ASO Author Reflections: Predicting High-Risk Oncotype DX Recurrence Scores as a Strategy for Assessing Neoadjuvant Chemotherapy Eligibility

Excerpt

Neoadjuvant chemotherapy (NACT) improves lumpectomy eligibility by tumor downstaging. Therefore, it is tempting to consider NACT for patients with bulky estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative tumors, but this phenotype responds more sluggishly.1 Furthermore, the Oncotype DX (ODX) 21-gene recurrence score data demonstrate that many of these patients have low-risk disease optimally controlled with endocrine agents as adjuvant systemic therapy and chemotherapy use would therefore represent overtreatment.2,3 On the other hand, a subset of these patients have high-risk ODX scores and might benefit from NACT downstaging. Although ODX testing on diagnostic core biopsy tissue is feasible, it is not uniformly successful and not necessarily covered by third-party payors. The authors have developed a dual-function model to identify patients likely to have high-risk ODX scores and to predict response to NACT.4 A highly relevant feature of this study was the diverse patient population because African Americans are more likely to have larger primary tumors (regardless of phenotype), yet data on ODX in African Americans are sparse. …