Invited discussant Anne Blaes, MD, Associate Professor of Medicine at the University of Minnesota, Minneapolis, commented on Dr. Braybrooke’s study. “In 18,000 patients in randomized trials initiated before 2012, there was a 15% improvement in recurrence with the use of anthracyclines plus taxanes vs taxanes alone, with a small improvement in breast cancer–specific  mortality. Regimens with concurrent anthracycline plus taxanes had a larger benefit vs sequential treatment. How do we put this together with other studies?” she asked.

Anne Blaes, MD

“Many women with early-stage breast cancer will do well and may require tamoxifen alone. The use of a genomic platforms is important to risk-stratify the role of chemotherapy. Premenopausal women, who are estrogen receptor–positive, with an Oncotype DX recurrence score of 11 to 25 and node-positive disease may benefit from chemotherapy. For high-risk patients who need chemotherapy, the addition of an anthracycline to a taxane will provide an additional 15% reduction in recurrence. For patients who receive chemotherapy, endocrine treatment with ovarian suppression plus an aromatase inhibitor provide the most protection against recurrence and overall survival,” she stated.

“In the current environment, questions remain about how to incorporate excellent responses [ie, pathologic complete response] into decisions about the optimal choice and duration of endocrine therapy. Weighing aspects of survivorship, such as cardiovascular risk, fertility, bone health, and quality of life, in discussions with patients is essential,” Dr. Blaes said.

DISCLOSURE: Dr. Blaes reported no conflicts of interest.