Mammoprint test

Mammaprint is not new - I had it done in 2010. One of the things people like about it is that it has a high or low recurrence score only - no intermediate score, is usable by ER- and Her2+ patients, and looks at a larger number of genes than some of the other assay tests do.

Mammaprint testing is done by Agendia in California, a subsidiary of a Dutch company.

I think part of the problem is insurance hasn't wanted to cover it. My oncologist wanted the mammaprint 7 years ago but my insurance refused it. I ended up getting the oncotype test

The MammaPrint or "70-gene" test is based on a 70-gene prognostic signature ("gene expression signature") proposed by investigators at the Netherlands Cancer Institute in a 2002 publication.

Agendia was founded to commercialize the test. The test first became commercially available in Europe (2004) and later in the USA (2008).

Artista928 and MTWoman are not talking about the same publications/work, although both happen to relate to the MammaPrint ("70-gene") test.

(1) 2017 ASCO Biomarker Guideline Update in view of MINDACT:

MTWoman, your MedPage Today feature discusses and links to a 2017 ASCO Biomarker Guideline Update just published on July 10, 2017 in which ASCO provides revised guidance regarding the clinical utility of the MammaPrint test in various patient subgroups and in light of "Clinical Risk Category" (classified per specific MINDACT Trial categorization methods).

The ASCO review and update was prompted by the publication of the MINDACT trial results in August of 2016 by Cardoso et al.

ASCO Guideline Update (2017): http://ascopubs.org/doi/full/10.1200/JCO.2017.74.0472

Cardoso (2016) (MINDACT TRIAL): "70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer"

Main Page: http://www.nejm.org/doi/full/10.1056/NEJMoa1602253

PDF version (Free): http://www.nejm.org/doi/pdf/10.1056/NEJMoa1602253

Supplementary Appendix (Free): http://www.nejm.org/doi/suppl/10.1056/NEJMoa1602253/suppl_file/nejmoa1602253_appendix.pdf

See also,

Hunter perspective (2016) (Free): http://www.nejm.org/doi/pdf/10.1056/NEJMp1608282

Hudis editorial (2016) (available for purchase): http://www.nejm.org/doi/pdf/10.1056/NEJMe1607947

(2) "Ultralow Risk" sub-group:

The commercial test output is a numerical MammaPrint Index and risk classification of "High Risk" or "Low Risk".

Artista's news report mentions UCSF and seems to relate to a completely different study published on June 29, 2017 from researchers at UCSF in which they sought to define another risk group: "ultralow risk".

Esserman et al. (2017)(UCSF): "Use of Molecular Tools to Identify Patients With Indolent Breast Cancers With Ultralow Risk Over 2 Decades"

http://jamanetwork.com/journals/jamaoncology/article-abstract/2634502

Unfortunately, the Esserman article is behind a paywall and the definition and threshold for "ultralow risk" is not clear to me from the abstract. In addition, the results are based on work using a specific clinical trial population, so it is possible that certain features of the study group (e.g., node-negative, post-menopausal) may potentially limit applicability of these results.

See also, this related NPR Feature with comments from other clinicians:

http://www.npr.org/sections/health-shots/2017/06/29/534882955/tumor-test-helps-identify-which-breast-cancers-dont-require-extra-treatment

Other groups have also been working on defining "ultralow risk" subsets, such as Delahaye:

Delahaye (2017), "A breast cancer gene signature for indolent disease"

https://link.springer.com/article/10.1007/s10549-017-4262-0

It is possible that due to differences in methodology and between the patient populations used, the definitions and thresholds for "ultralow risk" might differ from study to study.

The above publications by Esserman et al. (2017) and Delahaye et al. (2017) regarding "ultralow" risk do not appear to be considered in the above ASCO Guideline update.

====> With such highly technical documents, it is easy to misunderstand the meaning and/or applicability of the findings. If any outside material influences thinking about treatment decisions, patients should be sure to discuss their thinking with their oncologist.

BarredOwl