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Adjuvant Chemotherapy Use for Hormone Receptor-Positive, ERBB2-Negative Breast Cancer After RxPONDER Trial.

Jincong Q Freeman1,2,3, Poornima Saha4, Daniel S Peiffer5

  • 1Department of Public Health Sciences, The University of Chicago, Chicago, Illinois.

JAMA Network Open
|February 3, 2026
PubMed
Summary

Adjuvant chemotherapy use increased in premenopausal women with node-positive, HR-positive, ERBB2-negative breast cancer, especially those with low to intermediate genomic risk. However, disparities persist, with Black women showing lower chemotherapy receipt compared to White women.

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Area of Science:

  • Oncology
  • Genomics
  • Health Disparities

Background:

  • The 21-gene recurrence score (RS) guides adjuvant chemotherapy in HR-positive, ERBB2-negative breast cancer.
  • Applicability of RS to premenopausal women with positive nodes and minority groups remains unclear.

Purpose of the Study:

  • To analyze temporal trends and disparities in adjuvant chemotherapy use.
  • To examine chemotherapy use based on age, genomic risk, and nodal status in early-stage breast cancer.

Main Methods:

  • Retrospective cohort study using the National Cancer Database (2010-2022).
  • Included women with stage I-III HR-positive, ERBB2-negative breast cancer.
  • Categorized patients by menopausal status, nodal status, and genomic risk (RS 0-10 low, 11-25 intermediate, ≥26 high).

Main Results:

  • Chemotherapy use decreased in premenopausal node-negative, low/intermediate genomic risk patients.
  • Chemotherapy use increased in premenopausal node-positive, low/intermediate genomic risk patients (2019-2022).
  • Black women had lower odds of chemotherapy receipt than White women across various subgroups.

Conclusions:

  • Adjuvant chemotherapy use patterns shifted following TAILORx and RxPONDER trials, particularly in premenopausal node-positive patients.
  • Genomic assay utilization varies, impacting adjuvant therapy recommendations.
  • Significant racial disparities in chemotherapy receipt persist, highlighting a need for equitable care.