Menekse Göker*, Hannelore Denys, Koen van de Vijver, Geert Braems

Göker et al. J Clin Transl Res 2022; 8(6):9

Published online: November 10, 2022


Background: One of the current challenges in breast cancer is the appropriate treatment of invasive lobular breast cancer (ILC) and defining the high-risk group within ILC. The biological character of ILC typically translates to a good prognosis, however several studies have indicated that the long-term prognosis is worse than for patients diagnosed with the more commonly invasive ductal carcinoma (IDC). Many genomic tests are now available to determine whether those patients are at high-risk (HR) and enable tailored treatment. Unfortunately, most of the studies in which these genomic tests have been evaluated entail retrospective analysis of a prospective trial.
Aim: This review focuses on the validation of the available genomic assays based on trials performed in ILC patients, where in some instances the various subtypes of ILC (classical, pleomorphic, non-classic type) were taken into account.
Results: Using Oncotype DX in retrospective studies, only 1.3% to 8% of ILC tumors were categorized as HR tumors. For MammaPrint, 24% of patients were classified as HR, which was associated with poor outcome. In a recent sub-analysis of the Mindact study comprising 487 ILC patients, 16.2% were high genomic risk. Endopredict, Prosigna Breast Cancer Prognostic Gene Signature Assay, and the Breast Cancer Index have been validated in patients receiving only endocrine treatment.
Conclusion: Although ILC accounts for the second most common breast cancer subtype in women, none of these tests encompass tumor morphology in their algorithms. Prospective studies on ILC with genomic assays are warranted given the various subtypes of and treatment options for this underestimated, but frequently occurring cancer.
Relevance for patients: Genomic assays can be employed in ILC patients to predict the risk of recurrence and identify those patients who might benefit from chemotherapy in addition to their standard treatment regimen.


Author affiliation

1. Department of Gynecology, Ghent University, Ghent, Belgium
2. Department of Medical Oncology, Ghent University, Ghent, Belgium
3. Department of Histopathology, Ghent University, Ghent, Belgium

*Corresponding author
Menekse Göker
Department of Gynecology, Universiteit Gent, Corneel Heymanslaan 10, 9000 Ghent, Belgium,
Tel: +32-(0)93 327 847

Handling editor:
Michal Heger
Department of Pharmaceutics, Utrecht University, the Netherlands
Department of Pharmaceutics, Jiaxing University Medical College, Zhejiang, China


Epub ahead of print (534.4 KB)