Aetna Health, one of the nation’s largest health benefits companies, has formed an agreement with Genomic Health to establish pay rates for the use of Oncotype DX. This agreement establishes payment rates for all of Aenta’s plans for eligible members with early-stage breast cancer.
Node-negative, early breast cancer refers to cancer that has not spread from the breast to other sites in the body, including lymph nodes under the arms. Although chemotherapy is recommended for many women with early-stage, node-negative breast cancer, the benefit of chemotherapy varies. Identifying in advance those women who are most likely to benefit from chemotherapy may allow for more individualized treatment. As a result, women who are unlikely to benefit from chemotherapy could avoid the unwanted side effects of treatment, while women who would benefit from chemotherapy could be treated accordingly.
Oncotype DX is a genomic test that helps determine which patients with newly diagnosed, Stage I or II, node-negative, estrogen receptor-positive breast cancer may benefit from chemotherapy in addition to hormonal therapy. Oncotype DX predicts the patient’s risk for experiencing a recurrence of cancer 10 years following diagnosis, as well as the likelihood that a patient will benefit from chemotherapy. Oncotype DX evaluates the activity of 21 genes from a sample of the patient’s cancer and determines the patient’s risk of a recurrence by a measure called the Recurrence Score™. The Recurrence Score ranges from 0 to 100, with a higher score indicating a greater risk of recurrence.
Besides determining the risk of a cancer recurrence and the likelihood of benefit from treatment with chemotherapy for a large portion of patients with early breast cancer, results from previous trials have also demonstrated that Oncotype DX may help predict anticancer responses to the neoadjuvant chemotherapy (chemotherapy administered prior to surgery) with the agent Taxotere® (docetaxel). Furthermore, results from Oncotype DX have changed treatment decisions in at least one-quarter of women with early breast cancer. Medicare has established reimbursement for Oncotype DX and this assay continues to be evaluated in clinical trials to determine its optimal effectiveness.
Genomic Health. Available at: http://www.genomichealth.com/oncotype/default.aspx. Accessed November 2006.
Chang JC, Makris A, Hilsenbeck SG et al. Gene Expression Profiles in Formalin-Fixed, Paraffin-Embedded (FFPE) Core Biopsies Predict Docetaxel Chemosensitivity. Proceedings of the 42nd Annual Meeting of the American Society of Clinical Oncology. Atlanta, GA. 2006. Abstract # 538.
Oratz R, Paul D, Cohn A, Sedlacek S. Impact of Onoctype DX™ Recurrence Score on Decision Making in Early-Stage Breast Cancer. Proceedings from the 28th annual San Antonio Breast Cancer Symposium. December 2005. Abstract #2049.
Oncotype DX Predicts Chemotherapy Response in Early Breast Cancer (5/26/2006)
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