Early HR+/HER2- disease: chemo benefit seen even with midrange recurrence scores

  • Ma SJ & al.
  • JAMA Netw Open
  • 1 May 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Chemotherapy is as beneficial for survival in patients with oncotype recurrence scores of 26-30 as with scores ≥31, according to a nationwide database analysis of patients with early, hormone receptor (HR)-positive/HER2− breast cancer.

Why this matters

  • A 2018 pivotal study showed that chemotherapy conferred no extra benefit for women with scores of 11-25 vs ≥26, but did not address the benefit of scores in the 26-30 range.
  • These results suggest that patients with scores in this range should receive chemotherapy.

Study design

  • Retrospective US cohort study (n=17,197) of patients with early breast cancer and recurrence scores ≥26 in the National Cancer Database.
  • 12,741 received chemotherapy.
  • Funding: None disclosed.

Key results

  • Median follow-up was 40.7 months.
  • Regardless of chemotherapy status, vs lower scores, a recurrence score ≥31 was associated with worse mortality:
    • HR, 1.75 (P<.001>
  • In patients with scores of 26-30, chemotherapy was associated with better OS than not receiving chemotherapy:
    • HR, 0.70 (P=.04).
  • The extent of chemotherapy benefit was similar between patients with recurrence scores of: 
    • 26-30: HR, 0.59 (P<.001 and>
    • ≥31: HR, 0.56 (P<.001>

Limitations

  • Retrospective, observational.
  • Residual selection bias.