TAILORx: adjuvant chemotherapy guided by the 21-gene recurrence score in hormone receptor-positive, node-negative breast cancer
Women with hormone receptor-positive, HER2-negative, node-negative breast cancer and a mid-range 21-gene recurrence score did just as well with endocrine therapy alone as with chemotherapy added, sparing most of them chemotherapy.
Overview
Prospective trial of 10,273 women with hormone receptor-positive, HER2-negative, axillary node-negative breast cancer; those with a recurrence score of 11 to 25 (6,711 women) were randomised to endocrine therapy alone or chemoendocrine therapy.
Nine-year invasive disease-free survival was 83.3 percent with endocrine therapy against 84.3 percent with chemoendocrine therapy, meeting non-inferiority. Some benefit from chemotherapy was seen in women aged 50 or younger with scores of 16 to 25.
- Nine-year invasive disease-free survival 83.3 percent vs 84.3 percent for scores 11 to 25 (hazard ratio 1.08, non-inferior).
- Women 50 or younger with scores 16 to 25 had some chemotherapy benefit.
Most women with node-negative hormone receptor-positive breast cancer can safely skip chemotherapy on the basis of a genomic assay; the exception is premenopausal women with scores in the upper part of the intermediate range.
- The benefit in younger women may partly reflect chemotherapy-induced ovarian suppression.
- Node-positive disease was addressed separately in RxPONDER.
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