The Fellow on Call: The Heme/Onc Podcast Episode 058: Breast Cancer Series,Pt. 7-ER+, Early Stage Breast Cancer (con’t)
May 31, 2023
The hosts dive deep into the management of early stage ER+/HER2- breast cancer. They discuss who should receive chemotherapy and the relevance of gene expression assays like Oncotype and MammaPrint. Key trial results shed light on treatment distinctions based on menopausal and nodal status. The conversation also covers selecting appropriate chemotherapy regimens, the importance of survivorship care, and introduces targeted adjuvant therapies like abemaciclib for high-risk patients. It's a goldmine of insights for those navigating breast cancer treatment.
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When To Send Genomic Testing
- Send genomic assays (Oncotype) for ER+ tumors sized 0.5–5 cm to guide chemotherapy decisions.
- Give chemotherapy without testing for tumors >5 cm or for premenopausal women with nodal involvement.
Oncotype Score Defines A Risk Gap
- Oncotype DX produces a 0–100 recurrence score that stratifies long-term recurrence risk and chemo benefit.
- Early validations defined low risk ≤10 and higher risk >18, leaving an 11–25 intermediate zone needing further study.
TAILORx Clarified The Intermediate Group
- TAILORx randomized patients with Oncotype 11–25 to endocrine therapy ± chemotherapy to resolve the intermediate group.
- Postmenopausal women gained no chemo benefit, while premenopausal women had modest benefit, especially scores 16–25.