Keeping score.

Top Line: Does incorporation of clinical risk factors improve the performance of the 21-gene recurrence score?

The Study: This has previously been addressed by the RS pathology-clinical (RSPC) tool. RSPC performed better than the RS alone at predicting distant recurrence (DR) risk using data from >1700 patients in the B-14 and TransATAC trials. RSClin is a more contemporary model developed from >10,000 patients mostly from the TAILORx trial that is both prognostic of DR and predictive of chemotherapy benefit in women with node-negative, hormone receptor positive, HER2 negative breast cancer. The covariates included RS, tumor grade, tumor size, and patient age. RSClin performed better than either the RS or clinical factors alone at predicting DR. Remember how age played a role in chemo benefit in TAILORx? Think of the RSClin as the RS DR-risk curve specific for a certain age, grade, and tumor size. Therefore, the DR risk for a given RS result would be different depending on age, grade, and size. In addition, RSClin was incrementally predictive of absolute chemotherapy benefit beyond increasing RS result alone. The tool is allegedly online in the Oncotype portal.

TBL: RSClin is a tool that incorporates the 21-gene RS and clinical factors to more accurately predict distant recurrence risk and chemotherapy benefit. | Sparano, J Clin Oncol 2020

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