The Nottingham Prognostic Index Plus (NPI+) is an award winning decision making tool for clinicians to offer personalised medicine to all female patients with breast cancer. NPI+ builds considerably upon the original NPI that was developed in Nottingham in the early 1980s. NPI+ includes ground breaking functionality by predicting both clinical outcomes (survival) and by aiding customised therapeutics. NPI+ can be used for all female breast cancer patients, not just those who are oestrogen receptor positive.

NPI+ works by using a panel of biomarkers to assess the biological behaviour of an individual’s tumour by measuring protein expression levels. Combined with a novel bioinformatic and expert system, it can then can sub-classify patients into one of seven clinically distinct biological classes. Importantly, this approach has the potential to predict both clinical outcomes and relevant therapeutic options in breast cancer more accurately than existing methods. This helps clinicians and patients navigate the increasingly complex process of customised therapeutics.

NPI+ minimises over-treatment and resulting side-effects through targeted and personalised medicine. As a one-stop centralised test, it offers time and cost efficiencies and promises better targeting of treatments, potentially minimising follow-up hospital visits for post-surgery treatment.

It is intended that healthcare professionals will access the NPI+ test and subsequent results through a web interface that features survival modelling graphics. These help discussions and explanations between clinicians and patients about treatment options.

The NPI+ test is currently being validated with a view to setting up a spin-out company.

How NPI+ differs from the existing NPI

The existing NPI test divides patients into three classes (good, intermediate and poor prognosis) but it does not inform on targeted therapeutic treatment.

The original NPI was developed in the early 1980s in Nottingham and is still widely used in breast cancer clinical management. Treatment decisions are based on a limited number of clinical, pathological and biological features. Clinical outcome is influenced by tumour behaviour and the ability to predict prognosis can be measured using the Nottingham Prognostic Index (NPI). The tool assesses a number of tumour and clinical features including size of index lesion, number of involved lymph nodes and tumour grading. NPI gives a score which indicates how aggressively an individual patient should be treated with adjuvant (supporting or ancillary) therapy.

The Nottingham Prognostic Index Plus (NPI+) Development Team

The Nottingham Prognostic Index Plus (NPI+) was developed by a consortium of scientists from the University of Nottingham, Nottingham Trent University and Nottingham University Hospitals NHS Trust. This multidisciplinary team is headed by pathologist Prof Ian Ellis (University of Nottingham (UoN)) and comprises pathology scientists: Drs Des Powe (Nottingham University Hospitals Trust) and Andy Green (UoN); computer scientist Dr Jon Garibaldi (UoN); bioinformatician Dr Graham Ball, (Nottingham Trent University) and acting CEO Dr Chris Sheehan.

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