Clinical utility of the IHC4+C score in oestrogen receptor-positive early breast cancer: a prospective decision impact study |
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Authors: | B Yeo L Zabaglo M Hills A Dodson I Smith M Dowsett |
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Affiliation: | 1.Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK;2.Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK;3.Institute of Cancer Research, Fulham Road, London SW3 6JB, UK |
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Abstract: | Background: Most oestrogen receptor (ER)-positive early breast cancer diagnosed today is highly curable with multimodality treatment. Systemic adjuvant treatments including endocrine therapy and chemotherapy have made a significant contribution to the increasing cure rates over the past three decades. However not all women will require chemotherapy. The IHC4+C score is a prognostic tool that integrates four immunohistochemical measures with clinicopathological features to estimate the residual risk of distant recurrence at 10 years in post-menopausal women with ER-positive breast cancer who have received 5 years of endocrine therapy. Retrospective studies indicate that the test can identify a set of women that are at such low risk of recurrence that chemotherapy can be of little benefit.Methods: In this study, 124 patients were prospectively selected from the multidisciplinary team meeting between January 2013 and April 2014 for IHC4+C testing. Adjuvant systemic treatment recommendations by clinicians were recorded without and with the availability of the score in addition to the patient''s decision.Results: There was concordance in the MDT''s recommendation without and with the availability of the score in 73% of cases. Clinicians recommended chemotherapy or at least its discussion to 74 (59%) patients, which fell to 32 (34%) patients after the IHC4+C score was made available, sparing one in four tested patients a chemotherapy recommendation, along with its toxicity and expense.Conclusion: This decision impact study shows that when used by clinicians in the multidisciplinary team meeting for adjuvant decision-making, a significant proportion of patients are spared chemotherapy recommendations. |
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Keywords: | IHC4 early breast cancer oestrogen receptor positive adjuvant decision-making |
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