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De-escalating adjuvant therapy is feasible for younger early-stage breast cancer patients with low Oncotype DX 21-gene recurrence score (ODX RS). Completing at least one adjuvant therapy significantly lowers locoregional recurrence (LRR) risk, supporting ODX RS in treatment decisions.

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Area of Science:

  • Oncology
  • Genomic Biomarkers
  • Breast Cancer Treatment

Background:

  • Adjuvant therapy de-escalation is established for older breast cancer patients.
  • The role of genomic biomarkers like Oncotype DX 21-gene recurrence score (ODX RS) in de-escalating therapy for younger patients remains unclear.

Purpose of the Study:

  • To assess the outcomes of de-escalating radiotherapy (RT) or endocrine therapy (ET) in early-stage breast cancer patients aged 50-69 with an ODX RS of 18 or below.

Main Methods:

  • A cohort study analyzed 2249 patients (aged 50-69) with early-stage, hormone receptor-positive, ERBB2-negative breast cancer and ODX RS ≤18 treated with lumpectomy and ET, with or without RT.
  • Adherence to ET was defined as ≥5 years of treatment or ongoing therapy.

Main Results:

  • The 72-month cumulative incidence of locoregional recurrence (LRR) was significantly lower with RT (1.1%) compared to no RT (8.0%).
  • RT provided the lowest LRR risk regardless of ET adherence.
  • ET adherence alone (without RT) resulted in a 5.5% LRR, while nonadherence to both RT and ET showed the highest LRR (11.0%).

Conclusions:

  • Completing at least one adjuvant therapy (RT or ET) is associated with significantly lower LRR rates in younger early-stage breast cancer patients with ODX RS ≤18.
  • The ODX RS may help identify younger patients suitable for RT omission, expanding de-escalation options beyond current guidelines for those accepting a slightly increased LRR risk.