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PAM50 assay aids prediction of metastasis in early node-positive breast cancer

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Confirmatory analysis would be welcomed

The ATAC population was used in this study for training and validation of PAM50, which could lead to overestimation of the test’s prognostic value. That said, the data looked pretty impressive.

Is the assay ready for prime time in node-positive patients? In my mind, probably not quite yet. The present analysis involved the testing of multiple comparisons, and in the end, even with 543 specimens it was limited by a relatively small number of events.

PAM50 classification approaches are probably useful, but which approaches are best – the ROR score, the intrinsic subtype, or the ROR group – remains uncertain, and a confirmatory analysis would certainly be welcomed.

Dr. Eric P. Winer is with the Dana-Farber Cancer Institute in Boston. He was the invited discussant of the study. Dr. Winer disclosed ties to AstraZeneca, Merrimack, Pfizer, and other companies.


 

AT THE ASCO ANNUAL MEETING 2013

"Given the rather limited overall difference between anastrozole and tamoxifen both in the ATAC trial and in the sequencing study, ABCSG-8 – tamoxifen versus tamoxifen followed by anastrozole – I don’t think that we can reasonably comment on the interaction between these scores and treatment," Dr. Gnant replied.

Another attendee, Dr. Carlos Arteaga of the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., asked, "Until we all start doing these genomic tests, can you tell us whether the Ki-67 had equal power in your study? It’s a simple test, and we are all using 14% as a cutoff for luminal A and B [intrinsic subtypes]. How did that pan out in this cohort?

"We are trying to have central review for Ki-67 and bring it into the multivariate model. Hopefully, later this year we will be able to answer that question," Dr. Gnant replied.

Dr. Gnant disclosed ties to several companies including Sanofi-Aventis, Novartis, and Roche, as well as NanoString Technologies, the maker of the PAM50 assay.

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