Classifications

• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
  • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
  • C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
  • C12Q1/6883—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
  • C12Q1/6886—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material for cancer
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
  • G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer
  • G01N33/57407—Specifically defined cancers
  • G01N33/57415—Specifically defined cancers of breast
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q2600/00—Oligonucleotides characterized by their use
  • C12Q2600/118—Prognosis of disease development
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q2600/00—Oligonucleotides characterized by their use
  • C12Q2600/158—Expression markers

Definitions

• This disclosure generally relates to a molecular classification of disease and particularly to molecular markers for cancer prognosis and methods of use thereof.
• Cancer is a major public health problem, accounting for roughly 25% of all deaths in the United States.
• American Cancer Society FACTS AND FIGURES 2010.
• treatments have been devised for various cancers, these treatments often vary in severity of side effects. It is useful for clinicians to know how aggressive a patient's cancer is in order to determine how aggressively to treat the cancer.
• the inventors have discovered gene expression signatures related to classifying cancer. Classifying cancer using these signatures can include prediction of prognosis for survival (e.g., distant metastasis-free survival), treating cancer, monitoring cancer, selection of therapeutic treatments or regimens, and such.
• prognosis for survival e.g., distant metastasis-free survival
• ISGs immune system genes
• ISGs cancer prognosis
• Other Cancer Prognostic Genes herein referred to as "Other Cancer Prognostic Genes” or "OCPGs” or “OCPG” in the singular
• these genes have predictive power for classifying cancer.
• the genes identified in these studies include immune systems genes, or ISGs, that for convenience can further be subdivided into three sub-groups based on their general biological characteristics: B-cell related genes ("BCRGs” or “BCRG” in the singular), T-cell related genes (“TCRGs” or “TCRG” in the singular) and HLA class II activation-related genes ("HLAGs” or "HLAG” in the singular).
• B-cell related genes B-cell related genes
• TCRGs T-cell related genes
• HLAGs HLA class II activation-related genes
• the ISGs are genes whose higher or increased expression is associated with a good or better prognosis and lower or no increase in expression is associated with a worse prognosis.
• the BCRGs which are genes that are typically expressed in B-cells, were found to be expressed in cancer cells from patients and found to have prognostic value in these studies.
• the TCRGs which are genes that are typically expressed in T-cells, were found to be expressed in cancer cells from patients and found to have prognostic value in these studies.
• the HLAGs which are genes that are typically related to HLA class II activation, were found to be expressed in cancer cells from patients and found to have prognostic value in these studies. These genes are very useful for classifying cancer. As described in more detail below sets of genes selected from the BCRGs, TCRGs, and HLAGs, alone, or when added to other gene expression profiles such as cell cycle gene expression profiles, or the OCPGs, yield highly predictive signatures for cancer classification.
• OCPGs were identified in these studies. These genes are very useful for, e.g., predicting survival (e.g., distant metastasis free survival) in cancer patients.
• OCPGs can be further subdivided into two subgroups: one subgroup has genes whose higher expression is associated with a better prognosis (bpOCPGs or "better prognosis Other Cancer Prognostic Genes") and another subgroup that has genes whose higher expression is associated with worse prognosis (wpOCPGs or "worse prognosis Other Cancer Prognostic Genes").
• the OCPGs are genes with no clear linking biochemical tie as a group, which were found to be expressed in cancer cells from patients and found to have prognostic value in these studies.
• sets of genes selected from the OCPGs, alone, or when added to other gene expression profiles such as the cell cycle gene expression profiles or the genes from the BCRGs, TCRGs, or HLAGs yield highly predictive signatures for cancer classification.
• the inventors previously discovered that the expression of those genes whose expression closely tracks the cell cycle (“cell-cycle genes,” "CCGs,” or “CCP genes” as further defined below) is particularly useful in classifying various cancers including e.g., breast cancer and prostate cancer.
• genes from the BCRGs, TCRGs, HLAGs, and OCPGs are prognostic on their own, and add significant prediction power to CCG expression signatures in the prognosis of cancer.
• the p-value for predicting distant metastasis free survival for ER+ breast cancer patients when taking into account the genes descried herein and a set of CCGs was 3.5 x 10 "21 in one of the Examples described below.
• the present disclosure provides a method for determining gene expression in a sample from a patient identified as having cancer.
• the method includes at least the following steps: (1) obtaining, or providing, one or more samples from a patient identified as having cancer; (2) determining the expression of a panel of genes in said sample(s) including at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., selected from the genes listed in Tables l-6b or Immune Panel 1, 2 and/or 3 or Immune Panel 1 , 2 and/or 3); and (3) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from said panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide said test value, wherein at least 5%, at least 10%, at least 25%>, at least 50%>, at least 75%>
• the cancer is lung cancer, bladder cancer, prostate cancer, brain cancer, or breast cancer.
• the cancer is breast cancer.
• the cancer is ER positive breast cancer.
• the method includes at least the following steps: (1) obtaining, or providing, one or more samples from a patient identified as having cancer; (2) determining the expression of a panel of genes in said sample(s) including (a) at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more cell-cycle genes and (b) at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs; and (3) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from said panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide said test value, wherein at least 50%, at least 75%> or at least 90%> of said plurality of test genes are cell- cycle genes, BCRGs, TCRGs, HLAGs, or OCPGs (or wherein cell-cycle genes, BCRGs, TCRGs,
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient), which comprises: determining in a sample (e.g., tumor sample) from the patient the expression of at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., selected from the genes listed in Tables 1- 6b or Immune Panel 1, 2 and/or 3) and using the expression of the genes in classifying the cancer (e.g., determining the prognosis of the cancer in the patient, or predicting the cancer outcome, the likelihood of cancer recurrence or probability of post- surgery distant metastasis-free survival).
• the cancer is lung cancer, bladder cancer, prostate cancer, brain cancer, or breast cancer.
• the cancer is breast cancer.
• the cancer is breast cancer.
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient), which comprises: (a) determining in a sample (e.g., tumor sample) from the patient the expression of (1) at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., selected from the genes listed in Tables l-6b or Immune Panel 1, 2 and/or 3), and (2) and at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more cell-cycle genes (e.g., selected from the genes listed in Table 7), and (b) using the expression of the genes selected from BCRGs, TCRGs, HLAGs, or OCPGs, and cell-cycle genes in classifying the cancer (e.g., determining the
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient), which comprises: (1) determining in a sample (e.g., tumor sample) from the patient the expression of the PGR gene and at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., selected from the genes listed in Tables l-6b or Immune Panel 1, 2 and/or 3) and (2) using the expression of the PGR gene and the genes selected from BCRGs, TCRGs, HLAGs, or OCPGs in classifying the cancer (e.g., determining the prognosis of the cancer in the patient, or predicting the cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival).
• a sample e.g.,
• the expression of the ESR1 gene has been determined (e.g., to determine or confirm the breast cancer is ER+ or ER-).
• the patient is ER+ and node negative.
• the patient is ER+ and node negative, has undergone surgery to remove some or all of the tumor, and is placed on hormone therapy.
• the method further comprises determining whether the patient has undergone hormonal therapy. In these embodiments, if the patient has undergone hormonal therapy, then the method further comprises correlating increased PGR expression to better prognosis. Conversely, if the patient has not undergone hormonal therapy, then the method further comprises correlating increased PGR expression to worse prognosis. In some embodiments, the method comprises correlating increased PGR expression to an increased likelihood of response to hormonal therapy.
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient), which comprises: (1) determining in a sample (e.g., tumor sample) from the patient the expression of the PGR gene, and/or the ABCC5 gene, and at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., selected from the genes listed in Tables l-6b or Immune Panel 1, 2 and/or 3) and (2) using the expression of the PGR gene, and, or the ABCC5 gene and the genes selected from BCRGs, TCRGs, HLAGs, or OCPGs in classifying the cancer (e.g., determining the prognosis of the cancer in the patient, or predicting the cancer outcome, the likelihood of cancer recurrence or probability
• the expression of the ESRl gene has been determined (e.g., to determine or confirm the breast cancer is ER+ or ER-).
• the patient is ER+ and node negative.
• the patient is ER+ and node negative, has undergone surgery to remove some or all of the tumor in her breast, and is placed on hormone therapy.
• the method further comprises determining whether the patient has undergone hormonal therapy. In these embodiments, if the patient has undergone hormonal therapy, then the method further comprises correlating increased PGR expression to better prognosis. Conversely, if the patient has not undergone hormonal therapy, then the method further comprises correlating increased PGR expression to worse prognosis. In some embodiments, the method comprises correlating increased PGR expression to an increased likelihood of response to hormonal therapy. In some embodiments, the method comprises correlating increased ABCC5 expression to worse prognosis.
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient), which comprises: (1) determining in a sample (e.g., tumor sample) from the patient the expression of the PGR gene, at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., selected from the genes listed in Tables l-6b or Immune Panel 1, 2 and/or 3), and at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more cell-cycle genes (e.g., selected from the genes listed in Table 7) and (2) using the expression of the expression of the PGR gene, the genes selected from BCRGs, TCRGs, HLAGs, or OCPGs, and the cell-cycle genes in classifying the cancer (e.g., determining the
• the expression of the ESRl gene has been determined (e.g., to determine or confirm the breast cancer is ER+ or ER-).
• the patient is ER+ and node negative.
• the patient is ER+ and node negative, has undergone surgery to remove some or all of the tumor, and is placed on hormone therapy.
• the method further comprises determining whether the patient has undergone hormonal therapy. In these embodiments, if the patient has undergone hormonal therapy, then the method further comprises correlating increased PGR expression to better prognosis. Conversely, if the patient has not undergone hormonal therapy, then the method further comprises correlating increased PGR expression to worse prognosis. In some embodiments, the method comprises correlating increased PGR expression to an increased likelihood of response to hormonal therapy.
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient), which comprises: (1) determining in a sample (e.g., tumor sample) from the patient the expression of the PGR gene, and, or the ABCC5 gene, and at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., selected from the genes listed in Tables l-6b or Immune Panel 1, 2 and/or 3), and at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more cell-cycle genes (e.g., selected from the genes listed in Table 7) and (2) using the expression of the expression of the PGR gene, and, or the ABCC5 gene, the genes selected from BCRGs, TCRGs, HLAGs,
• the expression of the ESR1 gene has been determined (e.g., to determine or confirm the patient is ER+ or ER-).
• the patient is ER+ and node negative.
• the patient is ER+ and node negative, has undergone surgery to remove some or all of the tumor in her breast, and is placed on hormone therapy.
• the method further comprises determining whether the patient has undergone hormonal therapy. In these embodiments, if the patient has undergone hormonal therapy, then the method further comprises correlating increased PGR expression to better prognosis. Conversely, if the patient has not undergone hormonal therapy, then the method further comprises correlating increased PGR expression to worse prognosis. In some embodiments, the method comprises correlating increased PGR expression to an increased likelihood of response to hormonal therapy. In some embodiments, the method comprises correlating increased ABCC5 expression with worse prognosis.
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient), which comprises: determining in a sample from the patient the expression of a plurality of test genes comprising at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., selected from the genes listed in Tables l-6b or Immune Panel 1, 2 and/or 3), and determining at least one clinical parameter for the patient (e.g., age, tumor size, node status, tumor stage), and using the expression of said plurality of test genes and the clinical parameter(s) in classifying the cancer (e.g., determining the prognosis of the cancer
• the BCRGs, TCRGs, HLAGs, and/or OCPGs information and the clinical parameter information are combined to yield a quantitative (e.g., numerical) evaluation or score of the prognosis of the cancer in the patient, or cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival.
• the expression level of the genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs and the clinical parameter information are combined with the expression level of the genes selected from CCGs (e.g., genes listed in Table 7) to yield a quantitative evaluation score of the prognosis of the cancer in the patient, or cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival.
• CCGs e.g., genes listed in Table 7
• the expression level of the genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs and the clinical parameter information are combined with the expression level of the PGR, ABCC5 and/or ESR1 genes to yield a quantitative evaluation score of the prognosis of the cancer in the patient, or cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival.
• the present disclosure provides a method for treating cancer, which comprises: determining in a sample from a patient the expression of a plurality of test genes comprising at least 4, 6, 8, 10, 12, or 15 or more BCRGs, TCRGs, HLAGs, or OCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39), and recommending, prescribing or administering a particular treatment regimen (e.g., a treatment regimen comprising chemotherapy) based at least in part on the determined expression levels of said BCRGs, TCRGs, HLAGs, or OCPGs.
• a particular treatment regimen e.g., a treatment regimen comprising chemotherapy
• a treatment regimen comprising chemotherapy is recommended, prescribed or administered based at least in part on the determination that the sample has low (or not increased) expression of said BCRGs, TCRGs, HLAGs, or bpOCPGs.
• a treatment regimen comprising hormonal therapy is recommended, prescribed or administered based at least in part on the determination that the sample has high (or increased) expression of said BCRGs, TCRGs, HLAGs, or bpOCPGs.
• the present disclosure provides a method for treating cancer, which comprises: determining in a sample from a patient the expression of a plurality of test genes comprising at least 4, 6, 8, 10, 12, or 15 or more BCRGs, TCRGs, HLAGs, or OCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39), and at least 4, 6, 8, 10, 12, or 15 or more cell cycle genes (e.g., at least 3 of the genes listed in Table 7), and recommending, prescribing or administering a particular treatment regimen (e.g., a treatment regimen comprising chemotherapy) based at least in part on the determined expression levels of said BCRGs, TCRGs, HLAGs, or OCPGs, and said cell cycle genes.
• a particular treatment regimen e.g., a treatment regimen comprising chemotherapy
• a treatment regimen comprising chemotherapy is recommended, prescribed or administered based at least in part on the determination that the sample has low (or not increased) expression of said BCRGs, TCRGs, HLAGs, or bpOCPGs.
• a treatment regimen comprising hormonal therapy is recommended, prescribed or administered based at least in part on the determination that the sample has high (or increased) expression of said BCRGs, TCRGs, HLAGs, or bpOCPGs.
• the present disclosure provides a method for treating breast cancer in a patient, which comprises: determining in a sample from the patient the expression of a plurality of test genes comprising at least 4, 6, 8, 10, 12, or 15 or more BCRGs, TCRGs, HLAGs, or bpOCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39), and determining in the same or a different sample from the patient the expression of the PGR gene, and recommending, prescribing or administering a particular treatment regimen (e.g., a treatment regimen comprising chemotherapy) based at least in part on the determined expression of the plurality of test genes, as well as the determined PGR expression.
• a particular treatment regimen e.g., a treatment regimen comprising chemotherapy
• a treatment regimen comprising a non-hormonal therapy agent (e.g., chemotherapy) or radiotherapy is recommended, prescribed or administered based at least in part on any of (1) low (or not increased) expression levels of the plurality of test genes or (2) low (or decreased) level of PGR expression.
• a treatment regimen comprising hormonal therapy is recommended, prescribed or administered based at least in part on increased level of PGR expression.
• the present disclosure provides a method for treating breast cancer in a patient, which comprises: determining in a sample from the patient the expression of a plurality of test genes comprising at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, or 15 or more BCRGs, TCRGs, HLAGs, or bpOCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39), and determining in the same or a different sample from the patient the expression of the PGR gene, and the ABCC5 gene, and recommending, prescribing or administering a particular treatment regimen (e.g., a treatment regimen comprising chemotherapy) based at least in part on the determined expression of the plurality of test genes, as well as the determined PGR, and ABCC5 expression.
• a particular treatment regimen e.g., a treatment regimen comprising chemotherapy
• a treatment regimen comprising a non-hormonal therapy agent ⁇ e.g., chemotherapy) or radiotherapy is recommended, prescribed or administered based at least in part on any of (1) low (or not increased) expression levels of the plurality of test genes or (2) low (or decreased) level of PGR expression or (3) high (or increased) level of ABCC5 expression.
