Oncotype Dx is an RT PCR based assay done on breast cancer tissue to test the expression of 21 tumor related genes. It provides a recurrence score (RS) to predict the risk of distant recurrence in early stage breast cancer patients who are ER positive and her2neu negative. RS is defined as low risk (0-18), intermediate (19-30), and high (over 30). By using the NSABP B14 database, it showed that adjuvant chemotherapy provides no benefit for patients with 0-18 RS but provides definite benefit to those with more than 30 RS. A prospective trial, TailoRx was started in 2007 to understand the benefits of chemotherapy in ER positive, her2neu negative, node negative breast cancer patients who had RS of 11-25 and to confirm those with low risk of 0-10 RS. Partial results of TailoRx were reported in December 2015 and complete results in June 2018. In this study, we analyze the reported use of Oncotype Dx in early breast cancer patients before 2015, between 2015-2018, and after 2018. Method: We collected 18.2 million messages from 53 different unrestricted cancer forums, including 5.8 million messages from 26 breast cancer related forums; these provided clinically relevant information to our platform, “Voice of Cancer Patients (VoCP)”. We created custom ontology regarding breast cancer, GEP assays and various therapies, and then analyzed these messages by using artificial intelligence techniques, e.g., natural language processing and machine learning. We found 1.7 million messages related to early stage (1 and 2) breast cancer from 27,578 users with 4,202 users getting Oncotype Dx. Distribution of Oncotype Dx in early breast cancer patients over time

Between 2006 - 2012Between 2012 - 2015Between 2015 - 6/2018After 6/2018
total users 15,559 6,083 4,639 1,297 
Oncotype Dx 1,959 1,104 823 316 
Percentage % 12.59% 18.15% 17.74% 24.36% 
Stage 1 1,290 670 487 212 
Stage 2 669 434 336 104 
Nodal Involvement 257 159 104 27 
Between 2006 - 2012Between 2012 - 2015Between 2015 - 6/2018After 6/2018
total users 15,559 6,083 4,639 1,297 
Oncotype Dx 1,959 1,104 823 316 
Percentage % 12.59% 18.15% 17.74% 24.36% 
Stage 1 1,290 670 487 212 
Stage 2 669 434 336 104 
Nodal Involvement 257 159 104 27 

Of patient who had Oncotype Dx done, 536 reported their tumor size to be less than 1 cm, 1,436 reported between 1-2 cm, 686 reported between 2-3 cm, and 338 patients reported over 3 cm. Most patients who had Oncotype Dx were ER positive and her2neu negative although 101 reported being ER negative and 185 reported being her2neu positive. Most of the ER negative patients had the test done because of the discordance between biopsy and final pathology ER status, or due to ER negative but PR positive tumor. Regardless of the reason, all reported having RS over 30. Also, all her2neu positive patients reported RS over 30. • 623 patients identified themselves as premenopausal and 101 as perimenopausal. • Of 1,630 patients who reported 0-18 RS, 459 received chemotherapy. • Of 1,080 patients with 19-30 RS, 455 received chemotherapy. • Of 507 patients who reported more than 30 RS, 65 did not get chemotherapy. Among patients with 0-25 RS, over 90% patients received chemotherapy due to their young age, 20% reported tumor size above 2 cm, 20% reported grade 3 or nodal involvement or other discordant features between Oncotype RS and pathological results. 25% patients who had 0-30 RS received chemotherapy and this did not change before or after the results of TailorRx were published. Most common chemotherapy reported was Cytoxan/Taxotere. Conclusions: • Use of Oncotype Dx almost doubled from 2012 to 2018. • Almost 25% of stage 1 and 2 patients reported getting Oncotype Dx to help in deciding about adjuvant chemotherapy. • The decision to use adjuvant chemotherapy in 0-25 RS patients is also driven by patient age and tumor characteristics and did not change in the time period studied. • VoCP provides reliable insights into patients’ point of view about their disease and its treatment, and it highlights the areas of unmet needs where research and resources should be focused.

Citation Format: Sangeeta Aggarwal, Guroosh Chaudhary, Manish Singh, Ankit Gupta, Rishi Sharma, Alok Aggarwal. Voice of cancer patients; patients’ experience regarding use of Oncotype Dx before and after TailorRx trial results [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-16-02.