Clifford Hudis, MD, Chief of the Breast Medicine Service at Memorial Sloan Kettering Cancer Center, New York, said the findings suggest there is essentially no meaningful benefit from chemotherapy in the recurrence score low-risk subset.
“It is clinically appropriate to offer endocrine therapy alone to patients with node-negative disease when the recurrence score is below 11,” he said as a discussant of the trials results presented at the Presidential Session of the 2015 European Cancer Congress.
However, in his editorial in The New England Journal of Medicine, he suggested the results are “both reassuring and frustrating” and questioned whether clinicians might be confused by the modification of the risk scoring in the study.1 “For the many physicians already using the test, the gap between this [low-risk] cutoff point of 10 and the higher ‘standard’ cutoff point of 18 may be a concern,” Dr. Hudis said.
Conflicting Guides to Treatment
“There will be two conflicting guides to their treatment that need to be reconciled: the cutoff point used in this trial and the previously available cutoff point that is associated with the commercial test,” he explained.
Dr. Hudis added that risk (ie, prognosis) is related to both biology and anatomic presentation and that risk reductions are related to anatomic presentation, but only within appropriately identified and responsive biologic subsets, according to the results.
“The prediction of the benefit of chemotherapy remains to be validated,” he continued. “The key TAILORx result still pends: Does chemotherapy add for scores of 11–25? But, if it does, was 11 the right cut point? And what do we do about patients in the 11–18 range, given the commercial reports?” Efforts to answer these questions, he said, are part of the “many steps needed in the march to precision.” ■
Disclosure: Dr. Hudis reported no potential conflicts of interest.
Reference
1. Hudis CA: Biology before anatomy in early breast cancer: Precisely the point. Editorial. N Engl J Med. September 28, 2015 (early release online).