• a treatment regimen comprising hormonal therapy is recommended, prescribed or administered based at least in part on increased level of PGR expression and or increased level of ABCC5 expression.
• the present disclosure provides a method for treating breast cancer in a patient, which comprises: determining in a sample from the patient the expression of a plurality of test genes comprising at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more cell-cycle genes (e.g., at least 3 of the genes listed in Table 7) and at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, or 15 or more BCRGs, TCRGs, HLAGs, or OCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39), and determining in the same or different sample from the patient the expression of the PGR gene, and recommending, prescribing or administering a particular treatment regimen ⁇ e.g., a treatment regimen comprising chemotherapy) based at least in part on the determined expression of the plurality of test genes, as well as the determined PGR expression.
• a particular treatment regimen ⁇ e.g., a treatment regimen comprising chemotherapy
• a treatment regimen comprising a non-hormonal therapy agent ⁇ e.g., chemotherapy) or radiotherapy is recommended, prescribed or administered based at least in part on any one or both of (1) high (or increased) levels of the CCGs or wpOCPGs in the plurality of test genes or (2) low (or decreased) level of PGR expression.
• a treatment regimen comprising a non-hormonal therapy agent ⁇ e.g., chemotherapy) or radiotherapy, and not comprising hormonal therapy is recommended, prescribed or administered based at least in part on any one or both of (1) high (or increased) level of the CCGs or wpOCPGs in the plurality of test genes and (2) low (or decreased) level of PGR expression.
• a treatment regimen comprising hormonal therapy is recommended, prescribed or administered based at least in part on high (or increased) level of PGR expression.
• the patient is ER+ and node negative. In some embodiments, the patient is ER+ and node negative, has undergone surgery to remove the tumor in her breast, and is placed on hormone therapy. In some embodiments of the methods described above, the patient is ER+ and node positive. In some embodiments, the expression of the ESR1 gene has been determined (e.g., to determine or confirm the breast cancer is ER+ or ER-).
• the present disclosure provides a method for treating breast cancer in a patient, which comprises: determining in a sample from the patient the expression of a plurality of test genes comprising at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more cell-cycle genes (e.g., at least 3 of the genes listed in Table 7) and at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, or 15 or more BCRGs, TCRGs, HLAGs, or OCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39), and determining in the same or different sample from the patient the expression of the PGR gene, and the ABCC5 gene, and recommending, prescribing or administering a particular treatment regimen ⁇ e.g., a treatment regimen comprising chemotherapy) based at least in part on the determined expression of the plurality of test genes, as well as the determined PGR, and ABCC5 expression.
• a particular treatment regimen ⁇ e.g., a treatment regimen
• a treatment regimen comprising a non-hormonal therapy agent ⁇ e.g., chemotherapy) or radiotherapy is recommended, prescribed or administered based at least in part on any one or both of (1) high (or increased) levels of the CCGs or wpOCPGs in the plurality of test genes or (2) low (or decreased) level of PGR expression or (3) high (or increased) level of ABCC5 expression.
• a non-hormonal therapy agent e.g., chemotherapy
• radiotherapy is recommended, prescribed or administered based at least in part on any one or both of (1) high (or increased) levels of the CCGs or wpOCPGs in the plurality of test genes or (2) low (or decreased) level of PGR expression or (3) high (or increased) level of ABCC5 expression.
• a treatment regimen comprising a non-hormonal therapy agent ⁇ e.g., chemotherapy) or radiotherapy, and not comprising hormonal therapy is recommended, prescribed or administered based at least in part on any one or both of (1) high (or increased) level of the CCGs or wpOCPGs in the plurality of test genes and (2) low (or decreased) level of PGR expression and (3) high (or increased) level of ABCC5 expression.
• a treatment regimen comprising hormonal therapy is recommended, prescribed or administered based at least in part on high (or increased) level of PGR expression.
• a treatment regimen comprising hormonal therapy is recommended, prescribed or administered based at least in part on low (or decreased) level of ABCC5 expression.
• the patient is ER+ and node negative. In some embodiments, the patient is ER+ and node negative, has undergone surgery to remove the tumor in her breast, and is placed on hormone therapy. In some embodiments of the methods described above, the patient is ER+ and node positive.
• the plurality of test genes includes at least 3 genes selected from BCRGs, TCRGs, HLAGs, or OCPGs, or at least 4, 5, 6, 7, 8, 9, 10, 12, 15, 20, 25 or 30 BCRGs, TCRGs, HLAGs, or OCPGs. In some embodiments, all of the test genes are BCRGs, TCRGs, HLAGs, or OCPGs. In some embodiments, the plurality of test genes includes at least 3 BCRGs, TCRGs, HLAGs, or OCPGs, or at least 4, 5, 6, 7, 8, 9, 10, 12, 15, 20, 25 or 30 BCRGs, TCRGs, HLAGs, or OCPGs.
• the plurality of test genes are BCRGs, TCRGs, HLAGs, or OCPGs.
• the plurality of test genes in addition to the BCRGs, TCRGs, HLAGs, or OCPGs, includes at least 3 cell-cycle genes, or at least 4, 5, 6, 7, 8, 9, 10, 15, 20, 25 or 30 cell cycle genes.
• At least 10%, 15%, 20%, 25%, 30%, 40%, 50%, 60%, 70%, 80%, 85%, 90%, 95%, or 99% of the plurality of test genes are cell cycle genes and BCRGs, TCRGs, HLAGs, or OCPGs.
• the step of determining the expression of the plurality of test genes in the sample comprises measuring the amount of mRNA in the sample transcribed from each of 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more BCRGs, TCRGs, HLAGs, or OCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39); and measuring the amount of mRNA of one or more control (e.g., housekeeping) genes in the sample.
• the step of determining the expression of the plurality of test genes in the sample further comprises measuring the amount of mRNA in the sample transcribed from each of 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more cell cycle genes (e.g., at least 3 of the genes listed in Table 7).
• the mRNA is converted to cDNA.
• the cDNA is amplified by PCR.
• the step of determining the expression of the plurality of test genes in the sample comprises (1) determining in a sample from a patient having cancer the expression of a panel of genes in said sample including 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more BCRGs, TCRGs, HLAGs, or OCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39); and (2) providing a "ISG/OCPG score", "ISG score”, "BCRG score”, “TCRG score”, “HLAG score”, “OCPG score”, “BCRG/OCPG score”, “TCRG/OCPG score”, "TCRG/OCPG score", "HLAG/OCPG score", "BCRG/TCRG score", "BCRG/HLGA score", "TCRG/HLGA score", “BCRG/TCRG/OCPG score", “BCRG/HLGA/OCPG score", or "TCRG/HLGA/OCPG score”(depending on what type of genes were analyzed in step (1)) by
• At least 5%, at least 10%>, at least 25%, at least 50%, at least 75% or at least 85% of the plurality of test genes used to derive the ISG score are ISGs (and so forth for the other scores).
• at least one of the plurality of test genes is chosen from the group consisting of ABCC5, PGR, and ESRI.
• the plurality of test genes comprises ABCC5, PGR, and ESRI.
• the ABCC5, PGR, or ESRI genes ⁇ i.e., any one, all three together, or any combination of the three) represent at least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%) or more of the combined weight used to provide the combined score.
• the step of determining the expression of the plurality of test genes in the sample comprises (1) determining in a sample from a patient having cancer the expression of a panel of genes in said sample including (a) at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more cell-cycle genes and (b) at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more BCRGs, TCRGs, HLAGs, and OCGPs; and (2) providing a "ISG/OCPG/CCG combined score", "ISG/CCG combined score", "BCRG/CCG combined score", "TCRG/CCG combined score", "HLAG/CCG combined score", or "OCPG/CCG combined score", "OCPG/BCRG/CCG combined score", "OCPG/TCRG/CCG combined score", "OCPG/HLAG/CCG combined score", "BCRG/TCRG/CCG combined score", "BCRG/HLAG/CCG combined score", "TCRG/HLAG/CCG combined score", "OCPG/BCIG/CCG combined score", "
• ISGs and CCGs make up at least 5%, at least 10%, at least 25%, at least 50%, at least 75% or at least 85% of the plurality of test genes used to derive the ISG/CCG combined score (and so forth for the other combined scores).
• at least one of the plurality of test genes is chosen from the group consisting of ABCC5, PGR, and ESR1.
• the plurality of test genes comprises ABCC5, PGR, and ESR1.
• the ABCC5, PGR, or ESR1 genes ⁇ i.e., any one, all three together, or any combination of the three) represent at least 5%, 10%, 15%, 20%, 25%o, 30%), 35%), 40%), 45%, 50% or more of the combined weight used to provide the combined score.
• a method for determining gene expression in a sample from a patient identified as having cancer (e.g., breast cancer, prostate cancer, lung cancer, bladder cancer, ovarian cancer, colorectal cancer, or brain cancer).
• cancer e.g., breast cancer, prostate cancer, lung cancer, bladder cancer, ovarian cancer, colorectal cancer, or brain cancer.
• the method includes at least the following steps: (1) obtaining, or providing, a sample from a patient identified as having cancer (e.g., breast cancer, prostate cancer, lung cancer, bladder cancer, ovarian cancer, colorectal cancer, or brain cancer); (2) determining the expression of a panel of genes in said sample including at least 4 cell-cycle genes chosen from the group in Panel H in Table 17 and at least 4 BCRGs, TCRGs, HLAGs, or OCPGs chosen from the group in Table 1 (e.g., Immune Panel 1, 2 or 3); and (3) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from said panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide said test value, wherein at least 50%, at least 75% or at least 90%> of said plurality of test genes are cell-cycle genes and BCRGs, TCRGs, HLAGs, or OCPGs (or wherein CCGs and ISGs, BC
• the plurality of test genes includes at least 2, 3, 4,
• the plurality of test genes consists of (or consists essentially of) cell-cycle genes and BCRGs, TCRGs, HLAGs, or OCPGs.
• a method for determining the prognosis of breast cancer, prostate cancer, lung cancer, bladder cancer or brain cancer which comprises determining, in a sample from a patient diagnosed of breast cancer, prostate cancer, lung cancer, bladder cancer or brain cancer, the expression of at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more cell-cycle genes in Panel H in Table 17 and the expression of at least 2, 3, 4, 5, 6, 7,
• the cancer is breast cancer.
• the expression of the ESRl gene has been determined (e.g., to determine or confirm the patient is ER+ or ER-).
• the breast cancer is ER positive.
• the prognosis method comprises (1) determining in a sample from a patient diagnosed with breast cancer, prostate cancer, lung cancer, bladder cancer or brain cancer, the expression of a panel of genes in said sample including at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more cell-cycle genes in Panel H in Table 17 and at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more BCRGs, TCRGs, HLAGs or OCPGs in Table 1; (2) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from the panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide the test value, wherein at least 50%>, at least 75% or at least 85% of the plurality of test genes are cell-cycle genes in Panel H in Table 17 and BCRGs, TCRGs, HLAGs, bpOCPGs, or wpOCPGs in Table 1, and (3) correlating (a) a high (or increased)
• the prognosis method further includes a step of comparing the test value provided in step (2) above to one or more reference values, and correlating the test value to a risk of cancer progression or risk of cancer recurrence. Optionally an increased likelihood of poor or worse prognosis is indicated if the test value is greater than the reference value.
• the plurality of ISGS and/or OCPGs are chosen from Immune Panel 1, 2, and/or 3.
• ISGs and/or OCPGs are combined with CCGs to form a combined panel.
• the combined panel is Combined Panel 1 (as shown in Table 39), or a subset of 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25 or more genes thereof.
• the combined panel is Combined Panel 2 (as shown in Table 40), or a subset of 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 15, 16, 18, 20, 25 or more genes thereof.
• the present disclosure also provides a method of treating cancer in a patient identified as having breast cancer, prostate cancer, lung cancer, bladder cancer or brain cancer, comprising: (1) determining in a sample from a patient diagnosed with breast cancer, prostate cancer, lung cancer, bladder cancer or brain cancer, the expression of a panel of genes in the sample including at least 4 or at least 8 cell-cycle genes in Panel H in Table 17 and at least 4 or at least 8 BCRGs, TCRGs, HLAGs, wpOCPGs, or bpOCPGs in Table 1; (2) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from said panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide said test value, wherein at least 50% or 75% or 85% of the plurality of test genes are cell-cycle genes and BCRGs, TCRGs, HLAGs, wpOCPGs or bpOCPGs; (3) correlating (a)
• the present disclosure further provides a diagnostic kit for determining the prognosis of a cancer in a patient, comprising, in a compartmentalized container, a plurality of oligonucleotides hybridizing to at least 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more test genes, wherein less than 10%, 30% or less than 40%> of the test genes are not cell-cycle genes, BCRGs, TCRGs, HLAGs, or OCPGs.
• the kit further includes one or more oligonucleotides hybridizing to the PGR, ABCC5, or ESRI gene.
• the kit may further include one or more oligonucleotides hybridizing to at least one control (e.g., housekeeping) gene.
• the oligonucleotides can be hybridizing probes for hybridization with an amplification product of the gene(s) (e.g., an amplification product of an mRNA or cDNA corresponding to the gene) under stringent conditions or primers suitable for PCR amplification of the genes (e.g., suitable for amplification of an mRNA, or corresponding cDNA, of a sample obtained from, e.g., fresh tumor tissue or FFPE tumor tissue).
• an amplification product of the gene(s) e.g., an amplification product of an mRNA or cDNA corresponding to the gene
• primers suitable for PCR amplification of the genes e.g., suitable for amplification of an mRNA, or corresponding cDNA, of a sample obtained from, e.g., fresh tumor tissue or FFPE tumor tissue.
• the kit consists essentially of, in a compartmentalized container, a plurality of PCR reaction mixtures for PCR amplification of mRNA, or corresponding cDNA, from 5 or 10 to about 300 test genes, wherein at least 30%> or 50%>, at least 60%) or at least 80%> of such test genes are cell-cycle genes and BCRGs, TCRGs, HLAGs, or OCRGs, and wherein each reaction mixture comprises a PCR primer pair for PCR amplifying an mRNA, or corresponding cDNA, that corresponds to one of the test genes.
• the kit includes instructions for correlating (a) high (or increased) level of overall expression of the CCGs and wpOCPGs and low (or decreased or not increased), levels of expression of the BCRGs, TCRGs, HLAGs and bpOCPGs to a poor or worse prognosis, or (b) low (or decreased or not increased) overall expression of the CCGs and wpOCPGs test genes to a good or better prognosis (e.g., a low likelihood of recurrence of cancer in the patient or a higher likelihood of distant metastasis free survival).
• a good or better prognosis e.g., a low likelihood of recurrence of cancer in the patient or a higher likelihood of distant metastasis free survival.
• the kit comprises one or more computer software programs for calculating a test value representing the expression of the test genes (either the overall expression of all test genes or of some subset) and for comparing this test value to some reference value.
• such computer software is programmed to weight the test genes such that the cell-cycle genes and BCRGs, TCRGs, HLAGs, or OCRGs are weighted to contribute at least 50%, at least 75% or at least 85% of the test value.
• such computer software is programmed to communicate (e.g., display) a particular cancer classification (e.g., that the patient has a particular prognosis, such as an increased likelihood of response to a treatment regimen comprising chemotherapy if the test value is greater than the reference value (e.g., by more than some predetermined amount)).
• the kit includes reagents necessary for extracting mRNA from fresh tumor tissue, fresh frozen tumor tissue, or FFPE tumor tissue.
