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


ABSTRACT: 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.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.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.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.

SUBMITTER: Chia SK 

PROVIDER: S-EPMC3743663 | biostudies-literature | 2012 Aug

REPOSITORIES: biostudies-literature

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

Chia Stephen K SK   Bramwell Vivien H VH   Tu Dongsheng D   Shepherd Lois E LE   Jiang Shan S   Vickery Tammi T   Mardis Elaine E   Leung Samuel S   Ung Karen K   Pritchard Kathleen I KI   Parker Joel S JS   Bernard Philip S PS   Perou Charles M CM   Ellis Matthew J MJ   Nielsen Torsten O TO  

Clinical cancer research : an official journal of the American Association for Cancer Research 20120618 16


<h4>Purpose</h4>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.<h4>Experimental design</h4>Total RNA from 398 of 672 (5  ...[more]

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