Resident Duke University School of Medicine Durham, North Carolina, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Participants should be aware of the following financial/non-financial relationships:
Amanda L. Nash, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Introduction: OncotypeDx Recurrence Score (RS) is used to predict risk of recurrence and projected benefit from chemotherapy in patients diagnosed with hormone receptor (HR)-positive, HER2-negative invasive breast cancer. It has been used to better target adjuvant chemotherapy, according to the TAILORx study. However, premenopausal women with higher RS were underrepresentedwith little likelihood that the study will be repeated, and all received chemotherapy. We aimed to evaluate the benefit of chemotherapy according to RS among young women with HR-positive HER2-negative pN0-1 breast cancer.
Methods: Adult patients aged 50 and younger diagnosed with HR-positive, HER2-negative breast cancer between 2010 and 2017 with RS >25 were selected from the National Cancer Database. Patients were divided into groups according to their age and RS. Kaplan-Meier (K-M) curves were used to visualize unadjusted overall survival (OS), and the log-rank test was used to test for differences.Cox proportional hazards models were used to examine the association between select factors and survival.
Results: There were4,054 patients in the study cohort, 86.4% of whom received chemotherapy. Median age was similar: 45 among patients who received chemotherapy and 46 among those that did not. There were 3,239 patients in the 40-50 age group.Patients who received chemotherapy were more likely to havelarger and higher-gradetumors, node-positive disease, be PR negative, not receive endocrine therapy, and have higher RS.Using unadjusted K-M curves, the use of chemotherapy in patients aged 40-50 was associated with improved OS in patients with RS >30, but not with RS 26-30 (Figure 1).After adjustment,chemotherapy was associated with improved OS in patients aged 40-50 with RS >30 (p=.01), but not RS 26-30 (p=.16).
Conclusions: Among women aged 40-50 diagnosed with breast cancer, we found no improvement in OS with chemotherapy receipt in patients with RS 26-30, but a significant benefit for those with RS >30. Although adjuvant chemotherapy decisions must be individualized, these results support a patient-centered discussion inwomenbetween age 40-50 with RS < 30, including possible omission of chemotherapy.
Learning Objectives:
Upon completion, participant will be able to summarize the current clinical uses of the OncotypeDx test
Upon completion, participant will be able to state the limitations of the TAILORx study as it relates to young women with breast cancer.
Upon completion, participants will be able to describe the differential survival benefit of chemotherapy in young breast cancer patients according to RS.
