Symphony suite of tests for Breast Cancer – pro

'Breast cancer' highlighted in pink with felt tip pen

Symphony suite of tests includes Mammaprint, BluePrint and TargetPrint. According to the online article titled “Comparison of MammaPrint, BluePrint, and TargetPrint with Clinical Parameters in Patients with Breast Cancer: Findings from a Prospective United States Cohort”, it states that the multigene signature MammaPrint, as well as BluePrint and TargetPrint, provides additional information for treatment guidance. By combining MammaPrint with the BluePrint molecular subtyping profile, specific groups of patients can be recognized that are at high risk for recurrence and that would possibly benefit from specific treatment. It further stated that the study showed that TargetPrint provides a high quality second opinion for local IHC/FISH assessment. Another similar article titled “Comparison of molecular subtyping with BluePrint, MammaPrint, and TargetPrint to local clinical subtyping in breast cancer patients” states that the implementation of multigene assays such as TargetPrint, BluePrint, and MammaPrint may improve the clinical management of breast cancer patients. The TargetPrint is considered a macro array based gene expression test which offers a quantitative assessment of the patient’s overall level of estrogen receptor (ER), progesterone receptor (PR), and HER2/NEU overexpression within the breast cancer. By utilizing the TargetPrint studies, physicians are provided with additional insight into the biology of the patient’s individual tumor which can assist in the treatment decisions. Lastly, the BluePrint gene expression signature was developed for the classification of breast cancer into either a basal type, luminal type, or ERBB2-type. By identifying tumors that can be responsible for the hormonal interventions (which would be the luminal type), or sensitive to trastuzumab therapy or to cytotoxic therapy (which is basal type), the different subtypes can respond differently to different types of therapies and combination of therapies. Overall, the BluePrint provides a more personalized result to the physician which allows them to get the patient the most likely effective treatment for the patient—hormonal therapy, combined hormonal and chemo therapy, and combined chemo therapies alone. The three tests are put together in a panel in the Symphony panel.

At the same time, guidelines have not recommended this panel for this situation. Mammaprint is a test that purports to determine aggressiveness  of breast cancer. It is widely accepted in Europe and less so in the USA. More recently. TargetPrint is another iteration that purports to provides reliable, quantitative assessment of mRNA expression levels of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) and BluePrint similarly attempts to provide prognostic information. BluePrint, an 80-gene expression signature for the classification of breast cancer into Basal-type, Luminal-type and ERBB2-type.

Besides that these two latter tests still need to be fully validated, there is no literature support for the three together being more accurate or productive of more benefit than either one. Therefore, it would be important to perform definitive comparison of combinations of these assays.

 

References:

Nguyen, B., Sinha, R., Kerlin, D., Barone, J., Garcia, A., Yao, K., … & Deck, K. (2011). P3-04-06: Comparison of MammaPrint, BluePrint, and TargetPrint with Clinical Parameters in Patients with Breast Cancer: Findings from a Prospective United States Cohort. Cancer Research, 71(24 Supplement 3).

 

Nguyen, B., Cusumano, P. G., Deck, K., Kerlin, D., Garcia, A. A., Barone, J. L., … & Generali, D. (2012). Comparison of molecular subtyping with BluePrint, MammaPrint, and TargetPrint to local clinical subtyping in breast cancer patients. Annals of surgical oncology, 19(10), 3257-3263.

 

Daniel D. Von Hoff et al, Pilot Study Using Molecular Profiling of Patients’ Tumors to Find Potential Targets and Select Treatments for Their Refractory Cancers JCO October 4, 2010

Gevensleben H, Göhring UJ, Büttner R, Heukamp LC, Kunz G, Dimpfl T, Jackisch C, Ortmann O, Albert US, Bender R, De Snoo F, Krijgsman O, Glas AM, Ergönenc YH, Vogel C, Dykgers A, Langwieder C, Rees M, Anzeneder T. Comparison of MammaPrint and TargetPrint results with clinical parameters in German patients with early stage breast cancer. Int J Mol Med. 2010 Dec;26(6):837-43

Burstein HJ.Personalized medicine and breast cancer care. J Natl Compr Canc Netw. 2009 Feb;7(2):109.

Companion Diagnostics in Personalized Medicine and Cancer Therapy, Trimark Publications (190 pages), published Apr 2008

Raman G, Avendano EE, Chen M.Update on Emerging Genetic TestsCurrently Available for Clinical Use in Common CancersEvidence Report/TechnologyAssessment.

(Prepared by the Tufts Evidence based Practice Center under Contract No.290-2007-10055-I.)Rockville, MD: Agency for Healthcare Research and Quality.July2013

www.effectivehealthcare.gov/reports/final.cfm

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