Table 6 Synopsis of American Society of Clinical Oncology (ASCO)59,60,61 and the UK National Institute for Health and Care Excellence (NICE)55 recommendations on 21-gene recurrence score and 70-gene signature assay in hormone receptor-positive, HER2-negative, lymph node-negative or up to 3 nodes-positive invasive breast cancer.

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

 

ASCO58,60

NICE54

21-gene recurrence score

  Low clinical risk

Strong recommendation

 

  High clinical risk

Strong recommendation

Recommended if: clinical risk is “intermediate” according to the PREDICT tool53 or the Nottingham Prognostic Index, i.e. the additional benefit of chemotherapy is between 3 and 5% increase in survival, the decision on the therapy will depend on the test result, the test is provided at reduced price.

  Negative lymph nodes

Strong recommendation

Recommendation applies to both lymph node-negative patients and lymph node-positive patients, restricted to micro-metastases

  1 to 3 positive lymph nodes

Not recommended

 

ASCO60

NICE55

70-gene signature assay

  

  Low clinical risk

Strong against

Recommendation against because not cost effective

  High clinical risk

Strong in favour

  Negative lymph nodes

Strong in favour

  1 to 3 positive lymph nodes

Moderate in favour

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