Keerthi Gogineni, MD, MSHP
Keerthi Gogineni, MD, MSHP, Assistant Professor of Hematology and a medical oncologist at Emory University School of Medicine, Atlanta, commented on the long-term follow-up of the MINDACT trial presented at the 12th European Breast Cancer Conference.
She noted that, for patients with early-stage hormone receptor–positive, HER2-negative breast cancer, oncologists have multiple tools for estimating prognosis, most notably the 70-gene signature (MammaPrint) and the 21-gene recurrence score (Oncotype DX). The latter also predicts benefit from chemotherapy. These validated and widely adopted genomic assays can identify patients whose low genomic risk enables the omission of adjuvant chemotherapy and whose high risk of recurrence warrants risk reduction with cytotoxic chemotherapy, according to Dr. Gogineni.
MINDACT identified clinical and genomic risk among nearly 7,000 women with invasive breast cancer up to 5 cm and with up to three positive nodes using MammaPrint and Adjuvant! Online.1 Its primary objective was to determine whether patients with high clinical risk and low genomic risk would have a 5-year distant metastasis–free survival of more than 92%.
“The updated analysis with longer follow-up confirmed that patients with this profile had limited benefit (2.6%) from chemotherapy compared with those who did not receive chemotherapy. Of note, the subgroup analysis identified a larger benefit (5%) from chemotherapy in women aged 50 or younger who had a high clinical risk and a low genomic risk,” noted Dr. Gogineni. “These findings reinforce similar exploratory analyses in the TAILORx trial, which found that younger women with a high clinical risk and 21-gene recurrence scores of between 16 and 20 had lower recurrence rates with -chemotherapy.”2
Informed Decisions for Patients
“Aggressive endocrine blockade with ovarian suppression and aromatase inhibitors may achieve a similar benefit in premenopausal women. However, the trade-off between side effects and risk reduction from chemotherapy and endocrine blockade could be interpreted differently, depending on the patient,” Dr. Gogineni said.
“Postmenopausal women with a high clinical risk and low MammaPrint scores for whom a 2.6% benefit from chemotherapy is not meaningful can safely forgo adjuvant cytotoxic agents. Premenopausal women with a high clinical risk and low MammaPrint scores need to have a nuanced conversation with their oncologists to make informed adjuvant systemic therapy decisions,” she commented.
DISCLOSURE: Dr. Gogineni has received institutional funding from Merck, Calithera, Pfizer, Novartis, Seagen, and Genentech and has served on an advisory board and received foundation funding from Pfizer.
REFERENCES
1. Cardoso F, van’t Veer LJ, Bogaerts J, et al: 70-gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med 375:717-729, 2016.
2. Sparano JA, Gray RJ, Makower DF, et al: Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med 80:2395-2405, 2019.
