Gene expression profiling and expanded immunohistochemistry tests to guide selection of chemotherapy regimens in breast cancer management: a systematic review

摘要

OBJECTIVES: The aim of this report was to assess the clinical effectiveness of twoudGene expression profiling (GEP) and two expanded immunohistochemistry (IHC)udtests compared with current prognostic tools in guiding the use of adjuvantudchemotherapy in patients with early breast cancer.ududMETHODS: A systematic review of the evidence on clinical effectiveness ofudOncotypeDX, IHC4, MammaPrint and Mammostrat, compared with current clinicaludpractice using clinicopathological parameters, in women with early breast cancerudwas conducted. Ten databases were searched to include citations to May 2016.ududRESULTS: Searches identified 7064 citations, of which 41 citations satisfied theudcriteria for the review. A narrative synthesis was performed. Evidence forudOncotypeDX demonstrated the impact of the test on decision-making and there wasudsome support for OncotypeDX predicting chemotherapy benefit. There wereudrelatively lower levels of evidence for the other three tests included in the analysis.udMammaPrint, Mammostrat and IHC4 tests were limited to a small number of studies.udLimitations in relation to study design were identified for all tests.ududCONCLUSIONS: The evidence base for OncotypeDX is considered to be the mostudrobust. Methodological weaknesses relating to heterogeneity of patient cohorts andudissues arising from the retrospective nature of the evidence were identified. Furtherudevidence is required for all of the tests using prospective randomised controlled trialuddata.ud