Is Age Trumping Genetic Profiling in Clinical Practice? Relationship of Chemotherapy Recommendation and Oncotype DX Recurrence Score in Patients Aged < 50 Years versus ≥ 50 Years, and Trends Over Time

Abstract

The testing of oDX in BC has significantly increased since first implemented. Results from additional studies such as TAILORx will clarify the current discordant practice patterns between low oDX RSs and adjuvant chemotherapy recommendations.

Clinical utility of genomic signatures in young breast cancer patients: a systematic review

“…While this suggests that YWBC might not be under-represented in clinical studies, such low prevalence hinders the individual trials to perform statistically reliable subgroup analyses of these patients. Noteworthy, only 5% of the evaluated studies had a main objective focused on young women 22,37,38 . In the current systematic review, we have tried to address such limitations by performing a pooled analysis to refine the knowledge regarding the role of genomic tests in YWBC.…”

“…Other noteworthy analyses of prognostic value of Oncotype DX in YWBC include Harbeck et al 24 who demonstrated that patients aged <40 years with a high recurrence score using the TAILORx threshold (i.e., >25) had a similar DFS than their older counterparts when treated with chemotherapy, and Sparano et al 25 who showed that patients aged ≤40 years who had high-intermediate risk scores (i.e., [16][17][18][19][20][21][22][23][24][25] did not benefit from chemotherapy addition in terms of DFS.…”

“…3 Proportion of patients that underwent genomic testing with Oncotype DX according to age. Data were extracted from studies by Poorvu et al 21 , Lund et al 20 , and Williams et al 22 . Table 2.…”

“…Lastly, Barcenas et al 33 conducted a single center retrospective analysis on patients with stage I-II, hormone-receptor-positive/ HER2-negative, N0 disease who had an Oncotype DX test performed. Among patients with an intermediate score according to TAILORx thresholds (i.e., [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], it was found that patients who were treated with chemotherapy were younger (38% of patients aged ≤40 years received chemotherapy vs. 15% of their older counterparts), had larger tumors and a higher clinical stage.…”

Recent advances in breast cancer research impacting clinical diagnostic practice

“…Of patients with a low risk score (recurrence score [RS] < 10) who received endocrine therapy alone, 93.8% were distant recurrence‐free 5 years after diagnosis and overall survival was 98%, suggesting that chemotherapy can safely be withheld in this cohort . Expanding the investigation to include patients in the intermediate‐risk category (RS 11–25) showed that after 9 years there were no differences in disease‐free or overall survival between the two groups, except for women under 50 years of age, who benefited from the addition of chemotherapy . Overall, the TAILORx trials showed that early stage, HR‐positive/HER2‐negative patients with low or intermediate RS do not benefit from the addition of chemotherapy.…”