In the era of genomics, should tumor size be reconsidered as a criterion for neoadjuvant chemotherapy?

The Oncologist
Xavier PivotChristian Villanueva

Abstract

The Oncotype DX recurrence score (RS) assay has been validated for prediction of 10-year risk of distant recurrence and likelihood of benefit from chemotherapy in patients with estrogen receptor (ER)-positive, HER2-negative early breast cancer. Patients with high RS tumors have substantial benefit, and patients with low RS tumors have minimal if any benefit from chemotherapy. Tumor size is used as a key parameter when selecting patients for neoadjuvant chemotherapy. The aim of this study was to assess the distribution of RS in patients selected for neoadjuvant chemotherapy primarily according to tumor size. Patients with ER-positive and HER2-negative tumors that were node-negative or had no more than 1 positive node from three trials were included in this study. Oncotype DX was performed at Genomic Health, Inc., blinded to the clinical data. Descriptive statistics were calculated for distribution of RS for all cases. Of 277 patients, 96 met eligibility criteria, and 81 had sufficient material for analysis. Median tumor size was 40 mm (interquartile range [IQR], 30-50 mm). Grade I, II, and III were observed in 13, 49, and 17 cases, respectively. There was a wide distribution of RS with a median of 21.4 (IQR, 16.05-26.75). In tot...Continue Reading

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Citations

Nov 7, 2016·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·T P McVeighA J Lowery
Sep 20, 2018·The Breast Journal·Parker C WilsonMalini Harigopal
Jun 5, 2020·Journal of Surgical Oncology·Debbie M JakubowskiFrederick L Baehner
Nov 25, 2020·Annals of Surgical Oncology·Olga Kantor, Suzanne B Coopey
Feb 19, 2021·The Breast : Official Journal of the European Society of Mastology·Serafin Morales MurilloAntonieta Salud Salvia

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