Genomic Testing in Breast Cancer: Clinical Applications and Best Practices - Episode 5
Expert Insights on Genomic Test Selection in Breast Cancer: Strategies for Node-Negative vs Node-Positive Disease
Panelists discuss how clinical factors such as nodal status influence genomic testing decisions, referencing the TAILORx and RxPONDER trials whose data demonstrated that chemotherapy benefit varies based on recurrence score and menopausal status, highlighting the need for nuanced shared decision-making rather than strict cutoffs.
Clinical Factors Influencing Test Selection
Main Discussion Topics:
- Impact of nodal status, tumor size, and menopausal status on genomic test selection
- Interpretation of TAILORx and RxPONDER trial results in clinical practice
- Considerations for neoadjuvant therapy selection based on genomic testing
Key Points for Physicians:
- For ER+/HER2– patients, TAILORx and RxPONDER trial results guide decision-making for node-negative and node-positive patients respectively.
- The 16 to 24 recurrence score range in premenopausal patients requires nuanced shared decision-making.
- Neoadjuvant endocrine therapy may be underutilized for larger tumors with favorable biology.
Notable Insights:
- Genomic assays can help determine whether large ER+/HER2– tumors would benefit more from neoadjuvant chemotherapy or endocrine therapy.
- Recurrence score confidence intervals for node-negative groups and groups with 1 to 3 positive nodes overlap substantially
Clinical Significance: Clinical factors such as nodal status, tumor size, and menopausal status must be integrated with genomic test results to optimize treatment decision-making, particularly for premenopausal patients with intermediate recurrence scores.
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