Underestimated survival predictions of the prognostic tools Adjuvant! Online and PREDICT in BRCA1-associated breast cancer patients

Abstract + references

BRCA1-associated breast cancer is considered an unique clinical entity with its own specific histopathological characteristics. Several recently published large studies have shown that overall survival of BRCA1 mutation carriers having breast cancer is similar to sporadic breast cancer patients. It was also suggested that better response to chemotherapy is one of the most important factors that improves the clinical outcome of breast cancers with unfavorable histopathological subtypes in BRCA1 mutation carriers. Adjuvant! Online and PREDICT are web-based prognostic tools that estimate the survival benefit of adjuvant chemotherapy in primary breast cancer patients. These tools have been extensively validated in different populations; however, the accuracy of the predictions made by Adjuvant! Online and PREDICT among BRCA1 mutation carriers has not yet been investigated. In this study we have found, that predictions of overall and breast cancer-specific survival obtained from Adjuvant! Online and PREDICT were significantly lower than the observed survival percentages in the study population [predicted—observed difference for 10–year overall survival: −9.75 %, P < 0.0001 (Adjuvant! Online); −10.21 %, P < 0.0001 (PREDICT)]. Thus this study suggests that Adjuvant! Online and PREDICT should be used with caution in this group of patients.
Further updating of adjuvant therapy benefit calculation tools by inclusion of the information about inherited genetic alterations should be considered to improve the performance of the prognostic programs among hereditary breast cancer patients.

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References (32)

