Genomic Testing in Breast Cancer: Clinical Applications and Best Practices - Episode 7
Using RxPONDER Findings to Inform Testing and Treatment Approaches in Node-Positive Breast Cancer
Panelists discuss how the RxPONDER trial data transformed breast cancer treatment by demonstrating that postmenopausal women with 1 to 3 positive lymph nodes and low recurrence scores could safely avoid chemotherapy, while highlighting the controversy about chemotherapy benefit in premenopausal patients where clinical judgment and nuanced assessment of menopausal status remain crucial.
Genomic Testing in Node-Positive Disease
Main Discussion Topics:
- Interpretation of RxPONDER trial results for node-positive patients
- Differing approaches to premenopausal vs postmenopausal patients with node-positive disease
- Role of clinical judgment in treatment decisions
Key Points for Physicians:
- RxPONDER data showed that postmenopausal women with 1 to 3 positive nodes and low recurrence scores can safely avoid chemotherapy.
- Premenopausal women with positive nodes showed small but statistically significant chemotherapy benefit, requiring a nuanced approach.
- Clinical factors beyond age (proximity to menopause, family menopause history) should inform decisions.
Notable Insights:
- Treating all premenopausal patients with node-positive disease with chemotherapy regardless of recurrence score represents a “leap back to 1990.”
- For patients 45 to 50 years old who are perimenopausal, genomic testing still provides valuable information for shared decision-making.
Clinical Significance: Genomic testing remains valuable in node-positive disease but requires integration with clinical judgment and patient preferences, particularly for premenopausal patients for whom benefit may be modest.
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