Home » Academic posts » Endopredict vs Oncotype Dx for Breast Cancer

Endopredict vs Oncotype Dx for Breast Cancer

A new test, called EndoPredict, can predict the risk of a woman’s breast cancer spreading within 10 years of diagnosis more accurately than the current Oncotype Dx test. Also, research found that the results can be made available more quickly.
 
A study, published in the Journal of the National Cancer Institute, compared EndoPredict with Oncotype DX. Both tests can predict whether breast cancer will spread in women with oestrogen receptor positive, HER2 negative (ER+/HER2-) disease. This is a sub-type of breast cancer that accounts for about two-thirds of all cases.
 
The new EndoPredict test analyses eight different genes found in a sample of a patient’s tumour. This information, as well as the size of the patient’s tumour and their nodal status – whether the cancer has spread from the breast to their lymph nodes – are then used to determine the patient’s risk of their breast cancer spreading in the next 10 years.
 
An ‘EPclin’ score categorises patients into low- and high-risk groups. Patients placed in the high-risk group would be recommended to have chemotherapy, but those in the low-risk group could be spared this treatment – and the debilitating side effects associated with it.
 
In the study it was found that EndoPredict was more accurate and the results were available faster as compared to the conventional Oncotype Dx test.
 
Points to remember:
1. EndoPredict is meant for early breast cancers which are ER, PR positive (same as Oncotype Dx)
2. It analyses 8 genes as compared to 21 in Onctoype Dx
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2 thoughts on “Endopredict vs Oncotype Dx for Breast Cancer

  1. As clinician please read the original study and judge by yourself before reposting 2nd source texts, which could unsettle patients. It is a retrospective subgroup analysis.
    In this study confidence intervalls of Kaplan-Meier results of EP and ODX are overlapping, so these results are not statistically significant. All of these patients had endocrine treatment only and none chemo. There were N2 patients included in this study, but patients with more than 4 positive lymph nodes are not candidates for multigen-assays to decide for/against chemo. More than 92% of all N+ patients in this study were calculated with EP in the high-risk group, which would lead in practice to chemo. But would chemo be helpful for all of these N+-patients? As clinician you must have seen N+ patients, which had recurrences although they were treated with chemo.
    EP can´t distinguish for treatment decision. EP is only prognostic, which means for 10% risk of recurrence, the result is high risk for recurrence. But this does not indicate, whether the patient has an advantage of chemo or not.There are no studies from EP for treatment decision by comparison of the treatment arms endocrine vs. chemoendocrine, which would be predictive (BTW Oncotype made these studies).
    Please read also the validation studies – there are just 2 (ABCSG6,8 and GEICAM). ABCSG6,8 is only prognostic with endocrine setting – premenopausal patients were not included in this study. GEICAM is prognostic with chemoendocrine setting – nodalnegative patients were not included! In both studies the 10 year-follow up is not complete.
    Please check also in these validation studies, why the nodal status and tumor size are included in the EP-formula. If you look at the Kaplan-Meier for G1, T1 and N0, you can see, that the curves for the pure genetic score are not really spreading in low- and high-risk, esp. in the first 5 years (where chemoeffect happens). Therefore it needs the inclusion of additional pathological features to divide patient groups into low- or high risk.
    For the mentioned study, which has been published in Journal of the National Cancer Institute, it is very obvious, that the statistical methods used (e.g. tertiles), have been chosen to devalue Oncotype, which has been extensively evaluated and validated also on a prospective basis. EP is a German product, where the reimbursement of multigen-assays is currently in the decision-making process on political level in Berlin. The timing of this study should be seen in this context.

    • I completely agree with you. I am a strong proponent of Oncotype Dx and use it for my patients as well. Some of the posts are just meant to educate users about new technology. By this post, I am in no way endorsing EndoPredict

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