Dr. Rao on Treatment De-Escalation in HR+/HER2- Breast Cancer

Ruta D. Rao, MD, an associate professor at Rush University Medical Center, discusses therapy de-escalation for patients with early-stage hormone receptor (HR)-positive, HER2-negative breast cancer.

There are several genomic platforms that can be used to determine which patients with early-stage HR-positive, HER2-negative breast cancer would benefit from adjuvant chemotherapy, explains Rao. Previously, adjuvant chemotherapy was given to patients who had certain characteristics based on tumor size or lymph node status. However, recent data show that the tumor biology may more accurately predict an individual’s risk of recurrence. By identifying the tumors that have a higher risk of recurrence, overtreatment can be avoided in the majority of patients with early-stage breast cancer, says Rao. Additionally, more focus can be put on appropriately treating the patients at higher risk.

In terms of available assays, the TAILORx study demonstrated that Oncotype DX is helpful in patients with estrogen- and/or progesterone receptor-positive, HER2-negative, node-negative breast cancer. Whereas, in the MINDACT trial, MammaPrint was used in patients with lymph node-negative as well as lymph node-positive breast cancer.