On the road to precision,there is more practical medicine to be implemented |
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| Affiliation: | 1. Department of Radiotherapy, First Affiliated Hospital of Xi''an Jiaotong University, Xi''an, Shaanxi 710061, PR China;2. Center of Radiotherapy, Shaanxi Provincial Tumor Hospital, Xi''an, Shaanxi 710061, PR China;3. Department of Oncology, Shaanxi Provincial Tumor Hospital, Xi''an, Shaanxi 710061, PR China;4. Department of Gastroentology, The Third Affiliated Hospital of Xi''an Jiaotong University, Xi''an, Shaanxi 710068, PR China;1. Hôpital Saint-Louis, Paris, France;2. Universitätsklinikum Jena, Jena, Germany;3. Memorial Sloan Kettering Cancer Center, New York, USA;4. National Cancer Center Hospital East, Kashiwa, Japan;5. Almazov National Medical Research Centre, St Petersburg, Russian Federation;6. Russian Research Institute of Hematology and Transfusiology, St Petersburg, Russian Federation;7. National Medical Research Center for Hematology, Moscow, Russian Federation;8. Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si, Korea, Republic of;9. Centre for Haematology Imperial College London, London, United Kingdom;10. Georgia Cancer Center, Augusta, USA;11. Hospital de Clínicas de Porto Alegre (HCPA), er do Estado de São Paulo (ICESPSão Paulo, Brazil;12. Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil;13. Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada;14. Charité– Universitätsmedizin Berlin, Berlin, Germany;15. III. Medizinische Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany;16. Division of Hematology, AORN Cardarelli, Naples, Italy;17. South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, Australia;18. King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia;19. Peter MacCallum Cancer Center and The Royal Melbourne Hospital, Victoria, Australia;20. Servicio de Hematología, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain;21. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA;22. Novartis Pharmaceuticals Corporation, East Hanover, USA;23. Novartis Pharma AG, Basel, Switzerland;24. HEMORIO, State Institute of Hematology Arthur de Siquiera Cavalcanti, Rio de Janeiro, Brazil;25. Oncoclínica Centro de Tratamento Oncológico, Rio de Janeiro, Brazil;1. Faculty of Economics and Administrative Sciences, Department of Economics and Finance, Okan University Tuzla Campus Akfırat 34959 Istanbul Turkey;2. Faculty of Economics and Administrative Sciences, Department of Economics and Finance, Piri Reis University, 34940 Istanbul, Turkey |
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| Abstract: | Estimates are that of the annual global burden of 1.5 million new cases of breast cancer, two-thirds have hormone receptor positive tumors; a majority of these women come from low- and middle-income countries. For adjuvant patients with hormone receptor positive tumors, a major goal is identification of a “precision medicine”, implying a genomic, test whose application will allow identification of those whose systemic treatment can be hormonal therapy alone. Such tests in current use are very expensive and thus in the foreseeable future are out of reach of most women who pay out of pocket.For some time it has been evident that quantitative scoring of tumors for intensity and prevalence of tumor-cell staining for estrogen or progesterone receptor (ER or PR) expression (the commonest system was first described by Allred and thus provides “Allred” scores) gives an inexpensive measure of likelihood of response to hormonal therapies – a different predictive, precision medicine tool. Majorities of hormone receptor positive tumors (one third of all patients) have “Allred” scores of 6–8 (versus scores of 3–5) for both ER and PR and these tumor-bearing patients benefit significantly more from hormonal treatments than their lowering scoring-afflicted women. When ER and PR quantitative intensity and prevalence scoring is combined with Her-2/neu testing and careful tumor histologic grading, luminal A and B type tumors can be well-defined and gene-expression testing adds little practical predictive information.For women with hormone receptor positive tumors, high quality, cost-effective “precision medicine” is available without tumor gene-expression testing. |
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| Keywords: | Quantitative hormonal receptors Non-genomic variables Allred scores Cost-effectiveness |
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