Vol 6, No 3 (2021)
Original article
Published online: 2021-09-09

open access

Page views 6511
Article views/downloads 1084
Get Citation

Connect on Social Media

Connect on Social Media

The Oncotype DX recurrence score impact on the management of ER-positive, HER2-negative, node-negative breast cancer

Abdalla Saad Abdalla Al-Zawi1
Medical Research Journal 2021;6(3):211-216.


Introduction: Oncotype DX recurrence score is used to categorize estrogen-receptor-positive, human epidermal growth factor receptor-2 negative, lymph-node negative early breast cancer in high- or low-recurrence risk groups. It has a guiding significance for whether post-operative chemotherapy or only hormonal manipulation is selected as an adjuvant treatment.

Aims: Assess the impact of the Oncotype DX recurrence score on adjuvant chemotherapy-related management decision-making in the cases of ER+ve, HER2–ve, LN–ve early breast cancer in our local unit. Material and methods: A cohort of 76 patients with early breast cancer were included, two had bilateral disease. All were operated for estrogen-receptor-positive, human epidermal growth factor receptor-2 negative, lymph-node negative early breast cancer. Tumor grade, Ki67 proliferative index, PREDICT and Oncotype DX recurrence score results were obtained in addition to the offered treatment information for each case.

Results: After the primary tumor surgery and an Oncotype DX recurrence score assessment, 18 patients (24%) were eligible for adjuvant chemotherapy; out of them, 10 patients (56%) had a chemotherapy absolute survival benefit of > 15% at 10 years, where 5 patients (30%) had a chemotherapy relative survival benefit of ~ 6.5%, 3 patients (17%) had a chemotherapy relative survival benefit of ~1.6%. In this cohort, 10 patients (13%) had a low Oncotype DX recurrence score; however, they received adjuvant chemotherapy based on other clinico-biological parameters. The other 48 patients (63%) with a low recurrence risk were spared potential adverse events related to the systemic therapy. Based on the menopausal status, every patient had received suitable hormonal manipulation therapy. The data also revealed the absence of a relationship between the Ki67 proliferative index and the Oncotype DX recurrence score (p = 0.06); moreover, the size of the tumor did not correlate with the Oncotype DX recurrence score (p = 0.5).

Conclusion: The Oncotype DX recurrence score provides a credible prediction of distant disease recurrence risk in early breast cancer; however, it does not correlate with other prognostic markers, such as the Ki67 proliferative index as well as the tumor size. In this cohort, the use of the Oncotype DX recurrence score led to a 24% rate of treatment recommendations in the direction of adjuvant chemotherapy in addition to anti-hormonal therapy for estrogen-receptor-positive, human epidermal growth factor receptor-2 negative, lymph-node negative early breast cancer.

Article available in PDF format

View PDF Download PDF file


  1. Khan MA, Henderson L, Clarke D, et al. The Warwick experience of the Oncotype DX® Breast Recurrence Score® assay as a predictor of chemotherapy administration. Breast Care (Basel). 2018; 13(5): 369–372.
  2. Al-Zawi A. Ki -67 proliferative index as a predictive tool for axillary pathological complete response in node-positive breast cancer. International Journal Medical Science. 2020; 7(11): 1–4.
  3. Tan QX, Qin QH, Yang WP, et al. Prognostic value of Ki67 expression in HR-negative breast cancer before and after neoadjuvant chemotherapy. Int J Clin Exp Pathol. 2014; 7(10): 6862–6870.
  4. Siegelmann-Danieli N, Silverman B, Zick A, et al. The impact of the Oncotype DX Recurrence Score on treatment decisions and clinical outcomes in patients with early breast cancer: the Maccabi Healthcare Services experience with a unified testing policy. Ecancermedicalscience. 2013; 7: 380.
  5. Dieci MV, Guarneri V, Zustovich F, et al. Veneto Oncology Network. Impact of 21-gene breast cancer assay on treatment decision for patients with T1-T3, N0-N1, estrogen receptor-positive/human epidermal growth receptor 2-negative breast cancer: final results of the prospective multicenter ROXANE study. Oncologist. 2019; 24(11): 1424–1431.
  6. McVeigh TP, Hughes LM, Miller N, et al. The impact of Oncotype DX testing on breast cancer management and chemotherapy prescribing patterns in a tertiary referral centre. Eur J Cancer. 2014; 50(16): 2763–2770.
  7. Kim HJ, Choi WJ, Kim HH, et al. Association between Oncotype DX recurrence score and dynamic contrast-enhanced MRI features in patients with estrogen receptor-positive HER2-negative invasive breast cancer. Clin Imaging. 2021; 75: 131–137.
  8. Zheng A, Zhang L, Ji Z, et al. Oncotype DX for comprehensive treatment in male breast cancer: a case report and literature review. Am J Mens Health. 2019; 13(3): 1557988319847856.
  9. Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018; 379(2): 111–121.
  10. Rabie MA, Rankin A, Burger A, et al. The effect of Oncotype DX on adjuvant chemotherapy treatment decisions in early breast cancer. Ann R Coll Surg Engl. 2019; 101(8): 596–601.
  11. Loncaster J, Armstrong A, Howell S, et al. Impact of Oncotype DX breast Recurrence Score testing on adjuvant chemotherapy use in early breast cancer: Real world experience in Greater Manchester, UK. Eur J Surg Oncol. 2017; 43(5): 931–937.
  12. Crolley VE, Marashi H, Rawther S, et al. The impact of Oncotype DX breast cancer assay results on clinical practice: a UK experience. Breast Cancer Res Treat. 2020; 180(3): 809–817.
  13. Chang CH, Lin YH. Using Oncotype DX as an additional treatment decision tool in early breast cancer: a retrospective analysis from a single institution in Taiwan. Ther Radiol Oncol. 2018; 2: 7.
  14. Albain KS, Barlow WE, Ravdin PM, et al. Breast Cancer Intergroup of North America. Adjuvant chemotherapy and timing of tamoxifen in postmenopausal patients with endocrine-responsive, node-positive breast cancer: a phase 3, open-label, randomised controlled trial. Lancet. 2009; 374(9707): 2055–2063.
  15. Albain KS, Barlow WE, Shak S, et al. Breast Cancer Intergroup of North America. Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial. Lancet Oncol. 2010; 11(1): 55–65.
  16. Dowsett M, Cuzick J, Wale C, et al. Prediction of risk of distant recurrence using the 21-gene recurrence score in node-negative and node-positive postmenopausal patients with breast cancer treated with anastrozole or tamoxifen: a TransATAC study. J Clin Oncol. 2010; 28(11): 1829–1834.