Dr. Denise Yardley from the Sarah Cannon Research Institute discusses how a genomic assay calledOncotype DXcan help guide treatment for breast cancer.
Q: Welcome to Understanding Cancer. Today we’re speaking with Dr. Denise Yardley, the director of the breast cancer research program at the Sarah Cannon Research Institute in Nashville, Tennessee. Welcome.
A: Thank you.
Q: So patients, on a typical biopsy specimen, are going to have their hormonal status identified as either estrogen receptor positive or negative—
Q: –which has implications for future therapy.
Q: And they’re going to have a HER-2/neu—
Q: –test as part of their standard evaluation.
Q: There’s a newer test that I know some physicians are using called Oncotype.
Q: Are you familiar with this test?
A: I am. Oncotype DX, now that is a test, and that’s becoming increasingly incorporated in the management of patients. It’s not typically done on the biopsy, it’s done after the patients have completed their surgery. Their actual validated data is actually in a hormone receptor positive patient that is lymph node negative, so what we would consider a very good prognosis breast cancer. And that assay is utilized to try to figure out can we spare patients the role of chemotherapy, can some patients just have surgery, and if their tumor is estrogen and progesterone receptor positive, just take hormonal therapy.
And the assay looks at a panel of about 25 genes. Sixteen are cancer genes, five are normal reference genes or background genes for us to kind of figure out whether the test is working, and they are weighted so each gene gets a value assigned to it, and then it’s put through a computer and a total score, a recurrence score is what it’s called, is calculated from that tumor. And it gives us the likelihood of, again, how aggressive or non-aggressive that tumor may be.
And for patients that have a low score, they can be spared the consideration of chemotherapy and just undergo hormonal therapy. Patients with very high scores likely to benefit from both treatments and often get the recommendation of chemo and hormonal therapy. And the real conundrum is that intermediate, the group that—
A: –we’re not sure about. And there’s actually a big clinical trial underway that takes the patients who have the intermediate score and randomizes half to get chemo plus hormonal therapy and the other half just to get hormonal therapy, and we don’t have the answer to that at this point.
Q: So right now the test has its greatest application in women with an early stage invasive node negative—
A: Correct, right.
Q: –breast cancer? Is there any work being done to help women with node positive disease?
A: They’ve looked at it in node positive in at least one trial, and they found it to very much mirror some of the results they saw in the lymph node negative patients, but that hasn’t been, at this point, truly validated and incorporated in treatment decisions as much, ‘cause we know that our lymph node positive patients are higher risk patients to start with.
So those studies are still ongoing, and actually there are newer trials looking at neo-adjuvant therapy as well, trying to see if it can predict the role of hormonal and chemotherapy in that group of patients. So it’s a work in progress that they’re still utilizing for now in different stages of disease and exploring the lymph node positive patients.
Q: Well, Dr. Yardley, I’d like to thank you for your time today. I think our viewers will find this session most informative, and we look forward to having you back.
A: Thank you.
[End of recording.]