Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.

Abstract

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 (> or = 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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@article{Paik2006GeneEA, title={Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.}, author={Soonmyung Paik and Gong Tang and Steven Shak and Chungyeul Kim and Joffre Baker and Wanseop Kim and Maureen Cronin and Frederick L Baehner and Drew Watson and John Bryant and Joseph P Costantino and Charles E Geyer and D Lawrence Wickerham and Norman Wolmark}, journal={Journal of clinical oncology : official journal of the American Society of Clinical Oncology}, year={2006}, volume={24 23}, pages={3726-34} }