DR LOVE: How do you approach the issue of using an assay like this in a patient with node-positive disease? Again, there was an ASCO statement that came out that was very negative about it, which I thought was kind of amazing, because I know from our surveys, a lot of very respected investigators have used Oncotype, for example, lower volume, 1 node, 2 nodes. And now this statement says, “You’re not using” — I’ve heard people say it’s hard to get it paid for now. Any thoughts about that?

DR HURVITZ: I mean, there is a real difference between guidelines and a consensus statement, is what I was trying to say earlier. Guidelines are data based. And you can feel a little bit more comfortable about them. There’s a consensus statement relating to management of HER2-positive CNS disease, because there’s no data. So you have to take it with a grain of salt and realize that it’s opinion based — expert opinion, but opinion based.

There have certainly been patients with low-volume nodal disease that I have sent Oncotype on. They tend to be my older patients, not my 35-year-old but my 65-/70-year-old who has 1 or 2 lymph nodes positive but the tumor is low grade. The Ki-67 is less than 5% or less than 10%, strongly hormone receptor-positive, lobular histology. And I really feel uncomfortable giving chemo just because I know that patient hasn’t done a mammo in 5 years and that tumor’s been growing for a very long time, and it’s just the natural biology of the tumor, not because I think chemo is going to benefit the patient from a biological perspective.

So I will use it to reassure me that the use of chemotherapy is likely not going to have an impact when I am advising a patient I think we can avoid chemo in lymph node-positive disease. If I’m pretty sure that chemo is indicated — it’s higher grade and there are other features that are higher risk, lymphovascular invasion and just Ki-67 is higher or lack of PR expression — I tend not to do Oncotype, because I already have a good feeling about the tumor and the need for chemotherapy.

Genomic assays and (neo)adjuvant treatment decision-making

Early-stage breast cancer in the adjuvant and neoadjuvant settings

Management of metastatic breast cancer (mBC)

CDK4/6 inhibitors for the treatment of breast cancer

Checkpoint inhibitors and other novel immunotherapeutic approaches to breast cancer

Triple-negative and BRCA mutation-positive breast cancers