Premenopausal women with early-stage ER positive/HER2 negative breast cancer can sometimes be overtreated with chemotherapy.1,2 At what point do the risks of chemotherapy and its side-effects outweigh the benefits for young women?
EndoPredict can answer this with its prediction of individual chemotherapy benefit, allowing you to determine at 10 years if the risk of chemotherapy is greater than the chemotherapy benefit for your individual patient. Premenopausal EPclin low-risk patients have on average a 3% risk of distant recurrence and an expected chemotherapy benefit of below 3%. Therefore, the 2-3% risk of more serious side-effects by chemotherapy outweighs the expected benefit from chemotherapy.
Should we use genetic signatures for chemotherapy decisions in ER+/HER2- premenopausal patients? Dr. Anastasia Constantinidou shares key new data from ESMO Congress 2022 demonstrating how EndoPredict can help guide treatment decisions and avoid overtreatment for premenopausal women with ER+, HER2- early breast cancer.
EndoPredict is the only second generation breast cancer recurrence test validated for premenopausal and postmenopausal women with early-stage breast cancer that is ER positive, HER2 negative, node negative or positive3-9 – and the only second generation test with level of evidence 1A data.10,11
New data provide EndoPredict with prospective proof of previous published validation studies to make a confident breast cancer prognosis and treatment decision for premenopausal women. This study shows that EndoPredict clearly identifies young women who might forego chemotherapy.12
EndoPredict is also the only test providing a 15-year recurrence risk for long-term breast cancer prognosis3 – learn more about EndoPredict and long-term recurrence risk.
For the first generation Oncotype DX® test, two prospective randomized controlled trials are unclear about predicting chemotherapy benefit for node negative and node positive patients in a premenopausal setting, potentially leading to overtreatment in younger women.13,14
EndoPredict clearly identifies a large group of low-risk women who would not benefit from adjuvant chemotherapy due to a very low recurrence risk.9
The association between EPclin Risk Score and 10‑year distant recurrence was evaluated in women with ER positive, HER2 negative primary breast cancer who were premenopausal at the time of diagnosis and received endocrine therapy only:
Not all premenopausal women with node positive ER+, HER2- breast cancer need to be overtreated. In the same premenopausal validation study:
Trials like RxPonder and TAILORx suggest the outcome of a multigene assay differs with menopausal status, with premenopausal women supposedly receiving a greater benefit from chemotherapy. However, it remains unclear whether the observed benefit seen in these Oncotype DX® trials is a direct chemotherapy effect or due to chemotherapy-induced ovarian function suppression (OFS).
The Constantinidou et al. 2022 study conducted an exploratory subgroup analysis comparing EPclin low-risk patients who did not (N=171) and did (N=214) receive OFS. Results showed similar 10-years DRFS in patients with and without OFS, with less than 5% distant recurrence after 10 years in both groups – EndoPredict identifies low-risk women that can be treated with endocrine therapy only, regardless of menopausal status.
EndoPredict is the only second generation test which has prospective outcome data specifically in premenopausal patients with breast cancer.
This is the first prospective validation data in a randomized controlled trial of a second generation test, and confirms previous prospective-retrospective validation data
Despite all patients having node positive disease, in both pre- and postmenopausal women, those identified as low-risk by EndoPredict (12% and 15% respectively) had zero relapse at 10 years.
EndoPredict Breast Cancer Prognostic Test is available to order by clinicians via numerous local labs in your country or outside of the EU also via Myriad Genetics’ central laboratory in Salt Lake City, USA.