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GENE EXPRESSION PROFILING AND EXPANDED IMMUNOHISTOCHEMISTRY TESTS TO GUIDE SELECTION OF CHEMOTHERAPY REGIMENS IN BREAST CANCER MANAGEMENT: A SYSTEMATIC REVIEW

Published online by Cambridge University Press:  10 May 2017

Alison Scope ,
Munira Essat ,
Abdullah Pandor ,
Rachid Rafia ,
Sue E. Ward ,
Lynda Wyld ,
Simon Cross  and
Helen Buckley Woods
Alison Scope
Affiliation:
School of Health and Related Research (ScHARR), The University of Sheffielda.scope@sheffield.ac.uk
Munira Essat
Affiliation:
School of Health and Related Research (ScHARR), The University of Sheffield
Abdullah Pandor
Affiliation:
School of Health and Related Research (ScHARR), The University of Sheffield
Rachid Rafia
Affiliation:
School of Health and Related Research (ScHARR), The University of Sheffield
Sue E. Ward
Affiliation:
School of Health and Related Research (ScHARR), The University of Sheffield
Lynda Wyld
Affiliation:
Royal Hallamshire Hospital, Sheffield
Simon Cross
Affiliation:
Royal Hallamshire Hospital, Sheffield
Helen Buckley Woods
Affiliation:
School of Health and Related Research (ScHARR), The University of Sheffield
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Abstract

Objectives: The aim of this report was to assess the clinical effectiveness of two Gene expression profiling (GEP) and two expanded immunohistochemistry (IHC) tests compared with current prognostic tools in guiding the use of adjuvant chemotherapy in patients with early breast cancer.

Methods: A systematic review of the evidence on clinical effectiveness of OncotypeDX, IHC4, MammaPrint, and Mammostrat, compared with current clinical practice using clinicopathological parameters, in women with early breast cancer was conducted. Ten databases were searched to include citations to May 2016.

Results: Searches identified 7,064 citations, of which forty-one citations satisfied the criteria for the review. A narrative synthesis was performed. Evidence for OncotypeDX demonstrated the impact of the test on decision making and there was some support for OncotypeDX predicting chemotherapy benefit. There were relatively lower levels of evidence for the other three tests included in the analysis. MammaPrint, Mammostrat, and IHC4 tests were limited to a small number of studies. Limitations in relation to study design were identified for all tests.

Conclusions: The evidence base for OncotypeDX is considered to be the most robust. Methodological weaknesses relating to heterogeneity of patient cohorts and issues arising from the retrospective nature of the evidence were identified. Further evidence is required for all of the tests using prospective randomized controlled trial data.

Keywords

Gene expression profilingImmunohistochemistryBreast cancer
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 1 , 2017 , pp. 32 - 45
Copyright
Copyright © Cambridge University Press 2017 

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