• the present disclosure also provides the use of (1) a plurality of oligonucleotides hybridizing to mRNAs, or corresponding cDNAs, corresponding to at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more cell-cycle genes and a plurality of oligonucleotides hybridizing to mRNAs, or corresponding cDNAs, corresponding to at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs; optionally (2) one or more oligonucleotides hybridizing to an mRNA, or corresponding cDNA, corresponding to the PGR, ABCC5, or ESR1 gene, for determining the expression of the test genes in a sample from a patient having cancer, for the prognosis of cancer in the patient, wherein an increased level of the overall expression of the test genes indicates an increased likelihood, whereas no increase in the overall expression of the test genes indicates no increased likelihood.
• the oligonucleotides are PCR primers suitable for PCR amplification of the test genes. In other embodiments, the oligonucleotides are probes hybridizing to mRNAs, or corresponding cDNAs, that correspond to the test genes under stringent conditions. In some embodiments, the plurality of oligonucleotides are probes for hybridization under stringent conditions to, or are suitable for PCR amplification of mRNAs, or corresponding cDNAs, that correspond to from 4 to about 300 test genes, at least 50%, 70% or 80% or 90%> of the test genes being cell-cycle genes and BCRGs, TCRGs, HLAGs, or OCPGs.
• the plurality of oligonucleotides are hybridization probes for, or are suitable for PCR amplification of, mRNAs, or corresponding cDNAs, of from 20 to about 300 test genes, at least 30%, 40%, 50%, 70% or 80% or 90% of the test genes being cell-cycle genes and BCRGs, TCRGs, HLAGs, or OCPGs.
• the present disclosure further provides a system for classifying cancer in a patient, comprising: (1) a sample analyzer for determining the expression levels of a panel of genes in a sample including the expression levels of at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more test genes selected from BCRGs, TCRGs, HLAGs, or OCPGs, and optionally the ABCC5, PGR, or ESRI gene (i.e., any one, all three, or any combination of the three), wherein the sample analyzer contains the sample, mRNA molecules expressed from the panel of genes and extracted from the sample, or cDNA molecules corresponding to said mRNA molecules; (2) a first computer program for (a) receiving gene expression data on the test genes, (b) weighting the determined expression of each of the test genes with a predefined coefficient, and (c) combining the weighted expression to provide a test value, wherein at least 5%, at least 10%, at least 25%, at least 50%, at least 75% of the test genes are selected from BCRG
• the present disclosure further provides a system for classifying cancer in a patient, comprising: (1) a sample analyzer for determining the expression levels of a panel of genes in a sample including test genes comprising at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more cell- cycle genes, and the expression levels of at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12 or 15 or more BCRGs, TCRGs, HLAGs, or OCPGs, and optionally the ABCC5, PGR, or ESRI gene (any one, all three, or any combination of the three), wherein the sample analyzer contains the sample, mRNA molecules expressed from the panel of genes and extracted from the sample, or cDNA molecules corresponding to said mRNA molecules; (2) a first computer program for (a) receiving gene expression data on the test genes, (b) weighting the determined expression of each of the test genes with a predefined coefficient, and (c) combining the weighted expression to provide a test value, wherein at least 50%, at least at least 75% of the test
• the present disclosure is based, in part, on the discovery of gene expression signatures related to classifying cancer.
• Classifying cancer using these gene expression signatures can include prediction of prognosis for survival (e.g., predicting distant metastasis free survival, etc.) treating cancer (including selection of therapeutic treaments or regimens and predicting response to a particular treatment regimen, etc.), and monitoring cancer.
• ISGs immune system genes
• OCPGs other cancer prognostic genes
• CCGs cell-cycle genes
• CCP genes cell-cycle genes
• the genes identified in these studies include immune system genes, or ISGs, that for convenience can further be subdivided into three subgroups based on their general biological characteristics: B-cell related genes (“BCRGs”), T-cell related genes (“TCRGs”) and HLA related genes (“HLAGs”), and other cancer prognosis genes (“OCPGs”).
• BCRGs B-cell related genes
• TCRGs T-cell related genes
• HLAGs HLA related genes
• OCPGs cancer prognosis genes
• the HLAGs are genes that are typically related to HLA class II activation that were found to be expressed in cancer cells from patients and found to have prognostic value in these studies. These genes are very useful for classifying cancer (e.g., predicting recurrence or distant metastasis free survival in) patients. As described in more detail below, sets of genes selected from the BCRGs, TCRGs, and HLAGs when added to each other, or added to other gene expression profiles such as the CCG expression profiles or the OCPGs, yield extraordinarly predictive signatures for cancer prognosis.
• Table 1 Genes Whose Corresponding Expression Level Is Predictive of Cancer Prognosis &
• Table 1 above provides a representative set of BCRGs, TCRGs, HLAGs, and
• OCPGs from which the panels or prognostic signatures of the disclosure as described in the various embodiments and aspects of the disclosure can be constructed.
• representative probes and identifying information is given in Table 1 from which appropriate probes and/or primer pairs can be designed (or selected) for use in the methods and compositions of the disclosure as described herein.
• One set of preferred primer pairs and probes for use in the invention correspond to the specific probes (Probeset ID) as described in Table 1 and primers for amplifying an mRNA, or corresponding cDNA, that corresponds to the probe (e.g., binds specifically to the probe).
• B-cell related gene(s) and “BCRG(s)” refer to gene(s) that are characteristically expressed by B-cells, including those listed in Table 2. Table 2 also describes probes that are useful for detecting the expression of these genes. These BCRGs are very useful for classifying cancer. As described in more detail below sets of genes selected from the BCRGs alone, or when added to other gene expression profiles such as TCRGs, HLAGs, OCPGs or cell cycle gene profiles, yield extraordinarly predictive signatures for cancer classification.
• Non-limiting BCRGs are CKAP2, GUSBP11, IGHM, IGJ, IGkappa, IGKC, IGKV1-5, IGL1, IGLL3P, and IGVH.
• T-cell related gene(s) and TCRG(s) refer to gene(s) that are characteristically expressed by T-cells, including those listed in Table 3. Table 3 also describes probes that are useful for detecting the expression of these genes. These TCRGs are very useful for classifying cancer. As described in more detail below sets of genes selected from the BCRGs alone, or when added to other gene expression profiles such as BCRGs, HLAGs, OCPGs or cell cycle gene profiles, yield extraordinarly predictive signatures for cancer classification.
• Non-limiting TCRGs are CCL19, CCL5, CCR2, CD247, CD38, HLA-E, IRF1, IRF4, PTPN22, SELL, SEMA4D, and TCRA/D.
• HLA class II activation gene(s) and "HLAG(s)” refer to gene(s) that are characteristically expressed by cells during HLA class II activation, including those listed in Table 4. Table 4 also describes probes that are useful for detecting the expression of these genes. These HLAGs are very useful for classifying cancer. As described in more detail below sets of genes selected from the BCRGs alone, or when added to other gene expression profiles such as BCRGs, TCRGs, OCPGs or cell cycle gene profiles, yield extraordinarly predictive signatures for cancer classification.
• Non-limiting examples of HLAGs are CD74, EVI2B, HCLS1, HLA-DMA, HLA-DPAI, HLA-DPBI, HLA-DQBI, HLA-DRA, HLA-DRBI, HLA-DRBl/3, ITGB2, PECAMl, and PTPRC.
• Other Cancer Prognosis Gene(s) and “OCPG(s)” refer to gene(s) identified in these studies that have predictive power in the prognosis of cancer and are characteristic of other pathways in the cell (i.e., not characteristic of B-cells, T-cells, or HLA class II activation), including those listed in Table 5.
• the OCPGs can be divided into two groups: OCPGs whose higher or increased expression in cancer is associated with good or better prognosis (referred to herein as “better prognosis OCPGs” or “bpOCPGs”), and OCPGs whose higher or increased expression is associated with worse or bad prognosis (referred to herein as “worse prognosis OCPGs” or “wpOCPGs”).
• better prognosis OCPGs referred to herein as “better prognosis OCPGs” or “bpOCPGs”
• worse prognosis OCPGs whose higher or increased expression is associated with worse or bad prognosis
• wpOCPGs whose higher or increased expression is associated with worse or bad prognosis
• Table 5 also describes probes useful for detecting and measuring OCPGs.
• OCPGs are very useful for classifying cancer.
• Non-limiting examples of OCPGs are ABCC5, APOBEC3F, ARID5B, C3, CACNB3, CALDl, CEP57, CNOT2, CPTIA, CTTN, CXCL12, DLAT, EPB41L2, ERP29, ESR1, FTH1, GPRC5A, HSD11B1, LGR4, LITAF, LPPR2, MCF2L, NECAP2, NHLH2, NTM, PCDH12, PCDH17, PDGFB ,PGR,POLR2H, PPFIAl, RAC2, RACGAPl, RBM7, RFK, RPA2, RPL5, SIXI, SIX2, SLC35E3, SLC4A8, SRRMI, STAT5A, TPD52, XP07, and ZFP36L2.
• OCPGs of particular interest include ABCC5 and PGR.
• the ABCC5 gene (Entrez GenelD no. 10057) is also known as "ATP-binding cassette, sub-family C (CFTR/MRP), member 5.” Its expression can be determined by, e.g., using ABI Assay ID Hs00981085_ml .
• the PGR gene (Entrez GenelD no. 5241) is also known as "progesterone receptor gene" and its expression can be determined by, e.g., using ABI Assay ID Hs00172183_ml .
• Table 6A Top 100 ISGs and OCPGs and Probes by p-value for Independent Predictive Power
• the BCRGs, TCRGs, HLAGs, or OCPGs as described in the various embodiments and aspect herein are selected from those that correspond to probe # 1 through 5, 1 through 10, 1 through 15, 1 through 20, 1 through 25, 1 through 30, 1 through 40, 1 through 50, 1 through 55, 1 through 60, 1 through 65, 1 through 70, 1 through 75, 1 through 80, 1 through 85, 1 through 90, 1 through 95, or 1 through 100 of Table 6a.
• the cDNA corresponding to the BCRGs, TCRGs, HLAGs, or OCPGs as described in the various embodiments and aspects herein hybridize specifically to a probe or probes corresponding to those selected from probe # 1 through 5, 1 through 10, 1 through 15, 1 through 20, 1 through 25, 1 through 30, 1 through 40, 1 through 50, 1 through 55, 1 through 60, 1 through 65, 1 through 70, 1 through 75, 1 through 80, 1 through 85, 1 through 90, 1 through 95, or 1 through 100 of Table 6a.
• the primer pairs capable of amplifying an m NA, or corresponding cDNA, corresponding to BCRGs, TCRGs, HLAGs, or OCPGs as described in the various embodiments and aspects herein are selected from those capable of amplifying said cDNA or mRNA that is capable of specifically hybridizing to a probe or probes corresponding to those selected from probe # 1 through 5, 1 through 10, 1 through 15, 1 through 20, 1 through 25, 1 through 30, 1 through 40, 1 through 50, 1 through 55, 1 through 60, 1 through 65, 1 through 70, 1 through 75, 1 through 80, 1 through 85, 1 through 90, 1 through 95, or 1 through 100 of Table 6a.
• one or more ISGs or OCPGs are combined with one or more cell-cycle genes into a gene panel useful for classifying cancer.
• Cell-cycle gene and “CCG” herein refer to a gene whose expression level closely tracks the progression of the cell through the cell-cycle. See, e.g., Whitfield et al, MOL. BIOL. CELL (2002) 13: 1977-2000.
• the term "cell-cycle progression" or “CCP” will also be used in this application and will generally be interchangeable with CCG ⁇ i.e., a CCP gene is a CCG; a CCP score is a CCG score).
• CCGs show periodic increases and decreases in expression that coincide with certain phases of the cell cycle—e.g., STK15 and PLK show peak expression at G2/M. Id. Often CCGs have clear, recognized cell-cycle related function— e.g., in DNA synthesis or repair, in chromosome condensation, in cell-division, etc. However, some CCGs have expression levels that track the cell- cycle without having an obvious, direct role in the cell-cycle— e.g., UBE2S encodes a ubiquitin- conjugating enzyme, yet its expression closely tracks the cell-cycle. Thus a CCG according to the present disclosure need not have a recognized role in the cell-cycle.
• Exemplary CCGs are listed in Tables 7, 8, 9, 10, 11, 12, 13, or 14.
• a fuller discussion of CCGs, including an extensive (though not exhaustive) list of CCGs, can be found in International Application No. PCT /US2010/020397 (pub. no. WO/2010/080933 (see also corresponding U.S. Application No. 13/177,887)) (see, e.g., Table 1 in WO/2010/080933 and International Application No. PCT/ US2011/043228 (pub no. WO/2012/006447 (see also related U.S. Application No. 13/178,380)), the contents of which are hereby incorporated by reference in their entirety.
• Whether a particular gene is a CCG may be determined by any technique known in the art, including those taught in Whitfield et al, MOL. BIOL. CELL (2002) 13: 1977-2000; Whitfield et al, MOL. CELL. BIOL. (2000) 20:4188-4198; WO/2010/080933 fl[ [0039]). All of the CCGs in Table 7 below can together form a panel of CCGs ("Panel A") useful in the disclosure. As will be shown in detail throughout this document, individual CCGs (e.g., CCGs in Table 7) and subsets of these genes can also be used in the disclosure.
• PAICS* 10606 Hs00272390_ml NM 001079525.1;
• ABI Assay ID means the catalogue ID number for the gene expression assay commercially available from Applied Biosystems Inc. (Foster City, CA) for the particular gene.
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient).
• the method comprises: determining in a sample from a patient the expression of at least 4, 8, or 12 test genes selected from BCRGs, TCRGs, HLAGs, and OCPGs (e.g., selected from Tables 1, 2, 3, 4 and/or 5), and using the expression of the test genes in classifying the cancer (e.g., determining the prognosis of the cancer in the patient, predicting the cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis- free survival).
• the disclosure provides a method for classifying cancer comprising: determining in a sample from a patient the expression of a panel of genes comprising at least 4, 8, or 12 test genes selected from Tables 1, 2, 3, 4 and/or 5, and using the expression of the panel of genes in classifying the cancer.
• the method comprises correlating an increased or higher expression level of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a favorable cancer classification (e.g., good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post- surgery distant metastasis-free survival).
• the method comprises correlating no increase or lower expression levels of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to an unfavorable cancer classification (e.g., a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post- surgery distant metastasis-free survival).
• the method comprises correlating an increased or higher expression level of the wpOCPGs, to an unfavorable cancer classification (e.g., a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival).
• the method comprises correlating no increase, or lower expression level of the wpOCPGs, to a favorable cancer classification (e.g., good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival).
• a favorable cancer classification e.g., good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the present disclosure further provides a method for classifying cancer in a patient which comprises: determining in a sample from a patient the expression of at least 4, 8, or 12 test genes selected from BCRGs, TCRGs, HLAGs, and OCPGs (e.g., selected from Tables 1, 2, 3, 4 and/or 5), and at least 4,8, or 12 test genes selected from CCGs (e.g., selected from Table 7), and using the expression of the test genes in classifying the cancer (e.g., determining the prognosis of the cancer in the patient, predicting the cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival).
• a method for classifying cancer in a patient which comprises: determining in a sample from a patient the expression of at least 4, 8, or 12 test genes selected from BCRGs, TCRGs, HLAGs, and OCPGs (e.g., selected from Tables 1, 2, 3, 4 and/or 5), and at least 4,8, or 12
• the disclosure provides a method for classifying cancer comprising: determining in a sample from a patient the expression of a panel of genes comprising at least 4, 8, or 12 test genes selected from Tables 1, 2, 3, 4 and/or 5 and at least 4,8, or 12 genes selected from Table 7, and using the expression of the panel of genes in classifying the cancer.
• the method comprises correlating an increased or higher expression level of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a favorable cancer classification (e.g., good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post- surgery distant metastasis-free survival).
• the method comprises correlating no increase or lower expression levels of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to an unfavorable cancer classification (e.g., a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post- surgery distant metastasis-free survival).
