A RECENT analysis of the IDEAL clinical trial highlights a breakthrough for early-stage breast cancer. The study shows that a 70-gene expression risk-of-recurrence assay can guide decisions about extended endocrine therapy (EET), offering a tailored approach to treatment and reducing unnecessary side effects.
Extended endocrine therapy is known to lower the risk of breast cancer recurrence, but not all patients benefit equally. This new analysis identifies a subset of patients with hormone receptor–positive, early-stage breast cancer who can benefit from 5 years of EET with letrozole compared to the standard 2.5 years.
The study involved 515 postmenopausal women randomized to either 2.5 or 5 years of letrozole. Among these, patients with assay-classified low-risk tumors experienced a significant 10.1% reduction in distant recurrence when treated for five years (HR: 0.32; 95% CI: 0.12-0.87). Patients classified as high- or ultralow-risk saw no significant benefit from the extended treatment, suggesting they can safely avoid the additional side effects associated with prolonged therapy.
The findings emphasize the potential of genomic tools to refine treatment strategies, sparing some patients from the burdens of unnecessary therapy while focusing resources on those who stand to gain the most.
This personalized approach could be a game-changer in optimizing outcomes and reducing overtreatment.
Reference: van ’t Veer LJ et al. Selection of patients with early-stage breast cancer for extended endocrine therapy. JAMA Netw Open. 2024;7(11):e2447530.
