Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx

Abstract

Background. Recurrence score (RS) testing in early-stage, ER-positive breast cancer is used to predict the benefit of adjuvant chemotherapy for disease recurrence and overall survival. TAILORx results decreased the ambiguity of “intermediate risk” RS by creating a binary classification system. We aimed to determine how women ≥ 70 years with intermediate RS were redistributed post-TAILORx and to identify predictors of low RS. Methods. Patients ≥ 70 years with early-stage, node-negative, ER-positive breast cancers in the National Cancer Database(2006–2014) were included. “Pre-TAILORx” RS were classified as low (0–17), intermediate (18–30), and high (> 30). “Post-TAILORx” RS were classified as low (0–25) and high (> 25). Results. In total, 14,925 women were included. Average age was 74 years. 60% (n = 9009) had low pre-TAILORx RS, 31% (n = 4635) intermediate, and 9% (n = 1281) high. Of 4635 patients with intermediate RS, 72% (n = 3660) were reclassified to low RS. Only 12% (n = 1783) of patients received chemotherapy. Of patients with pre-TAILORx intermediate RS who received chemotherapy, 55% (n = 417) would have been spared chemotherapy by being reclassified with low RS post-TAILORx. The strongest predictor of post-TAILORx low RS was tumor grade; 95% of well-differentiated had low RS, compared with 56% of poorly/undifferentiated tumors (p < 0.001). Smaller tumor size also was associated with low RS. Age was not associated with RS. Conclusions. With post-TAILORx RS criteria, the vast majority of patients ≥ 70 years can be classified as low-risk and unlikely to benefit from chemotherapy. Given that the elderly have greater rates of chemotherapy-associated complications, reconsideration of routine RS testing in patients ≥ 70 years is warranted. Tumor grade and size also may inform the decision to omit RS testing.

The Utility of the Oncotype DX Test for Breast Cancer Patients in an Australian Multidisciplinary Setting

“…Since the development of Oncotype DX RS assay in 2004, RS testing has allowed for a more nuanced understanding of tumor biology and potential benefit from adjuvant chemotherapy in certain patient groups [ 9 ]. It has also led to the reduction of the use of adjuvant chemotherapy as demonstrated in a study by Hassett et al, reporting a 13% decline in the use of chemotherapy between 2006 and 2008 [ 10 ].…”

Evaluation of whether adjuvant chemotherapy can be safely omitted for older female patients with ER-positive, HER2-negative N1 breast cancer: a study based on the SEER database

“…The exploratory subgroup analysis showed that while the benefit of adjuvant CT was significant in the subgroup of patients with grade III BC, it was not significant in the grades I-II subgroups. Lee et al concluded that there was a significant correlation between tumor grade and RS; 95% of patients with well-differentiated tumors had low RS, and 56% of patients with poorly/undifferentiated tumors had low RS (25). The interim analysis of the RxPONDER trial, which was presented at the 2020 San Antonio Breast Cancer Symposium, also suggested that adjuvant CT did not benefit postmenopausal patients with ER+, HER2-N1 BC and RS ≤25.…”