The update confirms NICE’s provisional guidance issued in April 2018, recommending the use of EndoPredict, Oncotype DX and Prosigna to guide decisions on whether patients with a type of early breast cancer (ER positive, HER2 negative, lymph node negative) should also receive chemotherapy following surgery to remove the tumour.
The tumour profiling tests provide information on the activity of genes in tumour samples, giving a risk profile that can help determine the likelihood of cancer recurring, helping to define the treatment pathway.
In particular, the updated final guidance also recommends that use of these tests be extended to patients with ‘micrometastatic’ disease – where a small collection of breast cancer cells have been shed from the original tumour and have spread to another part of the body via the lymphatic system.
Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, said:
We’re delighted that these three tests have been recommended by NICE to help personalise breast cancer treatment and enable some women to be safely spared the gruelling side-effects of chemotherapy.
Chemotherapy remains a cornerstone of breast cancer treatment, but with such difficult side-effects it is so important we avoid giving it to those will be invaluable in guiding decisions about whether this treatment is necessary. Even the possibility of chemotherapy can cause great anxiety for many patients after their diagnosis, and these tools to help predict the risk of recurrence will be invaluable in guiding decisions about whether this treatment is necessary.
With this guidance not being mandatory, it’s essential that NHS England now makes their position clear on the future use and commissioning of these tests, to ensure access for all women that could benefit.
We’d encourage any patients who think they may benefit from these tests to speak to their doctors about whether they would be suitable to access them.
On the new clarity for patients with micrometastases provided in the final guidance, Baroness Morgan added:
It is fantastic news that these prognostic tests have now also been recommended for a small group of patients with ‘micrometastases’, and we hope this will now lead to much more consistent access for these women.