Abstract 3713
Background
Decision making on adjuvant systemic therapy in women with primary node-negative, HR+ breast cancer and intermediate risk scores on a molecular tumor profile has often been difficult, and may be based also on additional clinical factors such as age, tumor size and grade. In mid-2018 new level 1 evidence on the lack of additional benefit with chemo-hormonal therapy versus hormonal therapy for most of these patients emerged. We sought to determine if systemic adjuvant therapy choices have changed in a large community practice of over 200 medical oncologists in the U.S. using in-house tumor testing with the Prosigna PAM 50 assay. There is robust clinical evidence on recurrence risk estimation with PAM 50. Data from the ABCSG-8 estimates distant RFS of 91.3% at ten years in the intermediate risk group treated with hormonal therapy alone. Decreased chemo use would lead to decreased therapy-related toxicity and probable healthcare cost savings.
Methods
We compared Prosigna ROR results in individual postmenopausal women with HR+, node- primary breast cancers from the period 9/17 through 6/18, with the period 6/18 through 3/19. Approximately 800 total tests were run from one large practice in the U.S. About 20% fell into the intermediate score range We compared the number of patients receiving adjuvant chemohormonal therapy versus hormonal therapy alone or no systemic therapy. Physicians were polled as to whether their decisions were influenced by the ROR score, clinical factors, or both.
Results
During the period studied, the percentage of patients with intermediate ROR scores receiving adjuvant therapy declined. Physicians based their decisions on the scores primarily, along with other clinical factors. The percentages of physicians influenced by each factor and the totals for each category of treatment will be presented in the final poster.
Conclusions
Oncologists in a large practice are influenced in making breast cancer adjuvant therapy decisons by recent trial data, as well as clinical factors, and may extrapolate from one molecular profile to another. Adjuvant chemo use in HR+ node- patients is likely to remained confined to patients with a high-risk profile, regardless of the assay used.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Florida Cancer Specialists.
Funding
Has not received any funding.
Disclosure
L.L. Hart: Advisory / Consultancy, Travel / Accommodation / Expenses: Self. All other authors have declared no conflicts of interest.
Resources from the same session
5792 - A novel PET parameter for cancer stem cell metabolism: early prediction of chemosensitivity to neoadjuvant chemotherapy in locally advanced breast cancer
Presenter: Chanwoo Kim
Session: Poster Display session 2
Resources:
Abstract
3728 - Using nodal ratio to predict recurrence in patients with 4 or more positive lymph nodes early stage breast cancer
Presenter: Besma Graja
Session: Poster Display session 2
Resources:
Abstract
3395 - Re-sentinel node biopsy for local recurrence after breast-conserving surgery
Presenter: Yuka Matsubara
Session: Poster Display session 2
Resources:
Abstract
4302 - Assessment of prognostic and therapeutic factors in men with breast cancer
Presenter: Daniel Herrero Rivera
Session: Poster Display session 2
Resources:
Abstract
4263 - Genomic Profiling of Chinese Breast Cancer Patients
Presenter: Zhonghua Tao
Session: Poster Display session 2
Resources:
Abstract
2406 - Genome copy number alteration burden represents predictor of response in long-term, never relapse exceptional responders of trastuzumab-treated HER2+ metastatic breast cancer
Presenter: Naomi Walsh
Session: Poster Display session 2
Resources:
Abstract
2575 - Next-generation DNA Sequencing (NGS) Results for Tumors From Phase 2 ABRAZO Study of Talazoparib After Platinum or Cytotoxic Non-Platinum Regimens in Patients (pts) With Advanced Breast Cancer (ABC) and Germline BRCA1/2 (gBRCA) Mutations
Presenter: Nicholas C. Turner
Session: Poster Display session 2
Resources:
Abstract
4499 - FGFR1 and CCND1 gene amplifications are associated with breast cancer resistance to aromatase inhibitors
Presenter: Evgeny Imyanitov
Session: Poster Display session 2
Resources:
Abstract
4110 - Clinicopathologic features of BRCA mutated breast cancer patients: Hacettepe Experience
Presenter: Sercan Aksoy
Session: Poster Display session 2
Resources:
Abstract
5203 - Novel fusion genes identified from matched primary and recurred breast cancers by RNA-sequencing
Presenter: Soojeong Choi
Session: Poster Display session 2
Resources:
Abstract