Introduction: The COVID-19 pandemic prompted new ABS guidance regarding the use of genomic profiling in patients with 1-3 positive lymph nodes (N1) to aid prioritisation of limited theatre capacity and minimise patients placed at risk of chemotherapy associated immuno-compromise. NICE have approved Oncotype DX use in lymph node negative (N0) patients only. We assessed our utilisation of Oncotype DX in patients with N1 disease and the impact on their management.
Methods: Retrospective case series of consecutive Oncotype DX requests from 1st March -- 31st October 2020 in a single NHS Trust.
Results: Oncotype DX was ordered for 92 patients with ER positive, HER2 negative cancers, twenty-six (28.3%) were performed on core biopsy. Twenty-nine (31.5%) patients had N1 disease. Cancer and patient characteristics were comparable between N0 and N1 patients.
| N0 | N1 | |
|---|---|---|
| Median Recurrence Score (RS) | 18 (0 - 44) | 16 (1-33) |
| Neoadjuvant chemotherapy | 6 (9.5%) | 0 |
| Adjuvant chemotherapy | 14 (22.2%) | 9 (31.0)% |
| Neoadjuvant endocrine therapy | 9 (14.3%) | 4 (13.8%) |
Conclusions: Recent data from the RxPONDER trial demonstrates no benefit in chemotherapy in postmenopausal women with N1 disease with a recurrence score <25. In our N1 cohort 24.1% (7/29) fit these criteria for omission of chemotherapy. Our data suggests a small proportion of patients have a high oncotype DX score and benefit from chemotherapy and the use of genomic profiling alters the management of N1 patients in clinical practice.