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30-05-2022 | Breast Cancer | Epidemiology

Impact of genomic assays on treatment and outcomes in locally advanced breast cancer

Authors: Omar Picado, Deukwoo Kwon, Kristin Rojas, Jessica Crystal, Lora Wang, Reshma Mahtani, Frances Valdes, Neha Goel, Susan B. Kesmodel

Published in: Breast Cancer Research and Treatment | Issue 2/2022

Abstract

Purpose

Genomic profiling in early-stage breast cancer provides prognostic and predictive information. Genomic profiling assays have not been validated in locally advanced breast cancer (LABC). We examined a large cancer registry to evaluate genomic profiling in LABC and its effect on treatment decisions and survival.

Methods

Females with ER+/HER2− LABC who did not receive neoadjuvant therapy were selected from the National Cancer Database 2004–2017. We compared characteristics between patients with and without genomic profiling and with low genomic risk, 21-gene recurrence score ≤ 25 or low-risk 70-gene signature, treated with endocrine therapy ± chemotherapy. Propensity score methods were utilized to account for covariates that may have predicted treatment. Univariable and multivariable survival analyses were performed.

Results

Of 18,437 patients with LABC, 1258 (7%) had genomic profiling and 1022 (81%) had low genomic risk results. 562 patients (55%) with low genomic risk received chemotherapy and endocrine therapy (chemoendocrine). Patients who received chemoendocrine therapy were younger, had fewer comorbidities, presented with higher stage disease, had higher grade tumors, more frequently had partial mastectomy, and more often received radiation than those who received endocrine therapy alone. On multivariable analysis, endocrine therapy alone was associated with worse OS compared to chemoendocrine therapy (HR 1.77, 95% CI 1.13–2.78, p = 0.013).

Conclusion

In women with LABC and low genomic risk, endocrine therapy alone was associated with worse OS compared to chemoendocrine therapy. This suggests that genomic profiling is not predictive in LABC. Accordingly, genomic profiling should not be routinely utilized to make adjuvant treatment decisions in LABC in the absence of further data which shows a benefit.

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Title: Impact of genomic assays on treatment and outcomes in locally advanced breast cancer
Authors: Omar Picado
Deukwoo Kwon
Kristin Rojas
Jessica Crystal
Lora Wang
Reshma Mahtani
Frances Valdes
Neha Goel
Susan B. Kesmodel
Publication date: 30-05-2022
Publisher: Springer US
Keywords: Breast Cancer
Breast Cancer
Cytostatic Therapy
Published in: Breast Cancer Research and Treatment / Issue 2/2022
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-022-06625-0

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