Breast Cancer Update, Issue 2, 2016 (Video Program) - Video 11A 65-year-old woman with ER/PR-positive, HER2-negative infiltrating ductal carcinoma completes 5 years of tamoxifen, and a Breast Cancer Index assay indicates a low risk of distant recurrence
4:50 minutes.
TRANSCRIPTION:
DR LOVE: So let’s go on and talk about your 65-year-old lady. DR GOETZ: Sure. So this is a patient I just recently saw in the clinic. She had originally been diagnosed with a 1.2-cm, Grade 2 invasive ductal carcinoma. This tumor was estrogen and progesterone receptor strongly positive. And she had a Recurrence Score when she was originally diagnosed of 15. And so we elected and recommended treatment with hormonal therapy alone. At the time that we saw her, we had recommended anastrozole as a first-line therapy. And she had actually preferred to use tamoxifen. So we treated her with tamoxifen, and she completed a total of 5 years of tamoxifen. DR LOVE: How did she do on the tamoxifen? DR GOETZ: Oh, she did extremely well. She really had no significant toxicities other than some mild hot flashes. DR LOVE: So then she comes up to the 5-year point. How long ago was that? DR GOETZ: Yes. That actually was just about 4 months ago. And at that time, we had discussed the options. And that would be obviously to go off all endocrine therapy versus continuing on. In this case, we highly recommended that if we did continue on with therapy that we would switch to an aromatase inhibitor. And at that time, she was interested in learning more about the potential risks for late recurrence. And she was quite undecided. She certainly was aware of this issue of the possibility of a late recurrence, but she was not convinced, necessarily, that she wanted to move on to a different drug or continue on with endocrine therapy. DR LOVE: I don't know if she asked you this, but if she had, or if she did, and she said, “What’s the chance that, at some point in time moving forward after this 5 years, I will have a recurrence, assuming I do nothing?” What would be your best guess as to what it would be? And would that estimate have been influenced by the previous Recurrence Score she had, which was low? DR GOETZ: Yes. So I think the data with regard to the Recurrence Score, at least that have been published thus far, would suggest that that provides you with the best estimates for early recurrence risk. And the recent data that I have been most, if you will, impressed with and I have used quite commonly in my practice — and that’s the recent Oxford Overview that was just presented at ASCO — where in a cohort of nearly 50,000 women who had received 5 years of endocrine therapy the authors identified factors that were associated with late distant recurrence in years 5 through 14. And so in that particular study, for women who were node-negative, the risk of developing a late distant recurrence in years 5 through 14 was about 9%, or 9% to 10%. And so for this particular patient, that estimate of risk obviously for her, when we talked to her and said, “For a patient in this situation, the risk could be the same, it could be a bit lower. Obviously, it could also be a bit higher based on some of the multigene studies that suggests that one can identify higher risk for late recurrence.” DR LOVE: So were you interested or was she interested in trying to refine that 9% down so she’d get maybe even a better idea? DR GOETZ: Yes. So she certainly was. And so at that point, we did offer her testing with the Breast Cancer Index. And we did receive the results of that back. Her testing demonstrated a score of 6.6, which interestingly corresponded to a distant risk of about 8%. So in this particular situation, the score that was received really didn’t change much, if you will, the risk that I had quoted her initially. However, I think in this situation, knowing that the BCI test can identify a subset of patients with a higher risk or a much lower risk, I still think that the patient felt that this information was helpful. DR LOVE: And what did she decide and you decide to do? DR GOETZ: So based on this information and speaking with her, she actually felt that this risk was low enough that she did not want to proceed on with additional therapy. And so at this point, we’re observing her. |