Multigene tests for breast cancer: The physician’s perspective

Francesco Cognetti, Laura Biganzoli, Sabino de Placido, Lucia del Mastro, Riccardo Masetti, Giuseppe Naso, Giancarlo Pruneri, Donatella Santini, Carlo Alberto Tondini, Corrado Tinterri, Giuseppe Tonini, Sandro Barni

Research output: Contribution to journalReview articlepeer-review


Breast cancer is the most common tumour in women and the first cause of death for cancer in the female population. Preserving the quality of life has therefore become an important objective in the management of the disease. The benefits of adjuvant chemotherapy in patients with HR+ HER2- early breast cancer should always be balanced against its potential short and long-term adverse effects, and identifying the appropriate patients for whom chemotherapy can offer the highest clinical benefit is critical. Besides clinical and pathological factors, today four multigene tests able to guide the choice of the adjuvant therapy early breast cancer are available in Italy: Oncotype DX®, EndoPredict®, MammaPrint® e Prosigna®. This review evaluates the main characteristics of these diagnostic tests, the studies on clinical utility, their economic impact and their inclusion in international and national guidelines. The Oncotype DX Breast Recurrence Score® test is the only multigene test validated, with level IA evidence, to guide the adjuvant therapy decisions: hormone therapy alone for most patients with RS results 0–25, and chemotherapy for patients with RS results 26–100. Clinical data demonstrate that the Oncotype DX test is able to significantly impact therapeutic decisions, reducing chemotherapy use up to 49% and supporting the use of chemotherapy (up to 12%) in potentially under-treated patients. Based on the level of clinical evidence and established clinical utility, several multigene tests have been included in the main international guidelines, with recommendations ranging from “strong” to “moderate”.

Original languageEnglish
Pages (from-to)936-947
Number of pages12
Issue number9
Publication statusPublished - Apr 27 2021


  • Adjuvant chemotherapy
  • Adjuvant hormone therapy
  • Breast cancer
  • Genomic tests

ASJC Scopus subject areas

  • Oncology


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