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Title: The impact and indications for Oncotype DX on adjuvant treatment recommendations when third-party funding is unavailable.
Epworth Authors: Foo, Serene
Jennens, Ross
Other Authors: Chin-Lee, L.
De Boer, Richard
Segelov, E.
Marx, G.
Hughes, T.
McCarthy, N.
White, S.
Rutovitz, J.
Della-Fiorentina, S.
Antill, Y.
Tsoi, D.
Cronk, M.
Lombard, J.
Kiely, B.
Chirgwin, J.
Gorelik, A.
Mann, G.
Keywords: Oncotype Dx
Treatment Recommendations
Third-Party Payers
Selective Use
Self-Funded ODX
Hormone Receptor +/HER2
Tumor Characteristics
Indications For Use
Pre-Reoccurence Score
Post-Reoccurence Score
Primary Endpoint
T1 tumor
Grade 1
Grade 2
Grade 3
Node Negative
Confirmed Omission
Genuine Equipoise
Hormone Therapy
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Sep-2018
Publisher: Wiley
Citation: Asia Pac J Clin Oncol. 2018 Sep 30. doi: 10.1111/ajco.13075
Abstract: OBJECTIVES: Industry-supported decision impact studies demonstrate that Oncotype Dx (ODX) changes treatment recommendations (TR) in 24-40% of hormone receptor+/HER2- patients. ODX is not reimbursed by third-party payers in Australia, potentially resulting in more selective use. We sought to evaluate the impact of self-funded ODX on TRs. METHODS: Data collected included demographics, tumor characteristics, indication for ODX and pre- and post-recurrence score (RS) TR. Primary endpoint was frequency of TR change and associations with TR change were sought. RESULTS: Eighteen physicians contributed 382 patients (median age 54). A total of 232 (61%) of tumors were T1 and were grade 1, 2 and 3 in 49 (13%), 252 (66%) and 79 (21%). A total of 257 (67%) were node negative. Assay indications were: confirm need for chemotherapy (CT) (36%), confirm omission of CT (40%) and genuine equipoise (24%). RS was low (≤17) in 55%, intermediate (18-31) in 36% and high (≥32) in 9%. Thirty-eight percent of patients had TR change post-ODX. Sixty-five percent of patients recommended CT pre-ODX changed to hormone therapy alone (HT)-more likely if lower grade and if ER and/or PR > 10%. Fourteen percent of patients with pre-ODX TR for HT added CT-more likely if ER and/or PR ≤10% and if Ki67 > 15% Overall, TR for CT decreased from 47% to 24%. CONCLUSION: Patient-funded ODX changed TRs in 38% of patients, de-escalating 65% from CT to HT and adding CT to 14% of those recommended HT. These changes were greater than an industry-funded study suggesting that physicians can identify situations where the assay may influence decisions.
DOI: 10.1111/ajco.13075
PubMed URL:
ISSN: ‎1743-7555
Journal Title: Asia-Pacific Journal of Clinical Oncology
Type: Journal Article
Affiliated Organisations: The Royal Melbourne Hospital, Parkville, VIC, Australia.
Royal Women's Hospital, Parkville, VIC, Australia.
Sydney Adventist Hospital, Wahroonga, NSW, Australia.
University of Sydney, Sydney, NSW, Australia.
ICON Cancer Care Wesley, Auchenflower, QLD, Australia.
Austin Health, Heidelberg, VIC, Australia.
St Vincent's Private Hospital, East Melbourne, VIC, Australia.
Northern Haematology and Oncology Group, Wahroonga, NSW, Australia.
Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia.
Cabrini Health, Malvern, VIC, Australia.
St John of God Murdoch Hospital, Murdoch, VIC, Australia.
Sunshine Coast Hospital and Health Services, Nambour, QLD, Australia.
Calvary Mater Newcastle, Waratah, NSW, Australia.
Epworth HealthCare, Vic, Australia.
Type of Clinical Study or Trial: Decision Impact Study
Appears in Collections:Cancer Services

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