Personalized Therapy for Breast Cancer Gene Expression ：乳腺癌基因表达的个性化治疗.pptVIP

* * * * Patient’s age and tumor size are routinely used as predictors of recurrence in breast cancer When the recurrence score was combined with data pertaining to age and tumor size to predict risk of distant mets…only the recurrence score remained statistically significant Decreased risk with age may be in part related to increased ER expression in older patients’ tumors – this is captured in recurrence score For tumor size -- 1/3 of patients (tumors smaller than 1 cm) had intermediate-risk or high-risk recurrence scores and a 15-20% risk of distant recurrence. The subgroup analysis of age and tumor size should be interpreted cautiously Concordance b/w pathologists on poorly diff tumors was moderate and for the well-diff and moderately diff grades is low Traditional measures of ER and HER2 expression were only weakly predictive of the risk of distant recurrence (this information was encompassed in the RT-PCR assay) They concluded that they did not know whether the genes used correlate with recurrence in this population b/c they predict responsiveness to tamoxifen, b/c they show a relation with the natural history of breast cancer, or both * At 10 years, risk of death: low 2.8%, intermediate 10.7%, high 15.5% * NSABP Protocol B20, “A Clinical Trial to Determine the Worth of Chemotherapy and Tamoxifen Over Tamoxifen Alone in the Management of Patients with Primary Invasive Breast Cancer, Negative Axillary Nodes and Estrogen-Receptor-Positive Tumors,” enrolled 2,363 patients between October 17,1988, and March 5, 1993, who were randomly assigned to tamoxifen versus tamoxifen plus either CMF or MF * Kaplan-Meier plots for distant recurrence comparing treatment with tamoxifen (Tam) alone versus treatment with tamoxifen plus chemotherapy (Tam chemo). (A) All patients; (B) low risk (recurrence score [RS] 18); (C) intermediate risk (RS 18-30); (D) high risk (RS 31). The number of patients at risk and the number of distant recurrences (in parentheses) are provided belo