Limiting systemic endocrine overtreatment in postmenopausal breast cancer patients with an ultralow classification of the 70-gene signature

M. Opdam, V. van der Noort, M. Kleijn, A. Glas, I. Mandjes, S. Kleiterp, F. S. Hilbers, D. T. Kruger, A. D. Bins, P. C. de Jong, P. P.J.B.M. Schiphorst, T. van Dalen, B. Flameling, R. C. Rietbroek, A. Beeker, S. M. van den Heiligenberg, S. D. Bakker, A. N.M. Wymenga, I. M. Oving, R. M. BijlsmaP. J. van Diest, J. B. Vermorken, H. van Tinteren, S. C. Linn

Onderzoeksoutput: Bijdrage aan tijdschriftArtikelpeer review

Samenvatting

Purpose: Guidelines recommend endocrine treatment for estrogen receptor-positive (ER+) breast cancers for up to 10 years. Earlier data suggest that the 70-gene signature (MammaPrint) has potential to select patients that have an excellent survival without chemotherapy and limited or no tamoxifen treatment. The aim was to validate the 70-gene signature ultralow-risk classification for endocrine therapy decision making. Methods: In the IKA trial, postmenopausal patients with non-metastatic breast cancer had been randomized between no or limited adjuvant tamoxifen treatment without receiving chemotherapy. For this secondary analysis, FFPE tumor material was obtained of ER+HER2− patients with 0–3 positive lymph nodes and tested for the 70-gene signature. Distant recurrence-free interval (DRFI) long-term follow-up data were collected. Kaplan–Meier curves were used to estimate DRFI, stratified by lymph node status, for the three predefined 70-gene signature risk groups. Results: A reliable 70-gene signature could be obtained for 135 patients. Of the node-negative and node-positive patients, respectively, 20% and 13% had an ultralow-risk classification. No DRFI events were observed for node-negative patients with an ultralow-risk score in the first 10 years. The 10-year DRFI was 90% and 66% in the low-risk (but not ultralow) and high-risk classified node-negative patients, respectively. Conclusion: These survival analyses indicate that the postmenopausal node-negative ER+HER2− patients with an ultralow-risk 70-gene signature score have an excellent 10-year DRFI after surgery with a median of 1 year of endocrine treatment. This is in line with published results of the STO-3-randomized clinical trial and supports the concept that it is possible to reduce the duration of endocrine treatment in selected patients.

Originele taal-2Engels
Pagina's (van-tot)265-278
Aantal pagina's14
TijdschriftBreast Cancer Research and Treatment
Volume194
Nummer van het tijdschrift2
DOI's
StatusGepubliceerd - jul. 2022

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