The Prosigna gene expression assay and responsiveness to adjuvant cyclophosphamide-based chemotherapy in premenopausal high-risk patients with breast cancer

Research output: Contribution to journalJournal articlepeer-review


  • Maj-Britt Jensen
  • Lænkholm, Anne-Vibeke
  • Torsten O Nielsen
  • Jens Ole Eriksen
  • Pernille Wehn
  • Tressa Hood
  • Namratha Ram
  • Wesley Buckingham
  • Sean Ferree
  • Bent Ejlertsen

BACKGROUND: The PAM50-based (Prosigna) risk of recurrence (ROR) score and intrinsic subtypes are prognostic for women with high-risk breast cancer. We investigate the predictive ability of Prosigna regarding the effectiveness of cyclophosphamide-based adjuvant chemotherapy in premenopausal patients with high-risk breast cancer.

METHODS: Prosigna assays were performed on the NanoString platform in tumors from participants in Danish Breast Cancer Group (DBCG) 77B, a four-arm trial that randomized premenopausal women with high-risk early breast cancer to no systemic treatment, levamisole, oral cyclophosphamide (C) or cyclophosphamide, methotrexate and fluorouracil (CMF).

RESULTS: In total, this retrospective analysis included 460 women (40% of the 1146 randomized patients). The continuous Prosigna ROR score was prognostic in the no systemic treatment group (unadjusted P < 0.001 for disease-free survival (DFS), P = 0.001 for overall survival (OS)). No statistically significant interaction of continuous ROR score and treatment on DFS and OS was found. A highly significant association was observed between intrinsic subtypes and C/CMF treatment for DFS (Pinteraction = 0.003 unadjusted, P = 0.001 adjusted) and OS (Pinteraction = 0.04). In the adjusted analysis treatment with C/CMF was associated with a reduced risk of DFS events in patients with basal-like (hazard ratio (HR) 0.14; 95% CI 0.06; 0.32) and luminal B (HR 0.48; 95% CI 0.27; 0.84) subtypes but not in patients with Human epidermal growth factor receptor-enriched (HR 1.05; 95% CI 0.56; 1.95) or luminal A (HR 0.61; 95% CI 0.32; 1.16) subtypes.

CONCLUSION: The Prosigna ROR score and intrinsic subtypes were prognostic in high-risk premenopausal patients with breast cancer, and intrinsic subtypes identify high-risk patients with or without major benefit from adjuvant C/CMF treatment.

Original languageEnglish
Article number79
JournalBreast cancer research : BCR
Number of pages10
Publication statusPublished - 2018

    Research areas

  • Adult, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Breast/pathology, Breast Neoplasms/genetics, Chemotherapy, Adjuvant/methods, Clinical Trials, Phase III as Topic, Cyclophosphamide/therapeutic use, Disease-Free Survival, Female, Fluorouracil/therapeutic use, Follow-Up Studies, Gene Expression Profiling/methods, Humans, Mastectomy, Methotrexate/therapeutic use, Middle Aged, Neoplasm Recurrence, Local/diagnosis, Predictive Value of Tests, Premenopause, Prognosis, Receptor, ErbB-2/metabolism, Retrospective Studies, Risk Assessment/methods

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