54). A total of 232 (61%) of tumors were T1 and were grade 1, 2 and 3 in 49 (13%), 252 (66%) and 79 (21%). A total of 257 (67%) were node negative. Assay indications were: confirm need for chemotherapy (CT) (36%), confirm omission of CT (40%) and genuine equipoise (24%). RS was low (≤17) in 55%, intermediate (18-31) in 36% and high (≥32) in 9%.ÃÂ Thirty-eight percent of patients had TR change post-ODX. Sixty-five percent of patients recommended CT pre-ODX changed to hormone therapy alone (HT)—more likely if lower grade and if ER and/or PRÃÂ >ÃÂ 10%. Fourteen percent of patients with pre-ODX TR for HT added CT—more likely if ER and/or PR ≤10% and if Ki67ÃÂ >ÃÂ 15% Overall, TR for CT decreased from 47% to 24%. Conclusion: Patient-funded ODX changed TRs in 38% of patients, de-escalating 65% from CT to HT and adding CT to 14% of those recommended HT. These changes were greater than an industry-funded study suggesting that physicians can identify situations where the assay may influence decisions.
UR - https://hdl.handle.net/1959.7/uws:66510
U2 - 10.1111/ajco.13075
DO - 10.1111/ajco.13075
M3 - Article
SN - 1743-7555
VL - 14
SP - 410
EP - 416
JO - Asia-Pacific Journal of Clinical Oncology
JF - Asia-Pacific Journal of Clinical Oncology
IS - 6
ER -