DR GROTHEY: There’s another paper that was presented at ASCO this year that I think is very relevant: how, in those people who use Oncotype DX, how many times does it really change your clinical practice?
And I was surprised to see that in this analysis from the US Oncology Group, in 350 patients, that’s 29% of patients, the treatment decision was changed based on the Oncotype DX result in colon cancer. And this is higher than I would have expected it. And it was interesting to see that the most likely trend was to kind of downsize adjuvant therapy, meaning decrease the intensity or not give it at all, rather than intensify it.
So, in the end, I think this is exactly the analysis we need to do, is that we see: do these tests really change our clinical practice?
DR O'NEIL: The Stage III data I think are really interesting, because I do think we’re overtreating people with oxaliplatin.
And to have someone who might be on the fence about giving oxaliplatin and have a low-risk score, I think it is interesting to think about treating that patient with a fluoropyrimidine alone, especially knowing that, even in the entire group, the benefits are small. So I actually can see more potential for that use than the Stage II situation.
I’m glad to see with the Stage II situation that people are downgrading their therapy. I think right now there is a tremendous overuse of oxaliplatin in people with standard-risk Stage II colon cancer. There’s no evidence that oxaliplatin improves outcome in that patient population. So if the end result of the Oncotype test is that people will use less oxaliplatin in Stage II, then that’s a good thing and perhaps the test should be used more often than it has been.
DR LOVE: Although, there were some patients in that paper from Tom Cartwright, where they had high Recurrence Scores and they moved them toward —
DR GROTHEY: Correct. They utilized it in both ways. And again, overall it was in 29% of patients that the treatment approach was changed. And I think this is actually something which probably raises a flag, that there is a perceived need and there’s actually a need for better than just clinical staging treatment decisions.