In current practice, risk assessment for locoregional recurrence (LRR) in breast cancer is based on established anatomic and histopathologic factors. In a recent study, Mamounas and colleagues used the knowledge that the presence of LRR is a significant indicator of distant recurrence to hypothesize that “genomic profiles that predict risk for distant recurrence will also predict risk for LRR.”
The 21-gene recurrence score (RS) assay (Oncotype DX®) provides a validated, quantified risk of distant recurrence in patients with node-negative, estrogen receptor (ER)-positive, tamoxifen-treated breast cancer. Indeed, the guidelines from both ASCO and the National Comprehensive Cancer Network include the use of RS for the management of node-negative, ER-positive breast cancer.
“The primary objective of this study was to examine the relationship between the RS and risk of LRR in tamoxifen-treated patients” explains Mamounas, lead investigator of the study. The researchers achieved this by examining the RS and time to first LRR of 895 tamoxifen-treated patients, 355 placebo-treated patients and 424 patients who received chemotherapy and tamoxifen, all of whom had taken part in either the NSABP B-14 or NSABP B-20 trials.
A significant association between RS and LRR was observed for all cohorts, which was dependent on the treatment. In tamoxifen-treated and mastectomy-treated patients, the association was independent of age. By contrast, the association was more complex for patients receiving radiation therapy and lumpectomy; indicating that “radiation may be more effective as RS increases.”
Mamounas noted, “Given the strong association between distant recurrence and LRR, our findings are not surprising”; however, “this is the first demonstration of such an association based on a sizable population of patients from randomized clinical trials of adjuvant therapy.” Therefore, “these results have biologic and potential clinical implications.”
ORIGINAL RESEARCH PAPER
Mamounas, E. P. et al. Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J. Clin. Oncol. 28, 1677–1683 (2010)
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Kirk, R. Oncotype DX® assay predicts local recurrence in breast cancer. Nat Rev Clin Oncol 7, 300 (2010). https://doi.org/10.1038/nrclinonc.2010.75
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DOI: https://doi.org/10.1038/nrclinonc.2010.75
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