Breast Cancer Update for Surgeons, Issue 1, 2017 (Video Program)BC-specific survival for patients with ER-positive, node-negative invasive BC and 21-gene signature results in the SEER database
3:37 minutes.
TRANSCRIPTION:
DR SPARANO: It was a population-based study involving nearly 39,000 women, so it represents real-world situation. The primary endpoint they looked at was breast cancer-specific mortality. They couldn’t really look at distant recurrence. The SEER database that they were using doesn’t have that degree of granularity. And they linked this database with the data regarding Recurrence Score. And what they showed was that the 5-year risk of breast cancer-specific mortality for a Recurrence Score of less than 18, a low Recurrence Score, was 0.4%. For the intermediate group, it was 1.4%. And for the high-risk group, it was 4.4%. So prospectively validating in a real-world situation, if you will, that the Oncotype provides prognostic information not just for recurrence but for mortality. So these are not just patients who recurred but recurred and died early. The bottom shows the proportion of patients who fell in those groups. So it was 54% had a low Recurrence Score, 38% had an intermediate Recurrence Score and 8% had a high Recurrence Score. It also shows you the breast cancer-specific mortalities for each of those groups that I alluded to in the Kaplan-Meier curve, 0.4%, 1.4% and 4.4%, respectively. And it also shows you proportion of patients who received chemotherapy in each group and how that impacted, if it impacted, the recurrence rate. So starting with the low Recurrence Score group, you could see the majority of patients who had a low Recurrence Score, nearly 20,000 did not receive chemotherapy. Their risk of recurrence was 0.4%. About 1,500 did receive chemotherapy, so a minority. Their risk of recurrence was about 0.7%. If you go to the midrange Recurrence Score group, about two thirds didn’t receive chemo. About one third did. And you see that the mortality risk at 5 years was about the same, 1.4%. And in the highest-risk group, you could see the majority of patients did receive chemotherapy. About two thirds did. About one third didn’t. And you see that there was a lower breast cancer-specific mortality in those patients who received chemotherapy. So again, a real-world validation, if you will, of the prognostic information provided by the Recurrence Score not as it relates to distant recurrence but as it relates to breast cancer-specific mortality. One of the interesting things about this paper was that one normally assumes that older women do well. But one of the other important observations of this paper was that older women — when I say “older,” I mean 70 and above — who had a high Recurrence Score had much worse outcomes than younger women. Of course many of these patients didn’t get adjuvant chemotherapy. But on the other hand, they were well enough for the clinician to have ordered the Recurrence Score. So it raises the question: Are we undertreating older women? And I think it’s a very important observation that requires more thought and work. |