• the method comprises correlating an increased or higher expression level of the wpOCPGs and/or the CCGs, to an unfavorable cancer classification (e.g., a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival).
• the method comprises correlating no increase, or lower expression level of the wpOCPGs and /or CCGs, to a favorable cancer classification (e.g., good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival).
• a favorable cancer classification e.g., good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• At least one of said OCPGs is the PGR gene.
• the disclosure provides a method for classifying cancer comprising: determining in a sample from a patient the expression of the PGR gene and at least 3 genes selected from BCRGs, TCRGs, HLAGs, or OCPGs and using the expression of the PGR gene and the panel of genes in classifying the cancer.
• at least one of said OCPGs is the ABCC5 gene.
• the disclosure provides a method for classifying cancer comprising: determining in a sample from a patient the expression of the ABCC5 gene and at least 3 genes selected from BCRGs, TCRGs, HLAGs, or OCPGs and using the expression of the ABCC5 gene and the panel of genes in classifying the cancer.
• at least two of said OCPGs are the PGR and ABCC5 genes.
• the disclosure provides a method for classifying cancer comprising: determining in a sample from a patient the expression of the ABCC5 gene, the PGR gene and at least 2 genes selected from BCRGs, TCRGs, HLAGs, or OCPGs and using the expression of the ABCC5 and PGR gene and the panel of genes in classifying the cancer.
• at least one of said OCPGs is the ESR1 gene.
• the disclosure provides a method for classifying cancer comprising: determining in a sample from a patient the expression of the ESR1 gene and at least 3 genes selected from BCRGs, TCRGs, HLAGs, or OCPGs and using the expression of the ESR1 gene and the panel of genes in classifying the cancer.
• the cancer is lung cancer, bladder cancer, prostate cancer, brain cancer, or breast cancer.
• the cancer is breast cancer.
• the cancer is ER positive breast cancer.
• the present disclosure provides a method for classifying cancer in a patient (e.g., determining the patient's prognosis or the likelihood of cancer recurrence in the patient), which comprises: determining in a sample from the patient the expression of a plurality of test genes comprising at least 4, 6, 8, 10 or 15 or more genes selected from BCRGs, TCRGs, HLAGs, or OCPGs (e.g., at least 3 of the genes listed in Tables l-6b or at least three of the ISGs listed in Table 39), and determining at least one clinical parameter for the patient ⁇ e.g., age, tumor size, node status, tumor stage), and using the expression of said plurality of test genes and the clinical parameter(s), in classifying the cancer (e.g., determining the prognosis of the cancer in the patient, or predicting the
• the BCRGs, TCRGs, HLAGs, and/or OCPGs information and the clinical parameter information are combined to yield a quantitative ⁇ e.g., numerical) evaluation or score of the prognosis of the cancer in the patient, or cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival.
• the expression level of the genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs and the clinical parameter information are combined to yield a quantitative evaluation score of the prognosis of the cancer in the patient, or cancer outcome, the likelihood of cancer recurrence or probablitiy of post-surgery distant metastasis-free survival.
• the expression level of the genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs and the clinical parameter information are combined with the expression level of the PGR, ABCC5 and/or ESR1 genes to yield a quantitative evaluation score of the prognosis of the cancer in the patient, or cancer outcome, the likelihood of cancer recurrence or probablitiy of post- surgery distant metastasis-free survival.
• the present disclosure provides a method for classifying cancer in a patient which comprises: determining in a sample from a patient the expression of at least 4, 8, or 12 test genes selected from BCRGs, TCRGs, HLAGs, and OCPGs (e.g., selected from Tables 1, 2, 3, 4 and/or 5), and at least 4,8, or 12 test genes selected from CCGs (e.g., selected from Table 7), and determining at least one clinical parameter for the patient (e.g., age, tumor size, node status, tumor stage), and using the expression of the test genes in classifying the cancer (e.g., determining the prognosis of the cancer in the patient, predicting the cancer outcome, the likelihood of cancer recurrence or probability of post- surgery distant metastasis-free survival).
• at least 4, 8, or 12 test genes selected from BCRGs, TCRGs, HLAGs, and OCPGs e.g., selected from Tables 1, 2, 3, 4 and/or 5
• CCGs e.g
• the disclosure provides a method for classifying cancer comprising: determining in a sample from a patient the expression of a panel of genes comprising at least 4, 8, or 12 test genes selected from Tables 1, 2, 3, 4 and/or 5 and at least 4,8, or 12 genes selected from Table 7, and determining at least one clinical parameter for the patient (e.g., age, tumor size, node status, tumor stage), and using the expression of the panel of genes in classifying the cancer.
• the expression level of the genes selected from the BCRGs, TCRGs, HLAGs, OCPGs, and CCGs and the clinical parameter information are combined to yield a quantitative evaluation score of the prognosis of the cancer in the patient, or cancer outcome, the likelihood of cancer recurrence or probability of post- surgery distant metastasis-free survival.
• the present disclosure further provides a method for determining in a patient the prognosis of cancer or the likelihood of cancer recurrence, which comprises: determining the expression of a plurality of test genes comprising (1) at least 4, 6, 8, 10, 12 or 15 or more genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs (e.g., in Table 1) and using the expression of said plurality of test genes in determining the prognosis of the cancer in the patient, or predicting the cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival.
• a method for determining in a patient the prognosis of cancer or the likelihood of cancer recurrence which comprises: determining the expression of a plurality of test genes comprising (1) at least 4, 6, 8, 10, 12 or 15 or more genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs (e.g., in Table 1) and using the expression of said plurality of test genes
• the method comprises correlating an increased or higher expression level of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post- surgery distant metastasis-free survival. In some embodiments, the method comprises correlating no increase or lower expression levels of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased or higher expression level of the wpOCPGs, to a bad or worse prognosis, bad or worse cancer outcome, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival. In some embodiments, the method comprises correlating no increase, or lower expression level of the wpOCPGs, to a good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the cancer is lung cancer, bladder cancer, prostate cancer, brain cancer, or breast cancer. In another specific aspect, the cancer is breast cancer. In yet another specific aspect, the cancer is ER positive breast cancer.
• the present disclosure provides a method for determining the prognosis in a patient having breast cancer or the likelihood of breast cancer recurrence as described in the aspects and embodiments of the disclosure disclosed herein and further comprises: determining in a sample from the patient the expression of the PGR gene, and using the expression of the PGR gene in determining the prognosis of the breast cancer in the patient, or predicting the breast cancer outcome, or the likelihood of breast cancer recurrence or probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased expression level of the PGR gene, in patients who have received hormonal therapy, to a good or better prognosis, decreased likelihood of cancer recurrence, and increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased expression level of the PGR gene, in patients who have not received hormonal therapy, to a bad or worse prognosis, increased likelihood of cancer recurrence, and decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased expression level of the PGR gene to an increased likelihood of response to hormonal treatment.
• the method comprises correlating a decreased expression level of the PGR gene to a decreased likelihood of response to hormonal treatment.
• the present disclosure further provides a method for determining in a patient the prognosis of cancer or the likelihood of cancer recurrence, which comprises: determining the expression of a plurality of test genes comprising (1) at least 4, 6, 8, 10, 12 or 15 or more cell-cycle genes (e.g., CCGs in Table 7, Panel F in Table 16 or Panel H in Table 17) and at least 4, 6, 8, 10, 12 or 15 or more genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs (e.g., in Table 1) and using the expression of said plurality of test genes in determining the prognosis of the cancer in the patient, predicting the cancer outcome, or the likelihood of cancer recurrence or probability of post- surgery distant metastasis-free survival.
• a plurality of test genes comprising (1) at least 4, 6, 8, 10, 12 or 15 or more cell-cycle genes (e.g., CCG
• the method comprises correlating an overall increased expression level of cell-cycle genes, i.e., CCGs, to poor or worse prognosis of the cancer in the patient, poor or worse cancer outcome, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating no increase or lower expression level of cell-cycle genes, i.e., CCGs, to good or better prognosis of the cancer in the patient, good or better cancer outcome, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an overall increased or higher expression level of BCRGs, TCRGs, HLAGs, and bpOCPGs to good or better prognosis, of the cancer in the patient, good, or better, cancer outcome, or decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased or higher expression level of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating no increase or lower expression levels of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival. In some embodiments, the method comprises correlating an increased or higher expression level of the wpOCPGs, to a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating no increase, or lower expression level of the wpOCPGs, to a good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the cancer is lung cancer, bladder cancer, prostate cancer, brain cancer, or breast cancer.
• the cancer is breast cancer.
• the cancer is ER positive breast cancer.
• the present disclosure further provides a method for determining in a patient the prognosis of cancer or the likelihood of cancer recurrence, which comprises: determining the expression of a plurality of test genes comprising (1) at least 4, 6, 8, 10, 12, or 15, or more cell-cycle genes (e.g., CCGs in Table 7, Panel F in Table 16, or Panel H in Table 17) and at least 4, 6, 8, 10, 12, or 15, or more genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs (e.g., in Table 1) and/or (2) at least one of the ABCC5 gene and the PGR gene or both, together or separately in one or more samples from the patient, and using the expression of said plurality of test genes in determining the prognosis of the cancer in the patient, or predicting the cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival.
• a plurality of test genes comprising (1) at least 4, 6, 8, 10, 12, or 15, or more cell-cycle genes (
• the method comprises correlating an overall increased expression level of cell-cycle genes, i.e., CCGs, to poor or worse prognosis of the cancer in the patient, poor or worse cancer outcome, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating no increase or lower expression level of cell-cycle genes, i.e., CCGs, to good or better prognosis of the cancer in the patient, good or better cancer outcome, decreased likelihood of cancer recurrence, or increased probability of post- surgery distant metastasis-free survival.
• the method comprises correlating an increased or higher expression level of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival. In some embodiments, the method comprises correlating no increase or lower expression levels of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased or higher expression level of the wpOCPGs, to a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival. In some embodiments, the method comprises correlating no increase, or lower expression level of the wpOCPGs, to a good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased level of ABCC5 gene expression to poor or worse prognosis of the cancer in the patient, poor or worse cancer outcome, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased level of PGR gene expression, in patients who have received hormonal therapy, to better prognosis of the cancer in the patient, better cancer outcome, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased level of PGR gene expression, in patients who have not received hormonal therapy, to good or better prognosis of the cancer in the patient, better cancer outcome, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the cancer is lung cancer, bladder cancer, prostate cancer, brain cancer, or breast cancer.
• the cancer is breast cancer.
• the cancer is ER positive breast cancer.
• the present disclosure further provides a method for determining in a patient the prognosis of breast cancer or the likelihood of cancer recurrence in a patient diagnosed with breast cancer, which comprises: determining the expression of a plurality of test genes comprising (1) at least 4, 6, 8, 10, 12 or 15 or more cell-cycle genes ⁇ e.g., CCGs in Table 7, Panel F in Table 16, or Panel H in Table 17) and at least 4, 6, 8, 10, 12 or 15 or more genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs (e.g., in Table 1) and/or (2) at least one of the ABCC5 gene and the PGR gene or both, together or separately in one or more samples from the patient, and using the expression of said plurality of test genes in determining the prognosis of the breast cancer in the patient, or predicting the breast cancer outcome, the likelihood of cancer recurrence or probability of post-surgery distant metastasis-free survival.
• a plurality of test genes comprising (1) at least 4, 6,
• the method comprises correlating an overall increased expression level of cell-cycle genes, i.e., CCGs, to poor or worse prognosis of the breast cancer in the patient, poor or worse breast cancer outcome, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating no increase or lower expression level of cell-cycle genes, i.e., CCGs, to good or better prognosis of the breast cancer in the patient, good or better breast cancer outcome, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased or higher expression level of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival. In some embodiments, the method comprises correlating no increase or lower expression levels of the genes selected from BCRGs, TCRGs, HLAGs, and bpOCPGs, to a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased or higher expression level of the wpOCPGs, to a bad or worse prognosis, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival. In some embodiments, the method comprises correlating no increase, or lower expression level of the wpOCPGs, to a good or better prognosis, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased level of ABCC5 gene expression to poor or worse prognosis of the breast cancer in the patient, poor or worse breast cancer outcome, increased likelihood of cancer recurrence, or decreased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased level of PGR gene expression, in patients who have received hormonal therapy, to better prognosis of the breast cancer in the patient, better breast cancer outcome, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the method comprises correlating an increased level of PGR gene expression, in patients who have not received hormonal therapy, to good or better prognosis of the breast cancer in the patient, better breast cancer outcome, decreased likelihood of cancer recurrence, or increased probability of post-surgery distant metastasis-free survival.
• the patient is ER+ and node negative. In some embodiments, the patient is ER+ and node negative, has undergone surgery to remove the tumor in her breast, and is placed on hormone therapy. In some embodiments of the methods described above, the patient is ER+ and node positive. In some embodiments of the methods described above, the ER status of the tumor is determined prior to determination of a gene expression profile or signature as described herein. In some embodiments of the methods described above, the ER status of the tumor is determined prior to determination of a gene expression profile or signature as described herein by IHC.
• the ER status of the tumor is determined in conjunction with the determination of a gene expression profile or signature as described herein (e.g., the status of the ER is determined by gene expression analysis of the ESR1 gene, the status of the ER is determined by gene expression analysis with primers for amplifying an ESR1 gene product or a corresponding cDNA and a probe that corresponds to the amplification product).
• the ER status of the tumor is determined in conjunction with determination of the gene expression profile or signature as described herein to confirm or not confirm another analysis of ER status in the tumor (e.g., by IHC).
• PR status and/or ER status is optionally evaluated by
• IHC prior to the evaluation of the gene expression profiles or signatures as described herein. Any number of methods can be used to detect ER or PR status by IHC as is known by the skilled artisan. Preferred IHC methods for determining ER and PR status include the ER/PR pharmDx assay kit (Dako, Glostrup, Denmark), the method of Harvey et al. ((1999) J Clin Oncol 17: 1474-1481) for ER, or the method of Moshin et al. (2004) Mod Pathol 17: 1545-1554.
• the prognosis and treatment methods that involve determining a test value may further include a step of comparing the test value to one or more reference values, and correlating the test value to, e.g., a good or poor prognosis, an increased or decreased likelihood of recurrence, an increased or decreased likelihood of recurrence or metastasis-free survival, an increased or decreased likelihood of response to the particular treatment regimen, etc.
• the expression data from BCRGs, TCRG, HLAGs, and OCPGs are combined into one test value, which may then be compared against a reference value for the combined score.
• the BCRGs, TCRGs, HLAGs and OCPGs expression data are used to provide a discrete ISG/OCPG test value, which is then optionally combined with other parameters such as other gene expression signatures or clinical parameters.
• a test value greater than the reference value is correlated to an increased likelihood of response to treatment comprising chemotherapy.
• the test value is correlated to an increased likelihood of response to treatment (e.g., treatment comprising chemotherapy), poor prognosis, an increased likelihood of recurrence, and/or a decreased likelihood of recurrence or metastasis-free survival if the test value exceeds the reference value by at least some amount (e.g., at least 0.5, 0.75, 0.85, 0.90, 0.95, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 or more fold or standard deviations).
• treatment e.g., treatment comprising chemotherapy
• the prognosis and treatment methods that involve determining a test value may further include a step of comparing the test value to one or more reference values, and correlating the test value to, e.g., a good or poor prognosis, an increased or decreased likelihood of recurrence, an increased or decreased likelihood of recurrence or metastasis-free survival, an increased or decreased likelihood of response to the particular treatment regimen, etc.
• the expression data from BCRGs, TCRG, HLAGs, OCPGs, and CCPs are combined into one test value, which may then be compared against a reference value for the combined score.
