Choice of adjuvant systemic therapy in hormone receptor-positive, HER2-negative early breast cancer that is node negative

HER2: human epidermal growth factor receptor 2; RS: recurrence score.

* Using a gene expression profile to guide chemotherapy decisions is only appropriate in patients who are appropriate candidates for chemotherapy. Candidacy for chemotherapy is determined by baseline health status.

¶ Other gene expression profiles are available as well, including PAM50, Mammaprint, Endopredict, and the Breast Cancer Index.

Δ Data supporting chemotherapy for RS 25 to 30 are less clear than for RS >30. Refer to UpToDate topic on deciding when to use chemotherapy in hormone receptor-positive, HER2-negative breast cancer for further details.

◊ TAILORx suggested that in women ≤50 years and with an intermediate RS, chemotherapy plus endocrine therapy was associated with a lower rate of distant recurrence relative to endocrine therapy alone, particularly for those with high-intermediate scores (21 to 25) or clinical risk features. However, this was based only on exploratory subset analyses, and moreover, some of the benefit hypothetically may have been due to ovarian suppression in premenopausal women. Ovarian suppression was not assessed as a treatment strategy in this trial, however. In light of limitations in the data, either chemotherapy and endocrine therapy, or endocrine therapy only (with ovarian suppression in premenopausal women) are acceptable options. Refer to UpToDate topic on deciding when to use chemotherapy in hormone receptor-positive, HER2-negative breast cancer for further details.