NEJM: 21 gene testing provides prognostic information for the benefit of chemotherapy for patients with lymph node-positive breast cancer

The recurrence score based on 21-gene breast cancer detection can be used clinically to predict the benefit of chemotherapy for hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, and axillary lymph node-negative breast cancer
.
In women with positive lymph node disease, the role of recurrence score in predicting the benefit of adjuvant chemotherapy is unclear

Recently, the top medical journal NEJM published a research article.
In this prospective trial, researchers randomly assigned hormone receptor positive, HER2-negative breast cancer, 1 to 3 axillary lymph nodes positive, and a recurrence score of 25 or Patients with lower scores (scores ranging from 0 to 100, higher scores indicate a poor prognosis) patients receive only endocrine therapy or chemotherapy plus endocrine (chemical endocrine) therapy
.
The main purpose of this study is to clarify the effect of chemotherapy on non-invasive disease survival and whether this effect is affected by the recurrence score

The study included 5083 women (33.
2% were premenopausal women and 66.
8% were postmenopausal women) who were randomized and 5018 women participated in the trial
.
In the third pre-specified interim analysis, the benefits of chemotherapy in increasing survival without invasive disease varied according to menopausal status (compare the benefits of chemotherapy in pre- and post-menopausal participants, P=0.

Among premenopausal women, the 5-year survival rate without invasive disease was 89.
0% in the endocrine therapy group alone, and 93.
9% in the chemical endocrine therapy group (hazard ratio 0.
60; 95% CI 0.
43 to 0.
83; P=0.
002).
Survival without distant recurrence was similarly increased (hazard ratio 0.
58; 95% CI 0.
39 to 0.
87; P=0.
009)
.
As the recurrence score increased, the relative benefit of chemotherapy did not increase

It can be seen that among premenopausal women with 1 to 3 positive lymph nodes and a recurrence score of 25 or lower, women who received chemical endocrine therapy had better survival without invasive disease and no distant recurrence than those with endocrine therapy alone.
Women are longer, and the non-invasive disease survival of postmenopausal women is similar to the survival without distant recurrence, and they do not benefit from adjuvant chemotherapy
.

Original source: Kevin Kalinsky, et al.