Kathy S. Albain, MD, director, Breast Clinical Research Program, co-director, Breast Oncology Center, professor of medicine, Stritch School of Medicine, Loyola University Chicago, discusses a race-based analysis within the pivotal TAILORx trial.

Results of the phase III trial demonstrated noninferiority for adjuvant endocrine therapy versus chemotherapy and endocrine therapy in patients with hormone receptor—positive, HER2-negative, node-negative, early-stage breast cancer at an average risk of recurrence. A planned analysis led by Albain and colleagues set out to determine if this endpoint held true across subsets defined by race and ethnic background.

Secondly, researchers were also hoping to determine if there were racial or ethnic disparities in patient outcomes. Albain says that prior studies have suggested that African-American patients tend to do worse than Caucasian patients in population-based cohorts where the treatment isn’t the same, as well as in individual clinical trials where the treatment is the same.

Research presented at the 2018 San Antonio Breast Cancer Symposium indicated that African-American patients with early-stage breast cancer had worse outcomes than Caucasian patients following adjuvant therapy, despite having a similar risk of recurrence. The African-American patients had significantly worse invasive disease-free survival, overall survival, and relapse-free survival. Researchers observed a trend toward worse disease relapse-free interval as well.

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Kathy S. Albain, MD, director, Breast Clinical Research Program, co-director, Breast Oncology Center, professor of medicine, Stritch School of Medicine, Loyola University Chicago, discusses a race-based study within the TAILORx trial.

Dr. Albain Discusses Race-Based Breast Cancer Study Within TAILORx

Kathy S. Albain, MD, hematology/oncology, professor, Loyola University Chicago Stritch School of Medicine, discusses risk 5 years after tamoxifen in early stage ER-positive breast cancer.

Data was recently reported emphasizing that after patients stop 5 years of tamoxifen in early breast cancer, even if they have low-stage disease, there is a long-term recurrence rate out to 20 years, says Albain.

For the lowest stage, T1N0, the risk is 14%. The risk goes up incrementally as the number of nodes and the tumor size increases. There is a six-point scoring system that shows the gradations of increased risk across each stage of disease.

These data are very important as oncologists counsel women coming off 5 years of tamoxifen regarding their continued risk of recurrence.

Dr. Kathy S. Albain on Breast Cancer Risk After 5 Years of Tamoxifen

Kathy S. Albain, MD, medical oncologist, Loyola University Chicago, professor, Stritch School of Medicine, director, Breast Clinical Research Program, Thoracic Oncology Research Program, Cardinal Bernardin Cancer Center, discusses staging versus biology in breast cancer.

Physicians are often presented with patients who have high-stage disease signified by many positive nodes, larger tumor, or aggressive biologic features. In this situation, the decision is straightforward: A physician has to decide whether to give systemic chemotherapy or other, more intensive types of adjuvant therapy for curative intent.

Physicians are also presented with discordant clinical situations from time to time. In certain situations, a patient's stage of disease, tumor volume or disease burden may be high but the biology of the cancer may appear to be favorable or indolent. An equally discordant situation arises when a patient's small tumors have aggressive or unfavorable biology. In both of these situations, a physician is faced with questions regarding what should drive the treatment decision.

Dr. Albain on Staging and Biology in Breast Cancer

Kathy S. Albain, MD, medical oncologist, Loyola University Chicago, professor, Stritch School of Medicine, director, Breast Clinical Research Program, Thoracic Oncology Research Program, Cardinal Bernardin Cancer Center, discusses the difference between the 21-gene (Oncotype DX) assay and 70-gene (MammaPrint) assay in breast cancer.

Albain says that she's often asked which of the two tests should be ordered on a given patient. It is important to understand what data is available and that these are two different tests: one is based on 21 genes and the other on 70 genes with different technology. The 21-gene assay is a continuous variable, while the 70-gene assay gives a binary result of good risk or poor risk.

Both assays have been analyzed in the neoadjuvant setting. Albain says that six or seven studies have revealed the same result: If a patient is in the good-risk or low-risk categories as a result of either assay, the pathologic complete response to chemotherapy is extremely low.

Kathy S. Albain, MD, from the Loyola University Chicago and Cardinal Bernardin Cancer Center, discusses the difference between the 21-gene (Oncotype DX) assay and 70-gene (MammaPrint) assay in breast cancer.

Kathy S. Albain, MD

Articles

Dr. Albain Discusses Race-Based Breast Cancer Study Within TAILORx

Dr. Kathy S. Albain on Breast Cancer Risk After 5 Years of Tamoxifen

Dr. Albain on Staging and Biology in Breast Cancer

Dr. Albain on the 21- and 70- Gene Assays in Breast Cancer