Harold A. Burstein, M.D, discusses guideline updates on integration results from TAILORx.
Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: ASCO Clinical Practice Guideline UpdateIntegration of Results from TAILORx
Guideline Question
For women with early-stage invasive breast cancer, which other biomarkers have demonstrated clinical utility to guide decisions on the need for adjuvant systemic therapy?
Target Population
Women with early-stage invasive breast cancer being considered for adjuvant systemic therapy.
Target Audience
Medical, surgical, and radiation oncologists; oncology nurses and physician assistants; pathologists; general practitioners; and patients.
Methods
An Expert Panel was convened to update the clinical practice guideline recommendations based on a review of recently published literature.
Updated Recommendations
All recommendations refer to patients who present with a hormone receptorpositive, human epidermal growth factor receptor not overexpressed, axillary nodenegative early breast cancer
Recommendation 1.1.1.
For patients older than 50 years and whose tumors have Oncotype DX recurrence scores of less than 26, and for patients age 50 years or younger whose tumors have Oncotype DX recurrence scores of less than 16, there is little to no benefit from chemotherapy. Clinicians may offer endocrine therapy alone (Type of recommendation: evidence based, benefits outweigh harms; Evidence quality: high; Strength of recommendation: strong).
Recommendation 1.1.2.
For patients age 50 years or younger with Oncotype DX recurrence scores of 16 to 25, clinicians may offer chemoendocrine therapy (Type of recommendation: evidence based, benefits outweigh harms; Evidence quality: intermediate; Strength of recommendation: moderate).
Recommendation 1.1.3.
Patients with Oncotype DX recurrence scores of greater than 30 should be considered candidates for chemoendocrine therapy (Type of recommendation: evidence based, benefits outweigh harms; Evidence quality: high; Strength of recommendation: strong).
Recommendation 1.1.4.
Based on Expert Panel consensus, oncologists may offer chemoendocrine therapy to patients with Oncotype DX scores of 26 to 30 (Type of recommendation: informal consensus; Evidence quality: insufficient; Strength of recommendation: moderate).
Refer to Table 1 for the full list of the original recommendations for Question 1.
ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care, and that all patients should have the opportunity to participate.