A 50-gene intrinsic subtype classifier for prognosis and prediction of benefit from adjuvant tamoxifen.

Abstract

PURPOSE:

Gene expression profiling classifies breast cancer into intrinsic subtypes based on the biology of the underlying disease pathways. We have used material from a prospective randomized trial of tamoxifen versus placebo in premenopausal women with primary breast cancer (NCIC CTG MA.12) to evaluate the prognostic and predictive significance of intrinsic subtypes identified by both the PAM50 gene set and by immunohistochemistry.

EXPERIMENTAL DESIGN:

Total RNA from 398 of 672 (59%) patients was available for intrinsic subtyping with a quantitative reverse transcriptase PCR (qRT-PCR) 50-gene predictor (PAM50) for luminal A, luminal B, HER-2-enriched, and basal-like subtypes. A tissue microarray was also constructed from 492 of 672 (73%) of the study population to assess a panel of six immunohistochemical IHC antibodies to define the same intrinsic subtypes.

RESULTS:

Classification into intrinsic subtypes by the PAM50 assay was prognostic for both disease-free survival (DFS; P = 0.0003) and overall survival (OS; P = 0.0002), whereas classification by the IHC panel was not. Luminal subtype by PAM50 was predictive of tamoxifen benefit [DFS: HR, 0.52; 95% confidence interval (CI), 0.32-0.86 vs. HR, 0.80; 95% CI, 0.50-1.29 for nonluminal subtypes], although the interaction test was not significant (P = 0.24), whereas neither subtyping by central immunohistochemistry nor by local estrogen receptor (ER) or progesterone receptor (PR) status were predictive. Risk of relapse (ROR) modeling with the PAM50 assay produced a continuous risk score in both node-negative and node-positive disease.

CONCLUSIONS:

In the MA.12 study, intrinsic subtype classification by qRT-PCR with the PAM50 assay was superior to IHC profiling for both prognosis and prediction of benefit from adjuvant tamoxifen.

• Authors: Stephen K Chia, Vivien H Bramwell, Dongsheng Tu, Lois E Shepherd, Shan Jiang, Tammi Vickery, Elaine Mardis, Samuel Leung, Karen Ung, Kathleen I Pritchard, Joel S Parker, Philip S Bernard, Charles M Perou, Matthew J Ellis, Torsten O Nielsen
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 18 Issue 16 Pg. 4465-72 (Aug 15 2012) ISSN: 1557-3265 [Electronic] United States
• PMID: 22711706 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Antineoplastic Agents, Hormonal
• Tamoxifen

Topics

• Adult
• Antineoplastic Agents, Hormonal (therapeutic use)
• Breast Neoplasms (drug therapy, genetics, mortality, pathology)
• Chemotherapy, Adjuvant
• Female
• Gene Expression Profiling
• Humans
• Middle Aged
• Neoplasm Grading
• Neoplasm Staging
• Prognosis
• Recurrence
• Tamoxifen (therapeutic use)
• Treatment Outcome