Real-world analysis of clinical and economic impact of 21-gene recurrence score (RS) testing in early-stage breast cancer (ESBC) in Ireland

• Published in: Breast cancer research and treatment 2021-08, Vol.188 (3), p.789-798
• Main Authors: McSorley, L. M., Tharmabala, M., Al Rahbi, F., McSorley, K., Chew, S., Evoy, D., Geraghty, J. G., Prichard, R. S., Rothwell, J., McCartan, D. P., McDermott, E. W., Keane, M., Kennedy, M. J., O’Reilly, S., Millen, S. J., Crown, J. P., Smyth, L. M., Kelly, C. M., Quinn, C. M., Walshe, J. M.
• Format: Article
• Language: English
• Subjects: Breast cancer; Cancer research; Cancer therapies; Chemotherapy; Cost control; Epidemiology; Health care expenditures; Medicine; Medicine & Public Health; Oncology; Patients; Tumors
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-021-06211-w

Purpose Results from TAILOR-X suggest that up to 70% of hormone receptor-positive (HR+) node-negative (N0) ESBC patients (pts) may avoid chemotherapy (CT) with RS ≤ 25. We assess clinical and economic impacts of RS testing on treatment using real-world data. Methods From October 2011 to February 2019, a retrospective, cross-sectional observational study was conducted of HR+ N0 ESBC pts who had RS testing in Ireland. Pts were classified low risk (RS ≤ 25) and high risk (RS > 25). Clinical risk was calculated. Data were collected via electronic patient records. Cost data were supplied by the National Healthcare Pricing Regulatory Authority. Results 963 pts. Mean age is 56 years. Mean tumour size is 1.7 cm. 114 (11.8%), 635 (66%), 211 (22%), 3 (0.2%) pts had G1, G2, G3 and unknown G, respectively. 796 pts (82.8%) low RS, 159 (16.5%) high RS and 8 pts (0.7%) unknown RS. 263 pts (26%) were aged ≤ 50 at diagnosis; 117 (45%) had RS 0–15, 63 (24.5%) 16–20, 39 (15.3%) 21–25 and 40 (15.2%) RS 26–100. 4 pts (1.5%) had unknown RS. Post-RS testing, 602 pts (62.5%) had a change in CT decision; 593 changed to hormone therapy (HT) alone. In total, 262 pts received CT. Of pts receiving CT; 138 (53%) had RS > 25, 124 (47%) had RS ≤ 25. Of pts aged ≤ 50, 153 (58%) had high clinical risk, of whom 28 had RS 16–20. Assay use achieved a 62.5% change in treatment with 73% of pts avoiding CT. This resulted in savings of €4 million in treatment costs. Deducting assay costs, savings of €1.9 million were achieved. Conclusion Over the 8 years of the study, a 62.5% reduction in CT use was achieved with savings of over €1,900,000.