Fast Five Quiz: Early-Stage Breast Cancer

Maurie Markman, MD

Disclosures

January 14, 2021

Radiation therapy after lumpectomy is employed to eradicate local subclinical residual disease while decreasing local recurrence rates by approximately 75%. On the basis of positive data from several randomized controlled studies, irradiation of the intact breast is considered standard of care, even in the lowest-risk disease with the most favorable prognostic features. Postsurgical radiation therapy may be combined with other adjuvant treatment modalities, such as hormonal therapy and/or chemotherapy, as indicated.

Surgery is considered the primary treatment for early-stage breast cancer and may even be curative. The goals of breast cancer surgery include complete resection of the primary tumor with negative margins to lessen the risk for local recurrences and pathologic staging of the tumor and axillary lymph nodes (ALNs) to provide necessary prognostic information. As noted, adjuvant treatment may include radiation therapy and systemic therapy (including a variety of chemotherapeutic, hormonal, and biologic agents) to treat micrometastatic disease.

In early-stage breast cancer, tumor gene-expression assays can be employed to ascertain the probability of recurrence and thus the potential benefit of adjuvant chemotherapy. For example, with a commercially available 21-gene assay, a recurrence score of 0 to 10 is prognostic for a 2% rate of distant recurrence at 10 years that is unlikely to be improved by adjuvant chemotherapy. Conversely, a high score, which has variably been defined as 26 or higher, is predictive of chemotherapy benefit.

According to updated guidelines from the American Society of Clinical Oncology (ASCO), adjuvant endocrine therapy can be offered to patients > 50 years of age with hormone receptor–positive, node-negative tumors whose tumors have Oncotype DX recurrence scores less than 26, and for patients < 50 years of age or younger whose tumors have Oncotype DX recurrence scores < 16, as studies have shown there is little to no benefit from chemotherapy in these populations. ASCO based this recommendation on the evidence from two phase 3 trials: the Trial Assigning Individualized Options for Treatment (Rx) or TAILORx in women with hormone receptor–positive, node-negative tumors; and the Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy (MINDACT) trial.

For additional information, refer to the ASCO treatment guidelines.

Learn more about treatment options for early-stage breast cancer.

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