Table 5 European Commission Initiative on Breast Cancer guidelines development group recommendations on the use of multigene tests to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor-positive, HER-2 negative.

From: Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative

 

21-gene recurrence score

70-gene signature

Women with low clinical riska

Women with high clinical riska

Recommendation

For women with hormone receptor-positive, HER2-negative, lymph node-negative invasive breast cancer, the ECIBC’s Guidelines Development Group (GDG) suggests using the 21-gene recurrence score to guide the use of chemotherapy.

For women with hormone receptor-positive, HER2-negative, lymph node-negative or up to 3 lymph nodes-positive invasive breast cancer at low clinical risk, the ECIBC’s Guidelines Development Group (GDG) recommends not using the 70-gene signature test to guide the use of chemotherapy.

For women with hormone receptor-positive, HER2-negative, lymph node-negative or up to 3 lymph nodes-positive invasive breast cancer at high clinical risk, the ECIBC’s Guidelines Development Group (GDG) suggests using the 70-gene signature test to guide the use of chemotherapy.

Strength

Conditional recommendation for the intervention

Very low certainty of the evidence

Strong recommendation against the intervention

Low certainty of the evidence

Conditional recommendation for the intervention

Low certainty of the evidence

Sub-group considerations

The GDG did not consider women with node-positive invasive breast cancer to be included in this recommendation.

Women with high clinical riska and low genomic risk (larger tumour diameter and higher grade) may experience larger net desirable consequences and provide a better cost-benefit profile.

Women with low clinical riska and high genomic risk may experience smaller or no net desirable consequences. Indirect evidence from other gene based testing (e.g. 70-gene signature) supports that conclusion.

The proportion of women with 2 or 3 node-positive breast cancer was small, so the results may be less clear in this subgroup.

The proportion of women with 2 or 3 node-positive breast cancer was small, so the results may be less clear in this subgroup.

  1. aFor definitions of low and high clinical risk, see Supplementary Table 8.
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