Adoption of Gene Expression Profile Testing and Association With Use of Chemotherapy Among Women With Breast Cancer

作者：Hassett Michael J^*; Silver Samuel M; Hughes Melissa E; Blayney Douglas W; Edge Stephen B; Herman James G; Hudis Clifford A; Marcom P Kelly; Pettinga Jane E; Share David; Theriault Richard; Wong Yu Ning; Vandergrift Jonathan L; Niland Joyce C; Weeks Jane C

来源：Journal of Clinical Oncology, 2012, 30(18): 2218-2226.

DOI：10.1200/JCO.2011.38.5740

Purpose %26lt;br%26gt;Gene expression profile (GEP) testing is a relatively new technology that offers the potential of personalized medicine to patients, yet little is known about its adoption into routine practice. One of the first commercially available GEP tests, a 21-gene profile, was developed to estimate the benefit of adjuvant chemotherapy for hormone receptor-positive breast cancer (HR-positive BC). %26lt;br%26gt;Patients and Methods %26lt;br%26gt;By using a prospective registry data set outlining the routine care provided to women diagnosed from 2006 to 2008 with HR-positive BC at 17 comprehensive and community-based cancer centers, we assessed GEP test adoption and the association between testing and chemotherapy use. %26lt;br%26gt;Results %26lt;br%26gt;Of 7,375 women, 20.4% had GEP testing and 50.2% received chemotherapy. Over time, testing increased (14.7% in 2006 to 27.5% in 2008; P %26lt; .01) and use of chemotherapy decreased (53.9% in 2006 to 47.0% in 2008; P %26lt; .01). Characteristics independently associated with lower odds of testing included African American versus white race (odds ratio [OR], 0.70; 95% CI, 0.54 to 0.92) and high school or less versus more than high school education (OR, 0.63; 95% CI, 0.52 to 0.76). Overall, testing was associated with lower odds of chemotherapy use (OR, 0.70; 95% CI, 0.62 to 0.80). Stratified analyses demonstrated that for small, node-negative cancers, testing was associated with higher odds of chemotherapy use (OR, 11.13; 95% CI, 5.39 to 22.99), whereas for node-positive and large node-negative cancers, testing was associated with lower odds of chemotherapy use (OR, 0.11; 95% CI, 0.07 to 0.17). %26lt;br%26gt;Conclusion %26lt;br%26gt;There has been a progressive increase in use of this GEP test and an associated shift in the characteristics of and overall reduction in the proportion of women with HR-positive BC receiving adjuvant chemotherapy. J Clin Oncol 30:2218-2226.

• 出版日期2012-6-20