Rishabh Jain, Medical Consultant at Renova Hospital (RHL), shared on X:
“Are we overtreating early breast cancer with chemotherapy?
A timely perspective in Journal of Clinical Oncology revisits 4 landmark trials: MINDACT, TAILORx, RxPONDER, OPTIMA.
The evolution of genomic-guided chemotherapy in HR+/HER2− breast cancer is fascinating.
MINDACT | MammaPrint
High clinical risk ≠ automatic chemotherapy.
Favorable genomic biology can support omission.
TAILORx | Oncotype DX
Most node-negative patients with RS 11–25 can avoid chemotherapy.
Younger women remain an important exception.
RxPONDER | Oncotype DX
With 1–3 positive nodes and RS ≤25:
- Postmenopausal: No meaningful chemotherapy benefit.
- Premenopausal: Significant benefit persists.
OPTIMA | Prosigna (PAM50)
The next frontier!
- Included patients with up to 9 positive nodes.
- ROR ≤60 guided chemotherapy omission.
- ~2/3 avoided chemotherapy.
- Genomic-guided treatment was noninferior at 3.9 years’ median follow-up.
But here’s the BIG unanswered question: Does chemotherapy benefit younger women because of its cytotoxic effects, or because it suppresses ovarian function?
OPTIMA mandated ovarian suppression in premenopausal participants and found no significant heterogeneity by menopausal status.
This is hypothesis-generating, not definitive proof.
Next to watch: OFSET (NRG-BR009) and OPTIMA-YOUNG.
My takeaway: The future isn’t simply identifying who can skip chemotherapy.
It’s determining whether optimized endocrine therapy can replace chemotherapy in selected younger women.
Excellent perspective by Yara Abdou and Lisa Carey.”
Title: From TAILORx to OPTIMA: Evolving Evidence for Genomically Guided Chemotherapy in Hormone Receptor–Positive Human Epidermal Growth Factor Receptor 2–Negative Breast Cancer
Authors: Yara Abdou and Lisa Carey
Other articles about Breast Cancer on OncoDaily.