• the BCRGs, TCRGs, HLAGs, OCPGs and CCPs expression data are used to provide a discrete ISG/OCPG/CCP test value, which is then optionally combined with other parameters such as other gene expression signatures or clinical parameters.
• a test value greater than the reference value is correlated to an increased likelihood of response to treatment comprising chemotherapy.
• the test value is correlated to an increased likelihood of response to treatment (e.g., treatment comprising chemotherapy), poor prognosis, an increased likelihood of recurrence, and/or a decreased likelihood of recurrence or metastasis-free survival if the test value exceeds the reference value by at least some amount (e.g., at least 0.5, 0.75, 0.85, 0.90, 0.95, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 or more fold or standard deviations).
• treatment e.g., treatment comprising chemotherapy
• the prognosis and treatment methods that involve determining a test value may further include a step of comparing the test value to one or more reference values, and correlating the test value to, e.g., a good/better or poor/worse prognosis, an increased or decreased likelihood of recurrence, an increased or decreased likelihood of recurrence or metastasis-free survival, an increased or decreased likelihood of response to the particular treatment regimen, etc.
• the expression data from BCRGs, TCRG, HLAGs, and OCPGs and are combined with ABCC5 and/or PGR expression data into one test value, which may then be compared against a reference value for the combined score.
• the BCRGs, TCRGs, HLAGs and OCPGs expression data are used to provide a discrete ISG/OCPG test value, which is then combined with ABCC5 and/or PGR expression data.
• a test value greater than the reference value is correlated to an increased likelihood of response to treatment comprising chemotherapy.
• the test value is correlated to an increased likelihood of response to treatment (e.g., treatment comprising chemotherapy), poor prognosis, an increased likelihood of recurrence, and/or a decreased likelihood of recurrence or metastasis-free survival if the test value exceeds the reference value by at least some amount (e.g., at least 0.5, 0.75, 0.85, 0.90, 0.95, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 or more fold or standard deviations).
• treatment e.g., treatment comprising chemotherapy
• the prognosis and treatment methods that involve determining a test value may further include a step of comparing the test value to one or more reference values, and correlating the test value to, e.g., a good/better or poor/worse prognosis, an increased or decreased likelihood of recurrence, an increased or decreased likelihood of recurrence or metastasis-free survival, an increased or decreased likelihood of response to the particular treatment regimen, etc.
• the expression data from CCP, BCRGs, TCRG, HLAGs, and OCPGs and are combined with ABCC5 and/or PGR expression data into one test value, which may then be compared against a reference value for the combined score.
• the CCP, BCRGs, TCRGs, HLAGs and OCPGs expression data are used to provide a discrete ISG/OCPG/CCG test value, which is then combined with ABCC5 and/or PGR expression data.
• a test value greater than the reference value is correlated to an increased likelihood of response to treatment comprising chemotherapy.
• the test value is correlated to an increased likelihood of response to treatment ⁇ e.g., treatment comprising chemotherapy), poor prognosis, an increased likelihood of recurrence, and/or a decreased likelihood of recurrence or metastasis-free survival if the test value exceeds the reference value by at least some amount ⁇ e.g., at least 0.5, 0.75, 0.85, 0.90, 0.95, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 or more fold or standard deviations).
• the method of determining the likelihood of response to a particular treatment regimen comprises (1) determining in a sample from a patient having cancer the expression of a panel of genes in said sample including at least 4 or at least 8 genes selected from BCRGs, TCRGs, HLAGs and OCPGs; (2) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from the panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide the test value, wherein the BCRGs, TCRGs, HLAGs and OCPGS are weighted to contribute at least 50%, at least 75% or at least 85% of the test value; and (3)(a) correlating a test value that is greater than some reference to an increased likelihood of response to the particular treatment regimen ⁇ e.g., a treatment regimen comprising chemotherapy, a treatment regimen comprising hormonal therapy), or (b) correlating a test value that is not greater than some reference to no increased likelihood of response to the
• the method of determining the likelihood of response to a particular treatment regimen comprises (1) determining in a sample from a patient having breast cancer the expression of a panel of genes in said sample including at least 4 or at least 8 genes selected from BCRGs, TCRGs, HLAGs and OCPGs; (2) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from the panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide the test value, wherein the BCRGs, TCRGs, HLAGs and OCPGS are weighted to contribute at least 50%, at least 75% or at least 85% of the test value; (3) (a) correlating a test value that is greater than some reference to an increased likelihood of response to the particular treatment regimen (e.g., a treatment regimen comprising chemotherapy, a treatment regimen comprising hormonal therapy), or (b) correlating a test value that is not greater than some reference to no increased likelihood of response to the particular treatment regimen (e.g.,
• the method of determining the likelihood of response to a particular treatment regimen comprises (1) determining in a sample from a patient having breast cancer the expression of a panel of genes in said sample including at least 4 or at least 8 genes selected from BCRGs, TCRGs, HLAGs and OCPGs; (2) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from the panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide the test value, wherein the BCRGs, TCRGs, HLAGs and OCPGS are weighted to contribute at least 50%, at least 75% or at least 85% of the test value; (3) determining in a sample from the patient the expression of ABCC5 and/or PGR; and (4)(a) correlating a test value that is greater than some reference and/or ABCC5 expression that is greater than some reference and/or PGR expression that is greater than some reference to an increased likelihood of response to the particular treatment regimen
• a treatment regimen comprising chemotherapy a treatment regimen comprising hormonal therapy
• a treatment regimen comprising hormonal therapy or (b) correlating a test value that is not greater than some reference and/or ABCC5 expression that is not greater than some reference and/or PGR expression that is not greater than some reference to no increased likelihood of response to the particular treatment regimen (e.g., a treatment regimen comprising chemotherapy, a treatment regimen comprising hormonal therapy).
• the method of determining the likelihood of response to a particular treatment regimen comprises (1) determining in a sample from a patient having breast cancer the expression of a panel of genes in said sample including at least 4 or at least 8 cell-cycle genes and at least 4 or at least 8 genes selected from BCRGs, TCRGs, HLAGs and OCPGs; (2) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from the panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide the test value, wherein the cell-cycle genes, BCRGs, TCRGs, HLAGs and OCPGS are weighted to contribute at least 50%, at least 75% or at least 85% of the test value; (3) (a) correlating a test value that is greater than some reference to an increased likelihood of response to the particular treatment regimen (e.g., a treatment regimen comprising chemotherapy, a treatment regimen comprising hormonal therapy), or (b) correlating a test value
• the method of determining the likelihood of response to a particular treatment regimen comprises (1) determining in a sample from a patient having breast cancer the expression of a panel of genes in said sample including at least 4 or at least 8 cell-cycle genes and at least 4 or at least 8 genes selected from BCRGs, TCRGs, HLAGs and OCPGs; (2) providing a test value by (a) weighting the determined expression of each of a plurality of test genes selected from the panel of genes with a predefined coefficient, and (b) combining the weighted expression to provide the test value, wherein the cell-cycle genes, BCRGs, TCRGs, HLAGs and OCPGS are weighted to contribute at least 50%, at least 75% or at least 85% of the test value; (3) determining in a sample from the patient the expression of ABCC5 and/or PGR; and (4)(a) correlating a test value that is greater than some reference and/or ABCC5 expression that is greater than some reference and/or PGR expression
• the panel of genes in addition to the genes selected from the BCRGs, TCRGs, HLAGs, and OCPGs include at least 2, 4, 5, 6, 7, 8, 9, 10, 12, 14, 16, 18, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100 or more cell-cycle genes.
• the test genes are weighted such that the cell-cycle genes are weighted to contribute at least 50%, at least 55%, at least 60%, at least 65%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 99% or 100% of the test value.
• 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 75%, 80%, 85%, 90%, 95%, or at least 99% or 100% of the plurality of test genes are cell-cycle genes.
• the panel of genes includes at least 2, 4, 5, 6, 7, 8, 9, or
• test genes are weighted such that the BCRGs are weighted to contribute at least 1%, at least 2%, at least 3%, at least 4%, at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30% or at least 40 % of the test value.
• 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 30%, 40%, 50%, or at least 55%), or at least 60%, or at least 65%, or at least 70% or at least 75%, or at least 80%, or at least 85%), or at least 90% of the plurality of test genes are BCRGs.
• the panel of genes includes at least 2, 4, 5, 6, 7, 8, 9, or
• test genes are weighted such that the TCRGs are weighted to contribute at least 1%, at least 2%, at least 3%, at least 4%, at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30% or at least 40 % of the test value.
• 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 30%, 40%, 50%, or at least 55%), or at least 60%, or at least 65%, or at least 70% or at least 75%, or at least 80%, or at least 85%), or at least 90% of the plurality of test genes are TCRGs.
• the panel of genes includes at least 2, 4, 5, 6, 7, 8, 9, or
• the test genes are weighted such that the HLAGs are weighted to contribute at least 1%, at least 2%, at least 3%, at least 4%, at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30% or at least 40 % of the test value. In some embodiments 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 30%, 40%, 50%, or at least 55%), or at least 60%, or at least 65%, or at least 70% or at least 75%, or at least 80%, or at least 85%), or at least 90% of the plurality of test genes are HLAGs. [0079] In some embodiments, the panel of genes includes at least 2, 4, 5, 6, 7, 8, 9, or
• test genes are weighted such that the OCPGs are weighted to contribute at least 1%, at least 2%, at least 3%, at least 4%, at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30% or at least 40 % of the test value.
• 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 15%, 20%, 30%, 40%, 50%, or at least 55%), or at least 60%>, or at least 65%, or at least 70%> or at least 75%, or at least 80%>, or at least 85%o, or at least 90%> of the plurality of test genes are OCPGs.
• the plurality of test genes includes at least 2, 3 or 4
• the plurality of test genes includes at least 5, 6 or 7, or at least 8 ISGs and or OCPGs, which constitute at least 20%, 25%, 30%, 40%, 50%, 60%, 70%, 75%, 80% or 90% of the plurality of test genes, and preferably 100% of the plurality of test genes.
• the plurality of test genes comprises at least some number of ISGs and or OCPGS (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs) and this plurality of ISGs comprises the top 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40 or more ISGs and or OCPGs listed in any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• the plurality of test genes comprises at least some number of ISGs and or OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and or OCPGs) and this plurality of ISGs and or OCPGS comprises at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, or 20 of the following genes: CEP57, LITAF, ZFP36L2, SLC35E3, SLC4A8, HLA-DRB1/3, GPRC5A, HLA-DPA1, IGL1, CALD1, HLA-DPB1, ERP29, RACGAP1, IGLL3P, TCRA/D, IGHM, HLA-DRA, CD74, HLA-DMA and PDGFB.
• ISGs and or OCPGS comprises at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, or 20 of the following genes: CEP57, LITAF, ZFP36L2, SLC35E3, SLC4A8, HLA-DRB1/3, GPRC
• the plurality of test genes comprises at least some number of ISGs and/or OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and or OCPGs) and this plurality of ISGs comprises any one, two, three, four, five, six, seven, eight, nine, or ten or all of gene numbers 1 & 2, 1 to 3, 1 to 4, 1 to 5, 1 to 6, 1 to 7, 1 to 8, 1 to 9, or 1 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• ISGs and/or OCPGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and or OCPGs
• this plurality of ISGs comprises any one, two, three, four, five, six, seven, eight, nine, or ten or all of gene numbers 1 & 2, 1 to 3, 1 to 4, 1 to 5, 1 to 6, 1 to 7,
• the plurality of test genes comprises at least some number of ISGs and or OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and or OCPGs) and this plurality of ISGs and or OCPGs comprises any one, two, three, four, five, six, seven, eight, or nine or all of gene numbers 2 & 3, 2 to 4, 2 to 5, 2 to 6, 2 to 7, 2 to 8, 2 to 9, or 2 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• ISGs and or OCPGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and or OCPGs
• this plurality of ISGs and or OCPGs comprises any one, two, three, four, five, six, seven, eight, or nine or all of gene numbers 2 & 3, 2 to 4, 2 to 5, 2 to 6, 2 to 7, 2 to 8,
• the plurality of test genes comprises at least some number of ISGs and/or OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and/or OCPGs) and this plurality of ISG and or OCPGs comprises any one, two, three, four, five, six, seven, or eight or all of gene numbers 3 & 4, 3 to 5, 3 to 6, 3 to 7, 3 to 8, 3 to 9, or 3 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• ISGs and/or OCPGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and/or OCPGs
• this plurality of ISG and or OCPGs comprises any one, two, three, four, five, six, seven, or eight or all of gene numbers 3 & 4, 3 to 5, 3 to 6, 3 to 7, 3 to 8, 3 to 9, or 3 to 10 of
• the plurality of test genes comprises at least some number of ISGs and/or OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and/or OCPGs) and this plurality of ISGs and/or OCPGs comprises any one, two, three, four, five, six, or seven or all of gene numbers 4 & 5, 4 to 6, 4 to 7, 4 to 8, 4 to 9, or 4 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• the plurality of test genes comprises at least some number of ISGs and/or OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and/or OCPGs) and this plurality of ISGs and/or OCPGs comprises any one, two, three, four, five, six, seven, eight, nine, 10, 11, 12, 13, 14, or 15 or all of gene numbers 1 & 2, 1 to 3, 1 to 4, 1 to 5, 1 to 6, 1 to 7, 1 to 8, 1 to 9, 1 to 10, 1 to 11, 1 to 12, 1 to 13, 1 to 14, or 1 to 15 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• ISGs and/or OCPGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more ISGs and/or OCPGs
• this plurality of ISGs and/or OCPGs comprises any one, two, three, four, five, six
• the plurality of test genes includes at least 8, 10,
• ISGs and/or OCPGs which constitute at least 20%, 25%, 30%, 40%, 50%, 60%, 70%, 75%, 80% or 90% of the plurality of test genes, and preferably 100% of the plurality of test genes.
• Panels of genes selected from BCRGs, TCRGs, HLAGs and OCPGs, alone or in combination with CCGs (e.g., 2, 3, 4, 5, or 6 CCGs) can accurately predict cancer prognosis, and in particular breast cancer prognosis. But addition of the ABCC5 and PGR genes significantly increases the prediction power.
• the panel comprises at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 70, 80, 90, 100, 200, or more genes selected from BCRGs, TCRGs, HLAGs, OCPGs.
• the panel comprises the ABCC5 or PGR genes and at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 70, 80, 90, 100, 200, or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs.
• the panel comprises the ABCC5 and PGR genes and at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 70, 80, 90, 100, 200, or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs. In some embodiments the panel comprises at least 10, 15, 20, or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs.
• the panel comprises between 5 and 100 genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, between 7 and 40 genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, between 5 and 25 genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, between 10 and 20 genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, or between 10 and 15 genes selected from BCRGs, TCRGs, HLAGs, and OCPGs.
• the genes selected from BCRGs, TCRGs, HLAGs, and OCPGs comprise at least a certain proportion of the panel.
• the panel comprises at least 25%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% genes selected from BCRGs, TCRGs, HLAGs, and OCPGs.
• the panel comprises at least 10, 15, 20, 25, 30, 35, 40, 45, 50, 70, 80, 90, 100, 200, or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, and such genes selected from BCRGs, TCRGs, HLAGs, and OCPGs constitute of at least 50%, 60%, 70%, preferably at least 75%, 80%, 85%, more preferably at least 90%, 95%, 96%, 97%, 98%, or 99% or more of the total number of genes in the panel.
• the panel of genes selected from BCRGs, TCRGs, HLAGs, and OCPGs comprises the genes in Table 1, 2, 3, 5, 6a or 6b.
• the panel comprises at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, or more of the genes in Table 1, 2, 3, 5, 6a or 6b.
