Tuesday, February 27, 2018

Very Brief Blog: Flurry of Articles on Breast Cancer Prognostics

Briefly catching up with a flurry of new articles on breast cancer prognostics.

As discussed in Genomeweb, Sestak et al. did a large scale study of five prognostic tests, including Genoptix IHC4, Genomic Health Oncotype DX, BioTheranostics BCI, Nanostring Prosigna, and Myriad EndoPredict. 
  • Prosigna, BCI, and EndoPredict were "more prognostic."  
  • See Sestak et al  in JAMA ONCOLOGY in February, 2018.
In Journal of Clinical Oncology:
  • Holowaty et al. found that given the Oncotype Dx test, non hispanic blacks (NHB) had significantly higher risk scores on average than non hispanic whites (NHW); especially in the <50 group.  
    • This was a study of scores reported; not clinical correlations.
  • Chandler et al. found a range of cost per QALY values for Oncotype Dx "in community use," from $28,947 to $188,125 per QALY.
    • The "ASCO Post" provided its own news-item summary of Chandler; here.
    • Cost effectiveness of breast cancer profiling has been newly revisited by NICE (here).  
    • In Nature Reviews Genetics, Payne et al. provide a review of how messy genetics cost effectiveness studies are.
  • Mittmann et al. found that in many scenarios, Oncotype Dx somewhat increased (rather than decreased) costs.
  • Costa et al. provide an op ed "Do genomic assays [in breast cancer] provide the necessary confidence to de-escalate adjuvant therapy?"  Reviewing recent data, the answer seems yes, consistent with earlier recommendations of some major clinical groups.
Though not directly on breast cancer, current issues of Journal of Clinical Oncology provides two related articles, one on "fear of cancer recurrence" in an era of better therapies and better prognostics (Thewes et al.; open access) and a "Grand Rounds" review on prostate cancer recurrence prognostics by Morgans.