1. Early Breast Cancer Trialists’ Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 365(9472):1687–1717 CrossRef
2. Aebi S, Davidson T, Gruber G, Cardoso F, ESMO Guidelines Working Group (2011) Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 22(Suppl 6):vi12–vi24 CrossRef
3. Oakman C, Santarpia L, Di Leo A (2010) Breast cancer assessment tools and optimizing adjuvant therapy. Nat Rev Clin Oncol 7(12):725–732 CrossRef
4. Olivotto IA, Bajdik CD, Ravdin PM, Speers CH, Coldman AJ, Norris BD, Davis GJ, Chia SK, Gelmon KA (2005) Population-based validation of the prognostic model ADJUVANT! for early breast cancer. J Clin Oncol 23(12):2716–2725 CrossRef
5. Wishart GC, Bajdik CD, Azzato EM, Dicks E, Greenberg DC, Rashbass J, Caldas C, Pharoah PD (2011) A population-based validation of the prognostic model PREDICT for early breast cancer. Eur J Surg Oncol 37(5):411–417 CrossRef
6. Campbell HE, Taylor MA, Harris AL, Gray AM (2009) An investigation into the performance of the Adjuvant! Online prognostic programme in early breast cancer for a cohort of patients in the United Kingdom. Br J Cancer 101(7):1074–1084
7. Mook S, Schmidt MK, Rutgers EJ, van de Velde AO, Visser O, Rutgers SM, Armstrong N, van’t Veer LJ, Ravdin PM (2009) Calibration and discriminatory accuracy of prognosis calculation for breast cancer with the online Adjuvant! program: a hospital-based retrospective cohort study. Lancet Oncol 10(11):1070–1076 CrossRef
8. Hajage D, de Rycke Y, Bollet M, Savignoni A, Caly M, Pierga JY, Horlings HM, Van de Vijver MJ, Vincent-Salomon A, Sigal-Zafrani B, Senechal C, Asselain B, Sastre X, Reyal F (2011) External validation of Adjuvant! Online breast cancer prognosis tool. Prioritising recommendations for improvement. PLoS ONE 6(11):e27446 (Epub 2011 Nov 8) CrossRef
9. Bhoo-Pathy N, Yip CH, Hartman M, Saxena N, Taib NA, Ho GF, Looi LM, Bulgiba AM, Graaf Y, Verkooijen HM (2012) Adjuvant! Online is overoptimistic in predicting survival of Asian breast cancer patients. Eur J Cancer 48(7):982–989 CrossRef
10. Mavaddat N, Antoniou AC, Easton DF, Garcia-Closas M (2010) Genetic susceptibility to breast cancer. Mol Oncol 4(3):174–191 CrossRef
11. Goodwin PJ, Phillips KA, West DW, Ennis M, Hopper JL, John EM, O’Malley FP, Milne RL, Andrulis IL, Friedlander ML, Southey MC, Apicella C, Giles GG, Longacre TA (2012) Breast cancer prognosis in BRCA1 and BRCA2 mutation carriers: an international prospective breast cancer family registry population-based cohort study. J Clin Oncol 30(1):19–26 CrossRef
12. Rennert G, Bisland-Naggan S, Barnett-Griness O, Bar-Joseph N, Zhang S, Rennert HS, Narod SA (2007) Clinical outcomes of breast cancer in carriers of BRCA1 and BRCA2 mutations. N Engl J Med 357(2):115–123 CrossRef
13. Robson ME, Chappuis PO, Satagopan J, Wong N, Boyd J, Goffin JR, Hudis C, Roberge D, Norton L, Bégin LR, Offit K (2004) Foulkes WD A combined analysis of outcome following breast cancer: differences in survival based on BRCA1/BRCA2 mutation status and administration of adjuvant treatment. Breast Cancer Res 6(1):R8–R17 CrossRef
14. Evans DG, Howell A (2004) Are BRCA1- and BRCA2-related breast cancers associated with increased mortality? Breast Cancer Res 6(1):E7 CrossRef
15. Plakhins G, Irmejs A, Gardovskis A, Subatniece S, Rozite S, Bitina M, Keire G, Purkalne G, Teibe U, Trofimovics G, Miklasevics E, Gardovskis J (2011) Genotype-phenotype correlations among BRCA1 4153delA and 5382insC mutation carriers from Latvia. BMC Med Genet 27(12):147 CrossRef
16. Wishart GC, Azzato EM, Greenberg DC, Rashbass J, Kearins O, Lawrence G, Caldas C, Pharoah PD (2010) PREDICT: a new UK prognostic model that predicts survival following surgery for invasive breast cancer. Breast Cancer Res 12(1):R1 CrossRef
17. Ravdin PM, Siminoff LA, Davis GJ, Mercer MB, Hewlett J, Gerson N, Parker HL (2001) Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J Clin Oncol 19(4):980–991
18. Adjuvant! Breast Cancer Help files. https://www.adjuvantonline.com/breasthelp0306/breastindex.html
19. http://www.predict.nhs.uk/technical.shtml
20. Wishart GC, Bajdik CD, Dicks E, Provenzano E, Schmidt MK et al. (2012) PREDICT Plus: development and validation of a prognostic model for early breast cancer that includes HER2. Br J Cancer 107: 800–807
21. Agarwal V, O’Neill P (2011) Adjuvant! Online as a decision-making tool in early breast cancer-a UK national survey. Clin Oncol (R Coll Radiol) 23(2):159–160 CrossRef
22. Siminoff LA, Gordon NH, Silverman P, Budd T, Ravdin PM (2006) A decision aid to assist in adjuvant therapy choices for breast cancer. Psychooncology 15(11):1001–1013 CrossRef
23. Bordeleau L, Panchal S, Goodwin P (2010) Prognosis of BRCA-associated breast cancer: a summary of evidence. Breast Cancer Res Treat 119(1):13–24 CrossRef
24. Bayraktar S, Gutierrez-Barrera AM, Liu D, Tasbas T, Akar U, Litton JK, Lin E, Albarracin CT, Meric-Bernstam F, Gonzalez-Angulo AM, Hortobagyi GN, Arun BK (2011) Outcome of triple-negative breast cancer in patients with or without deleterious BRCA mutations. Breast Cancer Res Treat 130(1):145–153 CrossRef
25. Chappuis PO, Goffin J, Wong N, Perret C, Ghadirian P, Tonin PN, Foulkes WD (2002) A significant response to neoadjuvant chemotherapy in BRCA1/2 related breast cancer. J Med Genet 39(8):608–610 CrossRef
26. Byrski T, Gronwald J, Huzarski T, Grzybowska E, Budryk M, Stawicka M, Mierzwa T, Szwiec M, Wisniowski R, Siolek M, Dent R, Lubinski J, Narod S (2010) Pathologic complete response rates in young women with BRCA1-positive breast cancers after neoadjuvant chemotherapy. J Clin Oncol 28(3):375–379 CrossRef
27. Narod SA, Metcalfe K, Lynch HT, Ghadirian P, Robidoux A, Tung N, Gaughan E, Kim-Sing C, Olopade OI, Foulkes WD, Robson M, Offit K, Jakubowska A, Byrski T, Huzarski T, Sun P, Lubinski J (2013) Should all BRCA1 mutation carriers with stage I breast cancer receive chemotherapy? Breast Cancer Res Treat 138(1):273–279 CrossRef
28. Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, Margolese RG, Hoehn JL, Vogel VG, Dakhil SR, Tamkus D, King KM, Pajon ER, Wright MJ, Robert J, Paik S, Mamounas EP, Wolmark N (2008) Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B-18 and B-27. J Clin Oncol 26(5):778–785 CrossRef
29. Salhab M, Bismohun S, Mokbel K (2010) Risk-reducing strategies for women carrying brca1/2 mutations with a focus on prophylactic surgery. BMC Women’s Health 10:28 CrossRef
30. Rebbeck TR, Friebel T, Lynch HT, Neuhausen SL, Van ‘t Veer L, Garber JE, Evans GR, Narod SA, Isaacs C, Matloff E, Daly MB, Olopade OI, Weber BL (2004) Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 22(6):1055–1062 CrossRef
31. Kirova YM, Savignoni A, Sigal-Zafrani B, de La Rochefordiere A, Salmon RJ, This P, Asselain B, Stoppa-Lyonnet D, Fourquet A (2010) Is the breast-conserving treatment with radiotherapy appropriate in BRCA1/2 mutation carriers? Long-term results and review of the literature. Breast Cancer Res Treat 120(1):119–126 CrossRef
32. Smith KL, Isaacs C (2011) BRCA mutation testing in determining breast cancer therapy. Cancer J 17(6):492–499 CrossRef