21-Gene Recurrence Score (Oncotype Dx)

  • Both tamoxifen and aromatase inhibitors:
    • Have been shown to:
      • Reduce recurrence rates and improve survival in postmenopausal women
  • Although chemotherapy has been shown to be beneficial in many patient subsets:
    • The 21-gene recurrence score was developed:
      • To help ascertain which patients with:
        • ER-positive, node-negative breast cancer:
          • Would be most likely to benefit from chemotherapy in addition to adjuvant tamoxifen
  • In patients with an intermediate recurrence score:
    • The benefit of chemotherapy is unclear
  • The Trial Assigning IndividuaLized Options for Treatment (Rx) [TAILORx] trial:
    • Is a randomized prospective trial:
      • That randomized women with ER-positive breast cancer:
        • With a score of 11 to 25 to:
          • Chemotherapy plus endocrine therapy to endocrine therapy alone
    • This trial is closed to accrual, and the results of this trial for this cohort are pending:
      • However:
        • Outcomes data from a subset of 1626 patients with a recurrence score of less than 10:
          • Were recently published
        • These patients were assigned to:
          • Receive endocrine therapy alone without chemotherapy
        • This study reported a 5-year local recurrence rate of:
          • 0.5% in women with a recurrence score of:
            • Less than 10
        • Furthermore:
          • At 5 years:
            • The invasive disease–free survival was:
              • 93.8%
            • The rate of freedom from recurrence of breast cancer at a distant site was:
              • 99.3%
            • At distant or local site was:
              • 98.7%
            • Overall survival rate of:
              • 98%
    • The authors concluded that a favorable gene expression profile:
      • Is associated with a very low rate of recurrence:
        • At 5 years with endocrine therapy alone
  • References:
    • Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Dowsett M, Forbes JF, et al. Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet. 2015;386(10001):1341-1352.
    • Sparano JA, Gray RJ, Makower DF, et al. Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med. 2015;373(21):2005-2014.

#Arrangoiz #Surgeon #BreastSurgeon #CancerSurgeon #SurgicalOncologist

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