2018 ASCO Annual Meeting!
Session: Breast Cancer—Local/Regional/Adjuvant
Type: Poster Session
Time: Saturday June 2, 8:00 AM to 11:30 AM
Location: Hall A
Selection for Oncotype Dx testing among young women with early-stage ER+/HER2- breast cancer.
2018 ASCO Annual Meeting
Poster Board Number:
Poster Session (Board #25)
J Clin Oncol 36, 2018 (suppl; abstr 533)
Author(s): Philip Daniel Poorvu, Shari I. Gelber, Shoshana M. Rosenberg, Kathryn Jean Ruddy, Rulla Tamimi, Jeffrey M. Peppercorn, Lidia Schapira, Virginia F. Borges, Steven E. Come, Laura C. Collins, Ellen Warner, Ann H. Partridge; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Department of Oncology, Rochester, MN; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Stanford Cancer Center, Palo Alto, CA; University of Colorado Comprehensive Cancer Center, Aurora, CO; Beth Israel Deaconess Medical Center, Boston, MA; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Background: The Oncotype Dx Recurrence Score (RS) predicts distant recurrence risk and benefit from chemotherapy for women with early-stage estrogen receptor (ER) positive (+)/human epidermal growth factor receptor 2 (HER2) negative (-) breast cancer (BC). Due to the independent risk of young age and small proportion of young women in the validation studies, providers may be hesitant to rely on the RS among young women. Methods: Using a multi-center, prospective cohort study of women newly diagnosed with BC at age ≤40 years enrolled from 2006-2016, we identified participants with stage I-III, ER+/HER2- BC. Clinical data were obtained through patient surveys and medical record review. Factors associated with RS testing by univariable analyses (p < 0.20) were used to generate a multivariable logistic regression model. Results: 182 (32%) of 575 eligible women had a RS performed (Table 1). Younger women (ORage ≤30 vs 36-40= 0.49, p = 0.03) and those with larger (OR> 2cm vs ≤2cm= 0.54, p = 0.007), node positive (ORpos vs neg= 0.14, p < 0.0001) or high grade tumors (ORhigh vs low/intermediate= 0.37, p < 0.0001) were less likely to have a RS performed. Of women who had a RS performed, chemotherapy usage was 21/88 (24%), 44/77 (57%), and 17/17 (100%) among those with low, intermediate, and high RS, respectively. Most women with low risk RS who received chemotherapy had other low risk features: 67% T1, 67% N0, and 86% low/intermediate grade. Conclusions: Despite the development of multigene testing to assess the benefit of chemotherapy, many young women with node-negative ER+/HER2- BC are not tested, and when tested, a substantial percentage receive chemotherapy despite a low RS. This highlights an opportunity to improve individualized care for young women with BC.
|RS/N (%)||OR (95% CI)||p-value|
|Age ≤30||18/75 (24)||0.49 (0.26,0.93)||0.03|
|31-35||48/158 (30)||0.87 (0.55,1.34)||0.57|
|Tumor size ≤ 2cm||137/326 (42)||Ref|
|> 2cm||45/249 (18)||0.54 (0.35,0.85)||0.007|
|Nodal status N0||154/322 (48)||Ref|
|N+||25/249 (10)||0.14 (0.09,0.24)||< 0.0001|
|Grade Low/Intermediate||146/357 (41)||Ref|
|High||35/213 (16)||0.37 (0.24,0.59)||< 0.0001|
* Missing data and factors not associated with RS testing not included
1. TAILORx: Phase III trial of chemoendocrine therapy versus endocrine therapy alone in hormone receptor-positive, HER2-negative, node-negative breast cancer and an intermediate prognosis 21-gene recurrence score.