Chemotherapy and Recurrence in Breast Cancer

Chemotherapy and Recurrence in Breast Cancer


The 21-gene expression recurrence score provides
prognostic information in hormone-receptor-positive breast cancer. Research has shown that patients with a recurrence
score of more than 25 benefit from the combination of chemotherapy and endocrine therapy, and
patients with recurrence score of less than 11 benefit from endocrine therapy alone. However, the benefit of chemoendocrine therapy
for patients with a mid-range recurrence score of 11 to 25, a group that makes up about 2/3 of these patients, remains unclear. In this prospective clinical trial in women
with hormone-receptor-positive, human epidermal growth factor receptor 2-negative, axillary-node
negative breast cancer, patients with recurrence scores of less than 11 or greater than 25 received the recommended treatment, and patients with recurrence scores of 11 to 25 were randomized
to either endocrine therapy alone or chemoendocrine therapy. The primary endpoint was, invasive disease-free
survival. For patients with recurrence scores of 11
to 25 endocrine therapy alone was non-inferior to chemoendocrine therapy. 5-year invasive disease-free survival was
92.8% in patients randomized to endocrine therapy alone, and 93.1% in patients randomized
to chemoendocrine therapy. Endocrine therapy was likewise non-inferior
to chemoendocrine therapy with regard to 5-year overall survival and 9-year invasive disease-free
survival. The authors conclude that endocrine therapy
alone was non-inferior to chemoendocrine therapy for women with early breast cancer and recurrence
scores of 11 to 25. Full trial results are available at NEJM.org