DR LOVE: So in terms of the issue of genomic assays, of course the main area where people are utilizing these specifically in ER-positive, HER2-negative is up-front decisions, particularly about adjuvant chemotherapy. Can you talk first about in general how you approach decision-making and whether or not to use either that assay or any other one in the up-front situation?

DR GOETZ: Yes. So right now our practice, really, for patients where I see in the clinic, where decisions are being made with regard to chemotherapy, we’re using the Recurrence Score predominantly. And so my approach in these patients, obviously, the first thing that I ask and when I see patients is, before I order a Recurrence Score is to discuss with patients their potential ability to tolerate or interest in chemotherapy.

I see a fair number of patients in their sixties and seventies who tell me, regardless of the Recurrence Score, they really are not interested in or may not be candidates for chemotherapy. So this is obviously an important part of the decision-making.

There are other patients who I meet who are not interested in chemotherapy but are very interested in the prognosis — that is, the prognostic information that comes from the Recurrence Score. And so for these patients, I will offer them the Recurrence Score as well.

DR LOVE: What about in patients with node-positive disease?

DR GOETZ: Yes. So in patients with node-positive disease, I’m fairly convinced, Neil, of the fact that the Recurrence Score has been shown in multiple different studies to be prognostic. Obviously the data from SWOG-8814 in terms of the predictive ability would suggest that patients that are at highest risk, or in the high-risk category, do derive benefit from chemotherapy. But patients in the low-risk category, not only do they have a lower risk, but clearly in that study did not seem to derive benefit from adjuvant chemotherapy.

So my approach is, for patients that have 1 to 3 positive lymph nodes who have a cancer that otherwise would seemingly be endocrine responsive, to offer the Recurrence Score in that situation.

Early-stage breast cancer (BC) in the adjuvant and neoadjuvant settings

Genomic assays and (neo)adjuvant treatment decision-making

Management of metastatic BC (mBC)

CDK4/6 inhibitors for the treatment of BC

Novel approaches under investigation in BC