• the disclosure provides a method of determining the prognosis in a breast cancer patient comprising determining the status of the genes selected from BCRGs, TCRGs, HLAGs, and OCPGs in any one of Table 1, 2, 3, 5, 6a or 6b and using the combined expression to determine the prognosis of the breast cancer.
• the disclosure provides a method of determining the prognosis in a breast cancer patient comprising determining the status of the genes selected from BCRGs, TCRGs, HLAGs, and OCPGs in any one of Table 1, 2, 3, 5, 6a or 6b, determining the status of the ABCC5 gene or the PGR gene or both, and using the combined expression to determine the prognosis of the breast cancer.
• determining the status of a gene refers to determining the presence, absence, or extent/level of some physical, chemical, or genetic characteristic of the gene or its expression product(s). Such characteristics include, but are not limited to, expression levels, activity levels, mutations, copy number, methylation status, etc.
• characteristics include expression levels ⁇ e.g., mRNA, cDNA or protein levels) and activity levels. Characteristics may be assayed directly ⁇ e.g., by assaying a gene's expression level) or determined indirectly ⁇ e.g., assaying the level of a gene or genes whose expression level is correlated to the expression level of the gene).
• ABSORS means a marker's status in a particular sample differs from the status generally found in average samples (e.g., healthy samples, average diseased samples). Examples include mutated, elevated, decreased, present, absent, etc.
• An "elevated status” means that one or more of the above characteristics (e.g., expression or mRNA level) is higher than normal levels. Generally this means an increase in the characteristic (e.g., expression or mRNA level) as compared to an index value as discussed below.
• a “low status” means that one or more of the above characteristics (e.g., gene expression or mRNA level) is lower than normal levels. Generally this means a decrease in the characteristic (e.g. , expression) as compared to an index value as discussed below.
• a "negative status” generally means the characteristic is absent or undetectable or, in the case of sequence analysis, there is a deleterious sequence variant (including full or partial gene deletion).
• Gene expression can be determined either at the RNA level (i.e., mRNA or noncoding RNA (ncRNA)) (e.g., miRNA, tRNA, rRNA, snoRNA, siRNA and piRNA) or at the protein level.
• Measuring gene expression at the mRNA level includes measuring levels of cDNA corresponding to mRNA and can be determined by any known technique in the art, which include but are not limited to, qPCR, mircroarray, highthroughput RNA sequencing, etc. .
• Levels of proteins in a sample can be determined by any known technique in the art, e.g., HPLC, mass spectrometry, or using antibodies specific to selected proteins (e.g., IHC, ELISA, etc.).
• the amount of RNA transcribed from the panel of genes including test genes is measured in the sample.
• the amount of RNA of one or more housekeeping genes in the sample is also measured, and used to normalize or calibrate the expression of the test genes.
• normalizing genes and housekeeping genes are defined herein below.
• the plurality of test genes may include at least 2, 3 or 4 genes selected from BCRGs, TCRGs, HLAGs and OCRGs, which constitute at least 50%, 75% or 80%> of the plurality of test genes, and preferably 100%) of the plurality of test genes.
• the plurality of test genes includes at least 5, 6, 7, or at least 8 genes chosen from BCRGs, TCRGs, HLAGs, and OCPGs, which together constitute at least 20%, 25%, 30%, 40%, 50%, 60%, 70%, 75%, 80% or 90% of the plurality of test genes, and preferably 100% of the plurality of test genes.
• a panel of genes is a plurality of genes. In some embodiments these genes are assayed together in one or more samples from a patient.
• the plurality of test genes includes at least 8, 10, 12,
• genes selected from BCRGs, TCRGs, HLAGs, and OCPGs which together constitute at least 20%, 25%, 30%, 40%, 50%, 60%, 70%, 75%, 80% or 90% of the plurality of test genes, and preferably 100% of the plurality of test genes.
• the plurality of test genes may include at least 2, 3 or 4 genes cell-cycle genes and at least 2, 3 or 4 genes selected from BCRGs, TCRGs, HLAGs and OCRGs, together which constitute at least 50%, 75% or 80%) of the plurality of test genes, and preferably 100% of the plurality of test genes.
• the plurality of test genes includes at least 5, 6, 7, or at least 8 cell-cycle genes and at least 5, 6, 7, or at least 8 genes chosen from BCRGs, TCRGs, HLAGs, and OCPGs, which together constitute at least 20%, 25%, 30%, 40%, 50%, 60%, 70%, 75%, 80% or 90% of the plurality of test genes, and preferably 100% of the plurality of test genes.
• a panel of genes is a plurality of genes. In some embodiments these genes are assayed together in one or more samples from a patient.
• the plurality of test genes includes at least 8, 10, 12,
• tumor sample means any biological sample containing one or more tumor cells, or tumor-derived DNA, RNA or protein, and obtained from a an individual currently or previously diagnosed with cancer, an individual undergoing cancer treatment, or an individual not diagnosed with cancer but who presents with symptoms consistent with a cancer diagnosis .
• a tissue sample obtained from a tumor tissue of an individual is a useful tumor sample in the present disclosure.
• the tissue sample can be an FFPE sample, or fresh frozen sample, and preferably contain largely tumor cells.
• a single malignant cell from a a patient's tumor is also a useful tumor sample.
• Such a malignant cell can be obtained directly from the patient's tumor, or purified from the patient's bodily fluid (e.g., blood, urine).
• a bodily fluid such as blood, urine, sputum and saliva containing one or tumor cells, or tumor-derived DNA, R A or proteins, can also be useful as a tumor sample for purposes of practicing the present disclosure.
• RNA transcribed from, or the protein encoded by, the gene can be measured as the level of the mRNA transcribed from, or the protein encoded by, the gene.
• Useful techniques include, but are not limited to, microarray analysis (e.g., for assaying mRNA or microRNA expression, copy number, etc.), quantitative real-time PCRTM ("qRT-PCRTM", e.g., TaqManTM), immunoanalysis (e.g., ELISA, immunohistochemistry)
• qRT-PCRTM quantitative real-time PCRTM
• ELISA immunohistochemistry
• the activity level of a polypeptide encoded by a gene may be used in much the same way as the expression level of the gene or polypeptide.
• the disclosure provides any of the methods discussed above, wherein the activity level of a polypeptide encoded by the CCG, BCRG, TCRG, HLAG or OCPG is determined rather than or in addition to the expression level of the gene.
• the activity level of a polypeptide encoded by the CCG, BCRG, TCRG, HLAG or OCPG is determined rather than or in addition to the expression level of the gene.
• Those skilled in the art are familiar with techniques for measuring the activity of various such proteins, including those encoded by the CCG, BCRG, TCRG, HLAG and OCPG genes listed in herein, as listed in Tables 1 and 7, as and PGR, ESR1, and ERBB2.
• the methods of the disclosure may be practiced independent of the particular technique used.
• the expression of one or more normalizing (often called “housekeeping”) genes is also obtained for use in normalizing the expression of test genes.
• normalizing genes referred to the genes whose expression is used to calibrate or normalize the measured expression of the gene of interest (e.g., test genes).
• the expression of normalizing genes should be independent of cancer outcome/prognosis, and the expression of the normalizing genes is very similar among all the samples. The normalization ensures accurate comparison of expression of a test gene between different samples.
• housekeeping genes known in the art can be used.
• Housekeeping genes are well known in the art, with examples including, but are not limited to, GUSB (glucuronidase, beta), HMBS (hydroxymethylbilane synthase), SDHA (succinate dehydrogenase complex, subunit A, flavoprotein), UBC (ubiquitin C) and YWHAZ (tyrosine 3-monooxygenase/tryptophan 5- monooxygenase activation protein, zeta polypeptide).
• GUSB glucose curonidase, beta
• HMBS hydroxymethylbilane synthase
• SDHA succinate dehydrogenase complex, subunit A, flavoprotein
• UBC ubiquitin C
• YWHAZ tyrosine 3-monooxygenase/tryptophan 5- monooxygenase activation protein, zeta polypeptide.
• One or more housekeeping genes can be used.
• at least 2, 3, 4, 5, 7, 10 or 15 housekeeping genes are used to provide a combined normalizing
• the set of normalizing genes are or are selected from CLTC, GUSB, HMBS, MMADHC, MRFAP1, PPP2CA, PSMA1, PSMC1, RPL13A, RPL37, RPL38, RPL4, RPL8, RPS29, SDHA, SLC25A3, TXNL1, UBA52, UBC and YWHAZ.
• the set of normalizing genes are or are selected from CLTC, MMADHC, MRFAP1, PPP2CA, PSMA1, PSMC1, RPL13A, RPL37, RPL38, RPL4, RPL8, RPS29, SLC25A3, TXNL1, and UBA52.
• the disclosure is some aspects, relates to primers (e.g., primer pairs) or sets of primers for amplifying mRNA, or corresponding cDNA, that correspond to one or more and preferably two or more of these genes (e.g., as in sets of primer pairs for different genes).
• primers e.g., primer pairs
• sets of primers for amplifying mRNA, or corresponding cDNA that correspond to one or more and preferably two or more of these genes (e.g., as in sets of primer pairs for different genes).
• the disclosure is some aspects relates to probes or sets of probes (e.g., hybridization probes) for specifically detecting and/or quantitating the level of mRNA, or corresponding cDNA, that correspond to one or more and preferably two or more of these genes (e.g., as in sets of probes for different genes).
• probes or sets of probes e.g., hybridization probes
• RNA levels for the genes In the case of measuring RNA levels for the genes, one convenient and sensitive approach is real-time quantitative PCRTM (qPCR) assay, following a reverse transcription reaction.
• qPCR real-time quantitative PCRTM
• C t cycle threshold
• the overall expression of the one or more normalizing genes can be represented by a "normalizing value" which can be generated by combining the expression of all normalizing genes, either weighted eaqually (straight addition or averaging) or by different predefined coefficients.
• the normalizing value H can be the cycle threshold (C t ) of one single normalizing gene, or an average of the C t values of 2 or more, preferably 10 or more, or 15 or more normalizing genes, in which case, the predefined coefficient is 1/N, where N is the total number of normalizing genes used.
• C t cycle threshold
• the methods of the disclosure generally involve determining the level of expression of a panel of genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, which can optionally be combined with CCGs and/or the PGR gene.
• a panel of genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, which can optionally be combined with CCGs and/or the PGR gene.
• test genes comprising primarily genes selected from BCRGs, TCRGs, HLAGs, OCPGs and optionally CCGs and/or the PGR gene according to the present disclosure by combining the expression level values of the individual test genes to obtain a test value.
• the different prognostic value provided in the present disclosure represents the overall expression level of the plurality of test genes composed substantially of (or weighted to be represented substantially by) genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, and optionally, CCGs and/or the PGR.
• the specific prognostic value representing the overall expression of the plurality of test genes can be provided by combining the normalized expression of all test genes, either by straight addition or averaging (i.e., weighted equally) or by a different predefined coefficient.
• prognostic value (AC tl + AC t2 + " ' + AC ta )/n.
• this document discloses using the expression of a plurality of genes (e.g., “determining [in a sample from the patient] the expression of a plurality of test genes” or “correlating increased expression of said plurality of test genes to an increased likelihood of response”)
• this includes in some embodiments using a test value representing or corresponding to the overall expression of this plurality of genes (e.g., "determining [in a sample from the patient] a test value representing the expression of a plurality of test genes” or “correlating an increased test value [or a test value above some reference value] representing the expression of said plurality of test genes to an increased likelihood of response”).
• the normalized expression for the ABCC5 gene and/or PGR gene can be combined with a BCRG, TCRG, OCPG, and/or CCP value described above to provide a test value. Same or different weights can be assigned to different components using predefined coefficients.
• optimized CCGs, BCRGs, TCRGs, HLAGs, or OCPGs are used.
• One way of assessing whether particular genes will serve well in the methods and compositions of the disclosure is by assessing their correlation with the mean expression of CCGs, BCRGs, TCRGs, HLAGs, or OCPGs (e.g., all known CCGs, BCRGs, TCRGs, HLAGs, or OCPGs, a specific set of CCGs, BCRGs, TCRGs, HLAGs, or OCPGs, etc.).
• Those CCGs, BCRGs, TCRGs, HLAGs, or OCPGs that correlate particularly well with the mean are expected to perform well in assays of the disclosure, e.g., because these will reduce noise in the assay.
• CCGs, BCRGs, TCRGs, HLAGs, or OCRGs do not correlate well with the mean (e.g., ABCCS's correlation to the mean is 0.097) for the CCG profile or a BCRG, TCRG, HLAG, or OCPG profile.
• such genes may be grouped, tested, analyzed, etc. separately from those that correlate well. This is especially useful if these non-correlated genes are independently associated with the clinical feature of interest (e.g., prognosis, therapy response, etc.).
• ABCC5 an OCPG
• non-correlated genes are analyzed together with correlated genes.
• a BCRG, TCRG, HLAG, or OCPG is non-correlated if its correlation to its respective mean (e.g., cluster mean as described in the Examples) is less than 0.5, 0.4, 0.3, 0.2, 0.10, 0.09, 0.08, 0.07, 0.06, 0.05, 0.04, 0.03, 0.02, 0.01 or less.
• a CCG is non-correlated if its correlation to the CCG mean is less than 0.5, 0.4, 0.3, 0.2, 0.10, 0.09, 0.08, 0.07, 0.06, 0.05, 0.04, 0.03, 0.02, 0.01 or less.
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs).
• the plurality of test genes comprises the top 2, 3, 4, 5, 6, 7, 8, 9, 10, or all 11 genes selected from BCRGs, TCRGs, HLAGs and OCPGs listed in Table 30.
• the plurality of test genes comprises the top 2, 3, 4, 5, 6, 7, 8, 9, 10, or all 11 genes selected from BCRGs, TCRGs, HLAGs and OCPGs listed in Table 28.
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 14 of the following genes: IRF4, CCL19, SELL, CD38, CCL5, IGLL5/CKAP2, CCR2, TRDV3/TRDV1, IGHM, IGJ, or PTRPC.
• the plurality of test genes comprises the top 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or all 14 genes selected from BCRGs, TCRGs, HLAGs and OCPGs listed in Table 31.
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 14 of the following genes: ITGB2, EVI2B, HCLS1, HLA-DPB1, HLA-E, HLA-DPA1, HLA-DRA, HLA-DMA, PECAM1, EVI2B, PTPN22, IRFl, CD74, or, HLA-
• the plurality of test genes comprises the top 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or all 14 genes selected from BCRGs, TCRGs, HLAGs and OCPGs listed in Table 32.
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs ⁇ e.g., at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 14 of the following genes:IRF4, CD38, SELL, CCL5, IGHM, IGLL5/CKAP2, PTPRC, IGH, EVI2B, CCL19, TRD V3/TRD VI, PTPN22, or, PECAM1,
• the plurality of test genes comprises the top 2,
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises at least 1, 2, 3, 4, 5, 6, 7, 8, or, 9 of the following genes: HLA-DMA, HLA-DPB1, HLA-DRA, HLA-E, HLA-DPA1, HCLS1, ITGB2, HLA-DRB3, or, HLA-DRB 3 /HLA-DRB 1.
• the individual predictive power of each gene may be used to rank them in importance.
• the inventors have determined that the BCRGs, TCRGs, HLAGs, or OCPGs (or the indicated probes) can be ranked as shown in Table 6A and 6B above according to the predictive power of each individual gene. Further, a subset of the ISGs and OCPGs of the disclosure (Immune Panel 3) can be ranked according to Univariate and multivariate p-value as shown in Tables 8 and 9 below.
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs).
