Prediction of Distant Recurrence by EndoPredict in Patients with Estrogen Receptor-Positive, HER2-Negative Breast Cancer who Received Adjuvant Endocrine Therapy plus Chemotherapy (ET+C) or Endocrine Therapy Alone (ET)

Ivana Sestak1, Miguel Martin2, Peter Dubsky3, Federico Rojo4, Jack Cuzick1, Martin Filipits5, Amparo Ruiz6, William Gradishar7, Hatem Soliman8, Lee Schwartzberg9, Richard Buus10, Dominik Hlauschek11, Alvaro Rodriguez-Lescure12, Michael Gnant13

1 Centre for Cancer Prevention, QMUL, London, UK; 2 Hospital General Universitario Gregorio Maranon/GEICAM, Madrid, Spain; 3 Klink St. Anna/ABCSG, Lucerne, Switzerland; 4 CIBERONC-ISCII Fundacion Jimenez Diaz/GEICAM, Madrid, Spain; 5
Medical University Vienna/ABCSG, Vienna, Austria; 6 Instituto Valenciano de Oncologia/GEICAM, Madrid, Spain; 7 Robert H. Lurie Comprehensive Cancer Centre of NWU, Chicago, US; 8 H. Lee Moffitt Cancer Center, Tampa, US; 9 West Cancer
Center, Germantown, US; 10 The Breast Cancer Now Toby Robins Research Centre/ICR, London, UK; 8 Austrian Breast and Colorectal Group (ABCSG), Vienna, Austria; 9 Hospital Universitario de Elche/GEICAM, Valencia, Spain

 
 

Summary

  • Chemobenefit validated:
    • In over 3,700 patients with ER+, HER2- breast cancer.
    • With modern (taxane-containing) treatment regimens.
  • Patients with a low-risk EndoPredict result did not benefit from the addition of chemotherapy.
  • Patients with a higher EndoPredict score had a greater benefit from chemotherapy.

Background

EndoPredict (EPclin) is a prognostic test validated for early breast cancer patients with estrogen (ER) receptor positive, HER2-negative disease to help make decisions between 5 years of endocrine therapy alone or with chemotherapy.1,2,3

Objective

To investigate in a non-randomized setting whether EPclin can predict chemotherapy benefit in pre- and post-menopausal women with ER-positive, HER2-disease who have received five years of endocrine therapy alone (ET) or in combination with chemotherapy (ET+C).

Methods

  • A total of 3,746 women with ER-positive, HER2-negative disease were included in this analysis.
  • The primary objective was to evaluate the 10-year distant recurrence-free interval (DRFI) rates as a continuous function of EPclin separately for patients in ET+C and ET.

Results

  • Patients with a low-risk EndoPredict result did not benefit from the addition of chemotherapy.
  • Patients with higher EndoPredict scores had a greater benefit from chemotherapy.
  • Baseline demographics for the two cohorts are shown in Table 1.
  • Median follow-up for those on ET alone was 9.6 years (IQR 6.0-10.0) vs. 9.2 years (7.5-10.0) for ET+C.
  • Clear distinction in 10-year risk between ET alone vs ET+C as the EndoPredict score increases (Figure 2).
  • Interaction between EPclin and treatment was significant (P=0.02).

Conclusions

  • Patients with a high EPclin score on ET+C had a significantly lower 10-year distant recurrence (DR) risk than those on ET alone.
  • No differences in 10-year DR risks were observed between ET alone and ET+C for low EPclin scores (<3.3 low risk cut-off).
  • Interaction between EPclin and treatment was significant (P=0.02).
    • Potential benefit of adding chemotherapy to those with high EPclin scores.
  • Patients with higher EPclin scores have a disproportionate benefit from chemotherapy.
  • Results give insight into the predictive value of EPclin for women with ER-positive, HER2-negative breast cancer.

References

1. Dubsky et al., 2012; 2. Buus et al., 2017; 3. Martin et al., 2014

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