Gene Expression and Benefit of Chemotherapy in Women With Node-Negative, Estrogen Receptor–Positive Breast Cancer

American Society of Clinical Oncology (ASCO) - Tập 24 Số 23 - Trang 3726-3734 - 2006
Soonmyung Paik1, Gong Tang1, Steven Shak1, Chungyeul Kim1, Joffre Baker1, Wanseop Kim1, Maureen Cronin1, Frederick L. Baehner1, Drew Watson1, John Bryant1, Joseph P. Costantino1, Charles E. Geyer1, D. Lawrence Wickerham1, Norman Wolmark1
1From the Division of Pathology, Operations Center, and Biostatistical Center, National Surgical Adjuvant Breast and Bowel Project; Department of Biostatistics, School of Public Health, University of Pittsburgh; Department of Human Oncology, Allegheny General Hospital, Pittsburgh, PA; Genomic Health Inc, Redwood City, CA; and University of California, San Francisco, San Francisco, CA

Tóm tắt

Purpose The 21-gene recurrence score (RS) assay quantifies the likelihood of distant recurrence in women with estrogen receptor–positive, lymph node–negative breast cancer treated with adjuvant tamoxifen. The relationship between the RS and chemotherapy benefit is not known. Methods The RS was measured in tumors from the tamoxifen-treated and tamoxifen plus chemotherapy–treated patients in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B20 trial. Cox proportional hazards models were utilized to test for interaction between chemotherapy treatment and the RS. Results A total of 651 patients were assessable (227 randomly assigned to tamoxifen and 424 randomly assigned to tamoxifen plus chemotherapy). The test for interaction between chemotherapy treatment and RS was statistically significant (P = .038). Patients with high-RS (≥ 31) tumors (ie, high risk of recurrence) had a large benefit from chemotherapy (relative risk, 0.26; 95% CI, 0.13 to 0.53; absolute decrease in 10-year distant recurrence rate: mean, 27.6%; SE, 8.0%). Patients with low-RS (< 18) tumors derived minimal, if any, benefit from chemotherapy treatment (relative risk, 1.31; 95% CI, 0.46 to 3.78; absolute decrease in distant recurrence rate at 10 years: mean, −1.1%; SE, 2.2%). Patients with intermediate-RS tumors did not appear to have a large benefit, but the uncertainty in the estimate can not exclude a clinically important benefit. Conclusion The RS assay not only quantifies the likelihood of breast cancer recurrence in women with node-negative, estrogen receptor–positive breast cancer, but also predicts the magnitude of chemotherapy benefit.

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American Society of Clinical Oncology (ASCO)

Tập 24 Số 23

3726-3734

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