• the plurality of test genes comprises the top 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs listed in any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, or 20 of the following genes: CKAP2, GUSBP11, IGHM, IGJ IGkappa, IGKC, IGKV1-5, IGL1, IGLL3P, IGVH, CCL19, CCL5, CCR2, CD247, CD38, HLA-E, IRF1, IRF4, PTPN22, SELL, SEMA4D, TCRA/D, CD74, EVI2B, HCLS1, HLA-DMA, HLA-DPA1, HLA-
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of test genes comprises any one, two, three, four, five, six, seven, eight, nine, or ten or all of gene numbers 1, 1& 2, 1 to 3, 1 to 4, 1 to 5, 1 to 6, 1 to 7, 1 to 8, 1 to 9, or 1 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises any one, two, three, four, five, six, seven, eight, or nine or all of gene numbers 2, 2 & 3, 2 to 4, 2 to 5, 2 to 6, 2 to 7, 2 to 8, 2 to 9, or 2 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• genes selected from BCRGs, TCRGs, HLAGs and OCPGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OC
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises any one, two, three, four, five, six, seven, or eight or all of gene numbers 3, 3 & 4, 3 to 5, 3 to 6, 3 to 7, 3 to 8, 3 to 9, or 3 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• genes selected from BCRGs, TCRGs, HLAGs and OCPGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises any one, two, three, four, five, six, or seven or all of gene numbers 4, 4 & 5, 4 to 6, 4 to 7, 4 to 8, 4 to 9, or 4 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• the plurality of test genes comprises at least some number of genes selected from BCRGs, TCRGs, HLAGs and OCPGs ⁇ e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes selected from BCRGs, TCRGs, HLAGs and OCPGs) and this plurality of genes selected from BCRGs, TCRGs, HLAGs and OCPGs comprises any one, two, three, four, five, six, seven, eight, nine, 10, 11, 12, 13, 14, or 15 or all of gene numbers 1 , 1 & 2, 1 to 3, 1 to 4, 1 to 5, 1 to 6, 1 to 7, 1 to 8, 1 to 9, 1 to 10, 1 to 11, 1 to 12, 1 to 13, 1 to 14, or 1 to 15 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33.
• CCGs and 47 housekeeping genes had their expression compared to the CCG and housekeeping mean in order to determine preferred genes for use in some embodiments of the disclosure.
• Rankings of select CCGs according to their correlation with the mean CCG expression as well as their ranking according to predictive value are given in, e.g., Tables 10, 11, 12, 13, and 14. According to some embodiments or aspects of the disclosure, the methods and compositions include CCGs as described in more detail below.
• the individual predictive power of each gene may be used to rank them in importance.
• the inventors have determined that the CCGs in Panel C can be ranked as shown in Table 13 below according to the predictive power of each individual gene.
• the CCGs in Panel F can be similarly ranked as shown in Table 14 below.
• the plurality of test genes in addition to a plurality (e.g., at least 2, 4, 6, 8, 10, or 12 or more) of the BCRGs, TCRGs, HLAGs, and OCPGs as described herein, comprises the top 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40 or more CCGs listed in any of Tables 10, 11, 12, 13, 14, 15, 19, 20, 21, 22, 23, 24, 25, 34, or 35.
• the plurality of test genes in addition to at least 2, 4, 6, 8, 10, or 12 or more of the BCRGs, TCRGs, HLAGs, and OCPGS as described herein, comprises at least some number of CCGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs) and this plurality of CCGs comprises at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, or 20 of the following genes: ASPM, BIRC5, BUB1B, CCNB2, CDC2, CDC20, CDCA8, CDKN3, CENPF, DLGAP5, FOXM1, KIAA0101, KIF11, KIF2C, KIF4A, MCM10, NUSAP1, PRC1, RACGAPI, and TPX2.
• CCGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs
• ASPM BIRC5, BUB1B, CCNB2,
• the plurality of test genes in addition to at least 2, 4, 6, 8, 10, or 12 or more of the BCRGs, TCRGs, HLAGs, and OCPGs as described herein, comprises at least some number of CCGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs) and this plurality of CCGs comprises at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, or 20 of the following genes: TPX2, CCNB2, KIF4A, KIF2C, BIRC5, RACGAPI, CDC2, PRC1, DLGAP5/DLG7, CEP55, CCNB1, TOP2A, CDC20, KIF20A, BUB1B, CDKN3, NUSAP1, CCNA2, KIF11, and CDCA8.
• CCGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs
• this plurality of CCGs comprises at
• the plurality of test genes in addition to at least 2, 4, 6, 8, 10, or 12 or more of the BCRGs, TCRGs, HLAGs, and OCPGs as described herein, comprises at least some number of CCGs ⁇ e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs) and this plurality of CCGs comprises any one, two, three, four, five, six, seven, eight, nine, or ten or all of gene numbers 1, 1& 2, 1 to 3, 1 to 4, 1 to 5, 1 to 6, 1 to 7, 1 to 8, 1 to 9, or 1 to 10 of any of Tables 10, 11, 12, 13, 14, 15, 19, 20, 21, 22, 23, 24, 25, 34, or 35.
• the plurality of test genes in addition to at least 2, 4, 6, 8, 10, or 12 or more of the BCRGs, TCRGs, HLAGs, and OCPGs as described herein, comprises at least some number of CCGs ⁇ e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs) and this plurality of CCGs comprises any one, two, three, four, five, six, seven, eight, or nine or all of gene numbers 2, 2 & 3, 2 to 4, 2 to 5, 2 to 6, 2 to 7, 2 to 8, 2 to 9, or 2 to 10 of any of Tables 10, 11, 12, 13, 14, 15, 19, 20, 21, 22, 23, 24, 25, 34, or 35.
• the plurality of test genes in addition to at least 2, 4, 6, 8, 10, or 12 or more of the BCRGs, TCRGs, HLAGs, and OCPGs as described herein, comprises at least some number of CCGs ⁇ e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs) and this plurality of CCGs comprises any one, two, three, four, five, six, seven, or eight or all of gene numbers 3, 3 & 4, 3 to 5, 3 to 6, 3 to 7, 3 to 8, 3 to 9, or 3 to 10 of any of Tables 10, 11, 12, 13, 14, 15, 19, 20, 21, 22, 23, 24, 25, 34, or 35.
• the plurality of test genes in addition to at least 2, 4, 6, 8, 10, or 12 or more of the BCRGs, TCRGs, HLAGs, and OCPGs as described herein, comprises at least some number of CCGs ⁇ e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs) and this plurality of CCGs comprises any one, two, three, four, five, six, or seven or all of gene numbers 4, 4 & 5, 4 to 6, 4 to 7, 4 to 8, 4 to 9, or 4 to 10 of any of Tables 10, 11, 12, 13, 14, 15, 19, 20, 21, 22, 23, 24, 25, 34, or 35.
• the plurality of test genes in addition to at least 2, 4, 6, 8, 10, or 12 or more of the BCRGs, TCRGs, HLAGs, and OCPGs as described herein, comprises at least some number of CCGs ⁇ e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs) and this plurality of CCGs comprises any one, two, three, four, five, six, seven, eight, nine, 10, 11, 12, 13, 14, or 15 or all of gene numbers 1, 1 & 2, 1 to 3, 1 to 4, 1 to 5, 1 to 6, 1 to 7, 1 to 8, 1 to 9, 1 to 10, 1 to 11, 1 to 12, 1 to 13, 1 to 14, or 1 to 15 of any of Tables 10, 11, 12, 13, 14, 15, 19, 20, 21, 22, 23, 24, 25, 34, or 35.
• CCGs ⁇ e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more CCGs
• this plurality of CCGs comprises any one, two, three, four,
• the test value representing the overall expression of the plurality of test genes is compared to one or more reference values (or index values), and optionally correlated to breast cancer prognosis, or an increased or no increased likelihood of breast cancer recurrence or post-surgery metastasis-free survival.
• a test value greater than the reference value(s) can be correlated to increased likelihood of poor prognosis or decreased probability of post-surgery metastasis-free survival.
• the test value is deemed "greater than” the reference value (e.g., the threshold index value), and thus correlated to an increased likelihood of poor prognosis or decreased probability of post-surgery metastasis-free survival, if the test value exceeds the reference value by at least some amount (e.g., at least 0.5, 0.75, 0.85, 0.90, 0.95, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 or more fold or standard deviations).
• the reference value e.g., the threshold index value
• the index value may represent the gene expression levels found in a normal sample obtained from the patient of interest (including tissue surrounding the cancerous tissue in a biopsy), in which case an expression level in the sample significantly higher than this index value would indicate, e.g., increased likelihood of response to a particular treatment regimen (e.g., a treatment regimen comprising chemotherapy).
• a particular treatment regimen e.g., a treatment regimen comprising chemotherapy
• the index value may represent the average expression level for a set of individuals from a diverse cancer population or a subset of the population. For example, one may determine the average expression level of a gene or gene panel in a random sampling of patients with cancer (e.g., breast cancer). This average expression level may be termed the "threshold index value”.
• the index value may represent the average expression level of a particular gene or gene panel in a plurality of training patients (e.g., breast cancer patients) with similar outcomes whose clinical and follow-up data are available and sufficient to define and categorize the patients by disease outcome. See, e.g., Examples, infra.
• a "good prognosis index value” can be generated from a plurality of training cancer patients characterized as having "good prognosis” after breast cancer surgery and hormone deprivation therapy.
• a “poor prognosis index value” can be generated from a plurality of training cancer patients defined as having "poor prognosis” breast cancer surgery and hormone deprivation therapy.
• a good prognosis index value of a particular gene or gene panel may represent the average level of expression of the particular gene or gene panel in patients having a "good prognosis”
• a poor prognosis index value of a particular gene or gene panel represents the average level of expression of the particular gene or gene panel in patients having a "poor prognosis.”
• index values may be determined thusly:
• a threshold value may be set for the cell cycle mean combined with the ABCC5 mean, and optionally PGR mean.
• the optimal threshold value is selected based on the receiver operating characteristic (ROC) curve, which plots sensitivity vs (1 - specificity). For each increment of the combined mean, the sensitivity and specificity of the test is calculated using that value as a threshold.
• the actual threshold will be the value that optimizes these metrics according to the artisan's requirements (e.g., what degree of sensitivity or specificity is desired, etc.).
• a panel of genes i.e., a plurality of genes.
• a certain number e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30 or more
• a certain proportion e.g. 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%), 90%
• the expression of a panel of genes by determining the absolute copy number of the analyte representing each gene in the panel (e.g., mRNA, cDNA, protein) and either total or average these across the genes.
• Panels of genes selected from BCRGs, TCRGs, HLAGs and OCPGs, alone or in combination with CCGs can accurately predict cancer prognosis, and in particular breast cancer prognosis. But addition of the ABCC5 and PGR genes significantly increases the prediction power.
• the panel comprises at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 70, 80, 90, 100, 200, or more genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs.
• the panel comprises the ABCC5 and PGR genes and at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 70, 80, 90, 100, 200, or more genes selected from BCRGs, TCRGs, HLAGs, OCPGs and CCGs. In some embodiments the panel comprises at least 10, 15, 20, or more genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs.
• the panel comprises between 5 and 100 genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs, between 7 and 40 genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs, between 5 and 25 genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs, between 10 and 20 genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs, or between 10 and 15 genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs.
• the genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprise at least a certain proportion of the panel.
• the panel comprises at least 25%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs.
• the panel comprises at least 10, 15, 20, 25, 30, 35, 40, 45, 50, 70, 80, 90, 100, 200, or more genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs, and such genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs constitute of at least 50%, 60%, 70%, preferably at least 75%, 80%, 85%, more preferably at least 90%, 95%, 96%, 97%, 98%, or 99% or more of the total number of genes in the panel.
• the panel of genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprises the genes in Table 1, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, or 23 or Panel A, B, C, D, E, F, G, H, I, J, K, L, M, or N.
• the panel comprises at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, or more of the genes in Table 1, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13,14, 15, 16, 17, 18, 19 ,20, 21 , 22, or 23 or Panel A, B, C, D, E, F, or G, H, I J, K, L, M, or N.
• the disclosure provides a method of determining the prognosis in a breast cancer patient comprising determining the status of the genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs in any one of Table 1, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13,14, 15, 16, 17, 18, 19, 20, 21, 22, or 23 or Panel A, B, C, D, E, F, G, H, I, J, K, L, M or N determining the status of the ABCC5 gene or the PGR gene or both, and using the combined expression to determine the prognosis of the breast cancer. [00119] Several panels of CCGs (shown in Tables 7, 10, 11, 12, 13, 14, 15, 16, 17, 18,
• Panels A, B, C, D, E, F, G, H, I, J, L, M & N for use in combination genes selected from BCRGs, TCRGs, HLAGs, and OCPGs are useful in this regard.
• ESRl is optional and is analyzed primarily as a confirmation of the tumor's ER+ status.
• Panel J lacks ESRl.
• ESRl is optional and is analyzed primarily as a confirmation of the tumor's ER+ status.
• Panel J lacks ESRl.
• TCRGs, HLAGs, OCPGs, and/or CCGs assayed is often not as important as the total number of genes.
• the number of genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and/or CCGs that are assayed can vary depending on many factors, e.g., technical constraints, cost considerations, the classification being made, the cancer being tested, the desired level of predictive power, etc.
• Increasing the number of genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and/or CCGs that are assayed in a panel according to the disclosure is, as a general matter, advantageous because, e.g., a larger pool of mRNAs to be assayed means less "noise" caused by outliers and less chance of an assay error throwing off the overall predictive power of the test.
• cost and other considerations will generally limit this number and finding the optimal number of genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and/or CCGs for a signature is desirable.
• small CCG signatures ⁇ e.g., 2, 3, 4, 5, 6 CCGs, etc. are significant predictors and analogously small signatures of genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, alone, or in combination with CCGs.
• the optimal number of CCGs in a signature (no) can be found wherever the following is true
• P is the predictive power (i.e., P Sil is the predictive power of a signature with n genes and P Sil+i is the predictive power of a signature with n genes plus one) and Co is some optimization constant.
• Predictive power can be defined in many ways known to those skilled in the art including, but not limited to, the signature's p-value.
• Co can be chosen by the artisan based on his or her specific constraints. For example, if cost is not a critical factor and extremely high levels of sensitivity and specificity are desired, Co can be set very low such that only trivial increases in predictive power are disregarded.
• Co can be set higher such that only significant increases in predictive power warrant increasing the number of genes in the signature.
• the same priniciples also hold true on a general level when considering panels of genes selected from BCRGs, TCRGs, HLAGs, OCPGs, alone, or in combination with CCGs.
• a graph of predictive power as a function of gene number may be plotted and the second derivative of this plot taken.
• the point at which the second derivative decreases to some predetermined value (Co') may be the optimal number of genes in the signature. It has been shown that p-values ceased to improve significantly between about 10 and about 15 genes (e.g., CCGs, or analogously genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs), thus indicating that an optimal number of genes (e.g., CCGs, or analogously genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs) in a prognostic panel is from about 10 to about 15.
• genes e.g., CCGs, or analogously genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs
• between about 10 and about 15 genes are used in addition to the ABCC5 gene or the PGR gene or both.
• the panel comprises between about 10 and about 15 genes (e.g., CCGs, or analogously genes selected from BCRGs, TCRGs, HLAGs, OCPGs, and CCGs) and the genes constitute at least 80% of the panel (or are weighted to contribute at least 75%).
• the panel comprises CCGs plus one or more additional markers selected from BCRGs, TCRGs, HLAGs, and OCPGs, that significantly increase the predictive power of the panel (i.e., make the predictive power significantly better than if the panel consisted of only the CCGs).
