NEW RESEARCH presented at the San Antonio Breast Cancer Symposium (SABCS), 2024 have showed findings indicating that patients with early-stage, node-negative, HR-positive, HER2-negative breast cancer who have a high risk of recurrence may benefit from the addition of anthracyclines to taxane-based chemotherapy. Genomic testing, particularly the OncotypeDX test, was instrumental in identifying these patients, aiding in the determination of the most appropriate treatment approach.
While taxane-based chemotherapy has been the standard, the addition of anthracyclines has not been consistently supported due to limited data. However, the results from the TAILORx trial demonstrate that high-risk patients, defined as those with OncotypeDX recurrence scores (RS) above 26, experience improved outcomes when treated with anthracycline-based regimens.
In this study, patients with an RS greater than 31 exhibited significant improvements in survival outcomes when treated with taxane and anthracycline-based chemotherapy compared to those receiving taxane-based regimens alone. These patients had higher distant recurrence-free survival (96.1% vs. 90.7%) and overall survival (97.3% vs. 93.1%) at five years. In contrast, no benefit was observed for patients with RS scores between 26 and 30.
The findings were consistent across both premenopausal and postmenopausal patients, suggesting that the ovarian suppression effects of anthracyclines may not be the primary driver of the observed benefits. Higher RS values are often associated with tumors that have lower estrogen receptor expression and higher proliferation, traits that align more closely with triple-negative breast cancer – where the benefits of anthracyclines have been well-documented.
However, caution was advised regarding potential late effects, such as increased risks of non-breast cancer mortality. These findings highlight the importance of considering both the benefits and risks of anthracycline-based regimens, ensuring that decisions are made in consultation with patients to balance short-term survival improvements with potential long-term risks.
Overall, these results emphasize the role of genomic testing in guiding chemotherapy decisions, particularly for patients at high risk of recurrence, while paving the way for further research into anthracycline-based regimens.
Reference: Chen N et al. Â Impact of Anthracyclines in High Genomic Risk Node-Negative HR+/HER2- Breast Cancer. 2024. Available at: https://aacr.ent.box.com/s/nho7n0bqbxjt2i2d2t1e32viij71zg6a. Last accessed: 13 December 2024.
