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Tytuł:
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Change in therapeutic management after the EndoPredict assay in a prospective decision impact study of Mexican premenopausal breast cancer patients.
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Autorzy:
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Villarreal-Garza C; Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico.; Research and Breast Cancer Department, Instituto Nacional de Cancerologia, Mexico City, Mexico.
Lopez-Martinez EA; Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico.
Deneken-Hernandez Z; Fundacion de Cancer de Mama (FUCAM), Mexico City, Mexico.
Maffuz-Aziz A; Fundacion de Cancer de Mama (FUCAM), Mexico City, Mexico.
Muñoz-Lozano JF; Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico.
Barragan-Carrillo R; Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico.
Ramos-Elias P; Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico.
Moreno B; Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico.
Diaz-Perez H; Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico.
Peña-Curiel O; Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Nuevo Leon, Mexico.
Curiel-Valdez JJ; Grupo Diagnostico Laboratorio Clinico y Patologia, Mexico City, Mexico.
Bautista-Piña V; Fundacion de Cancer de Mama (FUCAM), Mexico City, Mexico.
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Źródło:
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PloS one [PLoS One] 2020 Mar 11; Vol. 15 (3), pp. e0228884. Date of Electronic Publication: 2020 Mar 11 (Print Publication: 2020).
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: San Francisco, CA : Public Library of Science
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MeSH Terms:
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Clinical Decision-Making*
Premenopause*
Transcriptome*
Antineoplastic Agents, Hormonal/*therapeutic use
Breast Neoplasms/*drug therapy
Chemotherapy, Adjuvant/*methods
Adult ; Breast Neoplasms/metabolism ; Cohort Studies ; Decision Making ; Female ; Humans ; Mexico ; Middle Aged ; Neoplasm Grading
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References:
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Substance Nomenclature:
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0 (Antineoplastic Agents, Hormonal)
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Entry Date(s):
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Date Created: 20200312 Date Completed: 20200619 Latest Revision: 20200619
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Update Code:
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20240105
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PubMed Central ID:
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PMC7065749
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DOI:
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10.1371/journal.pone.0228884
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PMID:
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32160201
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Objective: To evaluate the change in adjuvant therapeutic decision in a cohort of young women with breast cancer discussed by a multidisciplinary team, before and after EndoPredict testing.
Patients and Methods: 99 premenopausal women with hormone receptor-positive, HER2-negative, T1-T2, and N0-N1 breast cancer were included. Clinicopathological characteristics were recorded and cases were presented in a multidisciplinary tumor board. Consensual therapeutic decisions before and after EndoPredict results were registered. Medical records were reviewed at six-month follow-up to determine physicians' adherence to therapeutic recommendations. Pearson chi-square and McNemar's tests were used to analyze differences between groups and changes in treatment recommendations, respectively.
Results: Median age at diagnosis was 43 years. The most frequent tumor size was pT2 (53.5%) and 27% of patients had 1-3 positive lymph nodes. 46% of patients had a low-risk EPclin result. Nodal status and tumor grade were significantly associated with EPclin result (p < .00001 and p = .0110, respectively), while Ki67 levels and age ≤40 years were not. A change in chemotherapy decision was registered in 19.2% of patients (p = .066), with the greatest impact in de-escalation (9% net reduction). A change in chemotherapy or endocrine therapy regimen was suggested in 19% and 20% of cases, respectively, after EPclin results were available. A significant difference was found in the median EPclin score between patients with a low- vs. high-intensity chemotherapy and endocrine therapy regimen recommendation (p = 0.049 and p = 0.0001, respectively). Tumor board treatment recommendation adherence with the EndoPredict result was 95% and final treatment adherence to EPclin result was 93%.
Conclusions: The EndoPredict test successfully assisted the clinical decision-making process in premenopausal patients, with a clinically significant change in overall decision-making, with the greatest impact seen in chemotherapy reduction, and a high rate of therapeutic adherence.
Competing Interests: The authors have declared that no competing interests exist.
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