• CCGs including any of those listed in Table 7, 8, 9, 10, 11, 12, 13, or 14 or Panel A, B, C, D, E, F, or G
• OCPGs including any of those listed in Table 1, 2, 3, 4, 5, or 6
• the panel comprises at least 3, 4, 5, 6, 7, 8, 9, 10, 15,
• the panel comprises between 5 and 100 CCGs in combination with at least 2, 4, 6, 8, 10, or 12 or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, between 7 and 40 CCGs in combination with at least 2, 4, 6, 8, 10, or 12 or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, between 5 and 25 CCGs in combination with at least 2, 4, 6, 8, 10, or 12 or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, between 10 and 20 CCGs in combination with at least 2, 4, 6, 8, 10, or 12 or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, or between 10 and 15 CCGs in combination with at least 2, 4, 6, 8, 10, or
• CCGs, BCRGs, TCRGs, HLAGs and OCPGs comprise at least a certain proportion of the panel.
• the panel comprises at least 25%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% genes selected from CCGs, BCRGs, TCRGs, HLAGs and OCPGs.
• the CCGs are any of the genes listed in Table 7, 8, 9, 10, 11, 12, 13, or 14 or Panel A, B, C, D, E, F, or G, in combination with at least 2, 4, 6, 8, 10, or 12 or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs are any of those listed in Table 1, 2, 3, 4, 5, or 6.
• the panel comprises at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more genes in any of Table 7, 8, 9, 10, 11, 12, 13, or 14 or Panel A, B, C, D, E, F, or G in combination with at least 2, 4, 6, 8, 10, or 12 or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs as in any of Table 1, 2, 3, 4, 5, or 6.
• the panel comprises all of the genes in any of Table 7, 8, 9, 10, 11, 12, 13, or 14 or Panel A, B, C, D, E, F, or G, in combination with at least 2, 4, 6, 8, 10, or 12 or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs as in any of Table 1, 2, 3, 4, 5, or 6.
• CCGs of the disclosure have been analyzed to determine their correlation to the their respective mean and also, to determine their relative predictive value within a panel (see Tables 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 19, 20, 21, 22, and 23 and Panels A, B, C, D, E, F, G, and H).
• the plurality of test genes comprises at least some number of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more BCRGs, TCRGs, HLAGs, OCPGs, and CCGs) and this plurality of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprises the top 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40 or more BCRGs, TCRGs, HLAGs, OCPGs, and CCGs listed in any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33, and/or any of Tables 10, 11, 12, 13, 14, 15, 19, 20, 21, 22, 23, 24, 25, 34, and 35.
• CCGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more BCRGs, TCRGs,
• the plurality of test genes comprises at least some number of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more BCRGs, TCRGs, HLAGs, OCPGs, and CCGs) and this plurality of CCGs comprises at least 1, 2, 3,
• the plurality of test genes comprises at least some number of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs (e.g., at least 3, 4,
• BCRGs 4, 1 to 5 or more BCRGs, TCRGs, HLAGs, OCPGs, and CCGs
• this plurality of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprises any one, two, three, four, five, six, seven, eight, nine, or ten or all of gene numbers 1 & 2, 1 to 3, 1 to 4, 1 to 5, 1 to
• the plurality of test genes comprises at least some number of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more BCRGs, TCRGs, HLAGs, OCPGs, and CCGs) and this plurality of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprises any one, two, three, four, five, six, seven, eight, or nine or all of gene numbers 2 & 3, 2 to 4, 2 to 5, 2 to 6, 2 to 7, 2 to 8, 2 to 9, or 2 to 10 of any of Tables 1, 6A, 6B, 8, 9, 30, 31, 32, or 33, and/or
• the plurality of test genes comprises at least some number of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more BCRGs, TCRGs, HLAGs, OCPGs, and CCGs) and this plurality of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprises any one, two, three, four, five, six, seven, or eight or all of gene numbers 3 & 4, 3 to 5, 3 to 6, 3 to 7, 3 to 8, 3 to 9, or 3 to 10 of any of Tables 1 , 6A, 6B, 8, 9, 30, 31 , 32, or 33, and/or any of Tables 10, 1 1 , 12, 13, 14, 15, 19, 20, 21 , 22, 23, 24, 25, 34, and 35.
• CCGs e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more BCRGs
• the plurality of test genes comprises at least some number of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more BCRGs, TCRGs, HLAGs, OCPGs, and CCGs) and this plurality of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprises any one, two, three, four, five, six, or seven or all of gene numbers 4 & 5, 4 to 6, 4 to 7, 4 to 8, 4 to 9, or 4 to 10 of any of Tables 1 , 6A, 6B, 8, 9, 30, 31 , 32, or 33, and/or any of Tables 10, 1 1 , 12, 13, 14, 15, 19, 20, 21 , 22, 23, 24, 25, 34, and 35.
• this plurality of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprises any one, two, three, four, five, six
• the plurality of test genes comprises at least some number of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs (e.g., at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50 or more BCRGs, TCRGs, HLAGs, OCPGs, and CCGs) and this plurality of BCRGs, TCRGs, HLAGs, OCPGs, and CCGs comprises any one, two, three, four, five, six, seven, eight, nine, 10, 1 1 , 12, 13, 14, or 15 or all of gene numbers 1 & 2, 1 to 3, 1 to 4, 1 to 5, 1 to 6, 1 to 7, 1 to 8, 1 to 9, 1 to 10, 1 to 1 1 , 1 to 12, 1 to 13, 1 to 14, or 1 to 15 of any of Tables 1 , 6A, 6B, 8, 9, 30, 31 , 32, or 33, and/or any of Tables 10, 1 1 , 12, 13, 14, 15, 19, 20, 21 , 22, 23, 24, 25, 34, and
• multiple scores e.g., ISG, OCPG, CCG, ABCC5, clinical parameters or scores
• single component e.g., ISG
• combined test scores for a particular patient can be compared to single component or combined scores for reference populations as described herein, with differences between test and reference scores being correlated to or indicative of some clinical feature.
• the disclosure provides a method of determining a cancer patient's prognosis (or some other clinical feature as described herein) comprising (1) obtaining the measured expression levels of a plurality of gene comprising a plurality of ISGs and/or OCPGs (as described throughout this document) in a sample from the patient, (2) calculating a test value from these measured expression levels, (3) comparing said test value to a reference value calculated from measured expression levels of the plurality of genes in a reference population of patients, and (4)(a) correlating a test value greater than the reference value to a poor prognosis (or other unfavorable clinical feature as described herein) or (4)(b) correlating a test value equal to or less than the reference value to a good prognosis (or other favorable clinical feature as described herein).
• the test value is calculated by averaging the measured expression of the plurality of genes (as discussed below). In some embodiments the test value is calculated by weighting each of the plurality of genes in a particular way.
• the plurality of CCGs are weighted such that they contribute at least some proportion of the test value (e.g., 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%), 90%), 95%), 99%o, 100%).
• each of the plurality of genes is weighted such that not all are given equal weight (e.g., a particular ISG, OCPG or CCG weighted to contribute more to the test value than one, some or all other ISGs, OCPGs or CCGs in the plurality).
• the disclosure provides an method of determining a cancer patient's prognosis (or some other clinical feature as described herein) comprising: (1) obtaining the measured expression levels of a plurality of gene comprising a plurality of ISGs and/or OCPGs (as described throughout this document) in a sample from the patient; (2) obtaining one or more scores for the patient comprising (or calculated or derived from or reflecting) one or more clinical features (e.g., age, grade, tumor size, node status (including number of positive nodes, if any), hormone therapy); (3) deriving a combined test value from the measured levels obtained in (1) and the score(s) obtained in (2); (4) comparing the combined test value to a combined reference value derived from measured expression levels of the plurality of genes and a score comprising one or more clinical features in a reference population of patients; and (5)(a) correlating a combined test value greater than the combined reference value to a poor prognosis (or some other unfavorable clinical feature as
• the combined score includes ISG/OCPG (for convenience in these embodiments termed "Immune gene expression," with the score for the total expression of a panel of these genes being term the “Immune score”), CCP gene expression (CCP score, ABCC5 expression, tumor size and/or node status (e.g., number of positive nodes).
• Immune gene expression, CCP gene expression, and ABCC5 expression can be continuous numeric variables. Tumor size can be a continuous numeric variable with, e.g., size being expressed in centimeters.
• Node status can be a continuous numeric variable (e.g., the integer number of positive nodes).
• Such combined scores can be used as test values (or correspondingly reference values) in any methods or systems of the disclosure.
• the combined score is calculated according to any of the following formulae:
• one or more of the clinical variables can be combined into a clinical score (e.g., nomogram score), which can then be combined with one or more of the gene expression scores score to yield a combined score according to the following more generalized formula:
• any of formulae (1), (2) and/or (3) are used in the methods, systems, etc. of the disclosure to determine prognosis based on a patient's sample.
• Immune score and/or CCP score are the unweighted mean of C T values for the Immune gene expression or CCP gene expression, respectively, being analyzed, optionally normalized by the unweighted mean of the HK genes so that higher values indicate higher expression (in some embodiments one unit is equivalent to a two-fold change in expression).
• A 0.45
• B 0.52
• C 0.50
• D 0.60
• E 0.64.
• A, B, C, D, and/or E is within rounding of these values (e.g., A is between 0.445 and 0.454, etc.).
• a formula may not have all of the specified coefficients or have the value of 0 for one or more of the coefficients (and thus not incorporate the corresponding variable(s)).
• one of the embodiments mentioned previously may incorporate formula (1) where A in formula (1) is 0.95 and B in formula (2) is 0.61. C, D and E would not be applicable in this example.
• A is between 0.4 and 0.5, 0.4 and 0.49, 0.4 and 0.45, 0.35 and 0.45, 0.36 and 0.45, 0.37 and 0.45, 0.38 and 0.45, 0.39 and 0.45, 0.35 and 0.4, 0.3 and 0.45, 0.3 and 0.4, 0.3 and 0.45, 0.25 and 0.49, 0.25 and 0.45, 0.25 and 0.4, 0.25 and 0.35, or between 0.25 and 0.3.
• B is between 0.35 and 1, 0.40 and 0.99, 0.45 and 0.95, 0.45 and 0.8, 0.45 and 0.7, 0.45 and 0.65, 0.50 and 0.63, or between 0.50 and 0.54.
• C is between 0.10 and 1, 0.15 and 0.95, 0.20 and 0.90, 0.25 and 0.8, 0.30 and 0.7, 0.35 and 0.65, 0.40 and 0.60, or between 0.45 and 0.55.
• D is between 0.20 and 1, 0.25 and 0.95, 0.30 and 0.90, 0.35 and 0.85, 0.40 and 0.80, 0.45 and 0.75, 0.50 and 0.70, or between 0.55 and 0.65.
• D is between 0.20 and 1, 0.25 and 0.75, 0.30 and 0.65, 0.35 and 0.55, 0.40 and 0.50, or between 0.45 and 0.50.
• E is between 0.20 and 1, 0.25 and 0.95, 0.30 and 0.90, 0.35 and 0.85, 0.40 and 0.80, 0.45 and 0.75, 0.50 and 0.70, or between 0.55 and 0.65. In some embodiments E is between 0.20 and 1, 0.30 and 0.95, 0.30 and 0.90, 0.40 and 0.85, 0.50 and 0.80,
• F is between 0.001 and 0.2, 0.005 and 0.18, 0.01 and 0.16, 0.02 and 0.14, 0.04 and 0.12, 0.06 and 0.11, or between 0.08 and 0.10.
• A is between 0.1 and 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9,
• B is between 0.1 and 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1,
• C is between 0.1 and 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5,2, 2.5,3,3.5,4, 4.5,5,6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or 20; or between 0.2 and 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or 20; or between 0.3 and 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or 20; or between 0.3 and 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or 20; or between 0.4 and 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5,2, 2.5,3,3.5,4,4.5,5,6, 7, 8, 9, 10, 11, 12, 13,
• D is between 0.1 and 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9,
• A, B, and/or C is within rounding of any of these values (e.g., A is between
• the disclosure is related to the prognosis of such patients by determining the gene expression signatures as disclosed and described herein.
• surgery to remove the tumor is the standard of care. Because surgery can cure some patients and adjuvant chemotherapy is debilitating and expensive, the decision whether to undertake adjuvant chemotherapy is more difficult.
• aggressive treatment should be provided.
• Such aggressive treatment may include any treatment regimen beside surgery and hormone deprivation therapy (using blockers of estrogen receptor, or aromatase inhibitors).
• the present disclosure provides a method for treating breast cancer, which comprises determining the prognosis of breast cancer in a patient in the methods described above, and recommending, prescribing or administering a particular treatment regimen (e.g., a treatment regimen comprising chemotherapy) based in part on the determined prognosis.
• Neoadjuvant chemotherapy can cure some patients but the toxic drugs can be debilitating and expensive, making the decision whether to undertake neoadjuvant chemotherapy difficult.
• aggressive treatment comprising neoadjuvant chemotherapy may be provided. See Example 2, below.
• the present disclosure provides a method for treating breast cancer, which comprises determining the prognosis of breast cancer in a patient who has not yet had surgical resection of the tumor as described herein, and recommending, prescribing or administering a treatment regimen comprising neoadjuvant chemotherapy based at least in part on the determined prognosis.
• chemotherapy as used herein means adjuvant and/or neoadjuvant chemotherapy.
• the breast cancer treatment method includes: determining in a sample from the patient the expression of a plurality of test genes comprising at least 6, 8, 10 or 15 or more cell-cycle genes and at least 6, 8, 10 or 15 or more genes selected from BCRGs, TCRGs, HLAGs, and OCPGs, determining in the same or different sample from the patient the expression of the ABCC5 gene or the PGR gene or both, and recommending, prescribing or administering a particular treatment regimen (e.g., a treatment regimen comprising chemotherapy) based in part on the determined expression of the plurality of test genes, as well as the determined ABCC5 and/or PGR expression.
• a particular treatment regimen e.g., a treatment regimen comprising chemotherapy
• the method further comprises administering to the patient a non-hormone-blocking therapy agent or radiotherapy.
• “Hormone-blocking therapy” as generally understood in the art means drugs that block the estrogen receptor, e.g., tamoxifen, or block the production of estrogen, e.g., using aromatase inhibitors such as anastrozole (Arimidex) or letrozole (Femara).
• Non-hormone -blocking therapy agents suitable for breast cancer adjuvant therapy are known in the art and may include, e.g., cyclophosphamide, doxorubicin (Adriamycin), taxane, methotrexate, fluorouracil, and monoclonal antibodies such as Trastuzumab.
• a patient has an "increased likelihood" of some clinical feature or outcome (e.g., response) if the probability of the patient having the feature or outcome exceeds some reference probability or value.
• the reference probability may be the probability of the feature or outcome across the general relevant patient population. For example, if the probability of cancer recurrence after surgery in the general breast cancer patient population (or some specific subpopulation) is X% and a particular patient has been determined by the methods of the present disclosure to have a probability of recurrence of Y%, and if Y > X, then the patient has an "increased likelihood" of response.
• a threshold or reference value may be determined and a particular patient's probability of response may be compared to that threshold or reference. Because predicting outcome is a prognostic endeavor, "predicting prognosis” will sometimes be used herein to refer to predicting recurrence or survival.
• results of any analyses according to the disclosure will often be communicated to physicians, genetic counselors and/or patients (or other interested parties such as researchers) in a transmittable form that can be communicated or transmitted to any of the above parties.
• a transmittable form can vary and can be tangible or intangible.
• the results can be embodied in descriptive statements, diagrams, photographs, charts, images or any other visual forms. For example, graphs showing expression or activity level or sequence variation information for various genes can be used in explaining the results. Diagrams showing such information for additional target gene(s) are also useful in indicating some testing results.
• statements and visual forms can be recorded on a tangible medium such as papers, computer readable media such as floppy disks, compact disks, etc., or on an intangible medium, e.g., an electronic medium in the form of email or website on internet or intranet.
• results can also be recorded in a sound form and transmitted through any suitable medium, e.g., analog or digital cable lines, fiber optic cables, etc., via telephone, facsimile, wireless mobile phone, internet phone and the like.

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