DR HURVITZ: I’m actually more disinclined to do Oncotype in my younger patients, because I’m concerned about avoiding chemo. And I’m concerned about the applicability or the validity of this assay in very young women, because the majority of the women in the studies used to build and validate Oncotype were postmenopausal and above the age of 50. So when I do an Oncotype in a woman in her thirties, I cover it with caveats in my discussion with her about, “Your risk may actually be higher,” because it wasn’t only addressed in younger women who have other things going on from a hormonal perspective.

In my older patients — I haven’t said this, but I think it’s important to keep in mind that we’re fairly good, in my opinion, at academic centers with a reliable pathologist who knows how to do grading of tumors and Ki-67. We’re pretty good at predicting where a woman’s going to land in their Oncotype. The IHC4 score done at — I believe it was Mitch Dowsett who presented this data from the Royal Marsden — IHC4 was comparable to Recurrence Score prediction in patients that he looked at. So if you’ve got a reliable ER, PR, HER2 and Ki-67, it’s not entirely clear what doing Oncotype adds. And I feel that way for most of my patients.

I’ve been surprised once in the last year by a high-risk Oncotype that I thought would be intermediate risk. I thought it was going to be in the twenties, and it was in the high forties. And it turned out that the HER2-positive was wrong at my institution and was rechecked at a different institution. So I think that’s what was driving it. But it’s fairly easy to predict, if you have a pathologist upon which you rely.

And so if I have an older woman in her midseventies with a high Ki-67 or high-grade tumor, I will talk to her about chemotherapy. And if she needs convincing and needs a number, the real benefit of Oncotype is giving a patient a percent risk in the next 10 years. They really like that number and then looking at what happens to that number or gauging what happens to that number with the use of chemo.

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