Table 4.

Change in treatment recommendation based on Oncotype DX and MammaPrint

Study	Design	Population	Treatment	Results
Oncotype DX
Asad (2008)27	Retrospective chart review	ER+	CHT for high risk based on NCCN guidelines; and HT for low risk	GEP testing influenced CHT treatment decision in 37 (44%) of patients; 34% reduction in CHT recommendations
		LN− Mean age: 54 years N = 85
Rayhanabad (2008)28	Retrospective chart review	ER+	CHT for high risk based on NCCN guidelines; and HT for low risk	Results from GEP testing led to change in treatment decisions in 15 (26%) patients
		LN− Tumors ≤ 5 cm Mean age: 54 years (range: 26–78) N = 58
Geffen (2009)30	Prospective study	LN−	Not reported	Nine patients (36%) had their treatment recommendations changed following GEP testing, including six patients from CHT to no CHT
		N = 25
Henry (2009)29	Retrospective study	ER+	Discretion of medical oncologist; clinical data including Adjuvant! Online (AOL) risk estimates followed by RS	Results from GEP testing altered CHT decisions in 9/29 (31%) patients—seven from CHT to no CHT and two from no CHT to CHT with low RS
		LN− N = 29
Lo (2010)31	Prospective, multicenter study	ER+	Clinician treatment recommendation before and after GEP testing	Oncologist treatment decision changed in 28 (32%) of patients following GEP testing. 20 of these were from CHT to HT. 24 (27%) patients changed their own treatment decision, of whom 9 changed from CHT to HT, 7 from HT to CHT, 2 from undecided to HT, and 2 from undecided to CHT
		LN− Mean age: 55 years (range: 35–77) N = 89
Ademuyiwa (2011)32	Retrospective, consecutive series	ER+	CHT recommendations based on clinicopathological characteristics	RS led to change in treatment in 38% of patients, with 37 (13%) fewer patients receiving CHT
		LN− HER− Mean age: 54.8 years (range: 29–82) N = 276
Holt (2011)49*	Prospective cohort	ER+	Nottingham Prognostic Index	RS led to change in treatment recommendations in 35 (33%) patients, with 25 (23.5%) changing from CHT to no CHT
		LN− or N1 N = 106
Oratz (2007)34	Retrospective study	N = 74	Clinician treatment recommendation before and after GEP testing	RS led to change in treatment recommendations in 21% of patients, and in actual treatment received for 25% of patients
Klang (2010)35	Retrospective study	N = 313	Clinician treatment recommendation before and after GEP testing	RS led to change in treatment recommendations in 40% of patients; 27% reduction in CHT recommendations
Hornberger (2011)36	Retrospective study	N = 952	Treatment based on guideline recommendations	RS led to a 27% reduction in CHT
Joh (2011)37	Retrospective study	N = 154	Clinician panel	RS led to a 25% change in treatment recommendations
Partin (2011)38	Retrospective study	N = 169	Treatment recommendations based on AOL and St. Gallen	RS led to a change in treatment recommendation in 27–74% of patients depending on comparator guideline
MammaPrint
Bueno-de- Mesquita (2007)39	Prospective multicenter study	ER+/−	Initial CHT recommendations based on Dutch Institute for Healthcare Improvement (CBO) guidelines	Use of guidelines + prognosis signature + patients’ preferences led to an actual change of treatment for 19% of patients, with a 14% overall increase in adjuvant treatment (2% more CHT, 6% more HT, and 6% more CHT + HT)
		LN+/− Mean age: 48 years N = 427
Gevensleben (2010)40	Consecutive cohort	ER+/−	Not reported	GEP testing showed 40% of patients were either over- or undertreated
		LN+/− N = 136/140 had clinical treatment recorded

CHT, chemotherapy; ER, estrogen receptor; GEP, gene-expression profiling; HT, hormone therapy; LN, lymph node; NCCN, National Comprehensive Cancer Network; RS, recurrence score.

^*Results from conference abstract.