Settle on a score.

Top Line: Who really benefits from adjuvant chemo for breast cancer based on Oncotype score? 
The Study: Those with scores ≥31 per standard high risk criteria? Or all those with scores ≥26 just because they weren’t included in the randomized component of the TAILORx trial? After all, we know scores ≥31 have a higher risk of developing mets than those with scores 26-30, but none of these have ever been treated on trial without chemo. Thus, we turn to the next best thing. Or at least a thing, the NCDB. Between 2010 and 2015 over 17K women with T1-2N0 breast cancer with Oncotype scores ≥26 were treated, three-quarters with chemo and one-quarter without. First of all, while medical comorbidities obviously contribute to a decision on chemo delivery, those with lower scores were clearly less likely to receive chemo: 62% of those with scores 26-30 (n=7882) versus 84% of those with scores ≥31 (n=9315). Regardless of being more likely to receive chemo, women with scores ≥31 had significantly worse mortality on multivariate analysis (HR 1.75). The biggest question was answered with receipt of chemo nearly halving risk of mortality across the board (HR 0.58). In fact, interaction tests demonstrated a virtually equal relative benefit in survival after chemo with scores of either 26-30 (HR 0.59) or ≥31 (HR 0.56).
TBL: Until better data emerges, signs point to chemo for breast cancer with Oncotype scores of 26 and higher. | Ma, JAMA Netw Open 2020


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