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Access to tumour profiling tests for guiding adjuvant chemotherapy decisions expanded

Use of a breast cancer tool that can predict which breast cancer patients will benefit from adjuvant chemotherapy is to be expanded after a recommendation from the National Institute of Health & Care Excellence (NICE).

Tumour profiling tests are already recommended by NICE for guiding chemotherapy decisions in people with oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative, lymph-node negative early breast cancer.

This new recommendation expands their use to women who have been through the menopause or men with ER- or PR-positive, HER2-negative early breast cancer with one to three positive lymph nodes.

While the majority of patients with lymph node-positive early-stage breast cancer receive chemotherapy, research shows that only a minority actually benefit from the treatment.

As such, NICE’s independent diagnostic advisory committee reviewed the evidence behind tumour profiling tests and concluded that the tests can save patients from unnecessarily going through chemotherapy treatments after surgery, and cuts costs for the NHS by more accurately targeting chemotherapy treatment.

Mark Chapman, interim director of the Health Technologies Programme at NICE, said: ‘Choosing whether to have chemotherapy is a tough decision to make when you don’t have all the information available to you. A test that can help to predict the risk of the breast cancer spreading should be considered as a significant step forward for patients.

‘Our committee heard compelling patient testimony which outlined the significant emotional and psychological strain of having to make this decision. Having chemotherapy will be the right choice for some but for others they will not have to face the side effects which come with the treatment.’

NICE has recommended the tumour profiling tests EndoPredict, Prosigna and Oncotype DX for use on the NHS, all of which it says are clinically- and cost-effective.

The test results, which are returned in days, provide a risk profile of an individual’s breast cancer which can be combined with other factors, such as tumour size, to better predict the risk of disease recurrence in the future.

Oncotype DX could also allow clinicians to identify people who are less likely to benefit from chemotherapy after surgery, the committee found.

Previously, access to tumour profiling tests was depended on where patients live due to NHS trusts having to pay for the test out of local budgets, which was only possible in 60% of trusts. It is thought that an additional 3,000 breast cancer patients in England and Wales will now have access to the test through the NHS.

This will also improve patient care and cut unnecessary chemotherapy patient appointments by 41%, resulting in a £62,307 saving for each NHS Trust and around £770 per patient, NICE said.