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NICE-recommended tumour profiling tests could prevent some breast cancer chemotherapy

By May 14, 2024No Comments

NICE’s independent diagnostic advisory committee reviewed the evidence behind tumour profiling tests which are designed to provide information on the genetic makeup of breast cancer tumours.

This information can be used to guide the treatment of women who have been through the menopause, and men, with oestrogen receptor (ER) or progesterone receptor (PR)-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer with 1 to 3 positive lymph nodes.

The test results, which are returned in days, provide a risk profile of an individual’s breast cancer which can be combined with other factors, such as tumour size, to better predict the risk of disease recurrence in the future.

Three tumour profiling tests (EndoPredict, Prosigna, and Oncotype DX) can be used by the NHS.

Surgery is often the initial treatment for ER- or PR-positive, HER2-negative early and locally advanced breast cancer. After surgery, further treatment might be recommended which could include chemotherapy.

Currently decisions on chemotherapy after surgery for people with breast cancer that has spread to 1 to 3 lymph nodes are made based on several factors relating to the specific characteristics of the cancer, risk of recurrence and preference of the person with cancer. Additional information from tumour profiling tests may be helpful when making decisions about chemotherapy.

If tumour profiling test results indicate that a person is at low risk of cancer recurrence, they may feel more comfortable making the decision to forego chemotherapy. Fewer people having unnecessary chemotherapy would avoid harmful side effects.

Evidence presented to the committee suggests that tumour profiling tests can predict the risk of cancer coming back in a different part of the body. One of the tests (Oncotype DX) could also allow clinicians to identify people who are less likely to benefit from chemotherapy after surgery.

Tumour profiling tests are already recommended by NICE for guiding chemotherapy decisions in people with oestrogen receptor ER-positive, HER2-negative, lymph-node negative early breast cancer. NICE is now recommending their use can be expanded to women who have been through the menopause or men with ER- or PR-positive, HER2-negative early breast cancer with 1 to 3 positive lymph nodes.

Ben Kemp