Mammaprint is a test that idenitifies a profile of a tumor sample that is then used to assess risk. In February 2005, the BlueCross BlueShield Association Technology Evaluation Center (TEC) conducted a technology assessment on gene expression profiling for managing breast cancer treatment. The TEC Assessment summarized the evidence for four different gene expression profiling assays, in various stages of development, that are intended for eventual use in identifying those patients at low risk of recurrence for whom adjuvant chemotherapy can be avoided. The four assays were the 21-gene Oncotype DX (Genomic Health), the 70-gene MammaPrint® (Agendia; also referred to as the “Amsterdam signature”), the 76-gene “Rotterdam signature” (Veridex), and a 41-gene signature reported by Ahr and colleagues. Because current selection methods by traditional clinical and histopathological criteria exclude only a small proportion from adjuvant chemotherapy, and only a small proportion derive significant benefit, it is likely that a significant number of women could avoid the side effects of chemotherapy if more accurate selection methods were available. However, the TEC Assessment concluded that because published evidence supporting clinical utility is not available, the evidence for all of the gene expression panels is insufficient to permit conclusions concerning the effect of gene expression profiling on selecting patients who do not need chemotherapy for the purpose of avoiding adverse outcomes, while maintaining or improving disease-free or overall survival outcomes.by Paik and colleagues discussed above.
Sicne then, NCCN has recommended Oncotype but not Mammaprint. The two tests are not identical and Oncotype recommendation by NCCN does not translate into an approval for Mammaprint, as per Californai Tachn Assessment Forum(http://www.gopathdx.com/?action-model-name-research-itemid-13) and Medicare(http://palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~7WLQ5C4784?open&navmenu=Articles%7C%7C%7C%7C).
de Snoo, F. A., Knauer, M., Bender, R. A., Stork-Sloots, L., Rutgers, E. J., Glas, A. M., Linn, S. C., Van 't Veer, L. J.
Outcome prediction by the 70-gene profile in the context of the National Comprehensive Cancer Network (NCCN) guidelines
J Clin Oncol (Meeting Abstracts) 2009 27: 535
http://www.springerlink.com/content/03vw93w25440442u/fulltext.pdf
2007 TEC Assessment: Gene expression profiling for managing breast cancer treatment. www.bcbs.com/tec/vol20/20_03.html
National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Breast Cancer. http://nccn.org/professionals/physician_gls/PDF/breast.pdf
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