This day consisted of a review of the important endocrine (hormonal) therapy data that was presented the day before. This laid the groundwork for new guidelines to be put in place regarding the treatment of hormone receptor positive breast cancer patients. The long and short of it was really that options for endocrine therapy in both pre-and post-menopausal women need to be individualized based on the patient’s age at diagnosis, risk factors for aggressive disease and other medical issues that might make one regimen more favorable over another.
There was also some new data presented regarding the use of a Ductal Carcinoma In Situ (DCIS) Recurrence Score developed by Genomic Health, the company that developed Oncotype DX. The DCIS Score was developed to distinguish patients in the DCIS population who might be at low risk of local recurrence. Based on this better prognosis, they are suggesting that these women may not need radiation after surgery, as is commonly offered to most patients with DCIS. The study looked at 571 women with DCIS who underwent breast-conserving surgery alone over the course of 9 years. The DCIS Score was run on their surgical specimen and was categorized as low, intermediate or high risk. The study found that the DCIS Score was able to predict which groups had a higher risk of local recurrence for DCIS (5.4% for the low risk group, 14.1% for the intermediate group and 13.7% for the high risk group) and for invasive cancer (8.0% for the low risk group, 20.9% for the intermediate group and 15.5% for the high risk group). Interestingly, the DCIS Score was not as good at differentiating intermediate risk from high risk, thus, the company may decide to make the score have either “low” or “high” results, without the intermediate.
Either way, this may be another tool we can use in the future to help minimize exposure of women to unnecessary therapy. However, we are still waiting on important data that includes patients who have been treated with radiation therapy to see if radiation makes a difference in those with low and/or high risk scores. This information is essential for determining if the DCIS Score is not only good at telling us information on prognosis but will also provide information on who benefits from different types of therapy, particularly radiation therapy. Until this data is presented, I believe most breast specialists will not be using this test routinely in practice.
There was a whole lot more interesting data presented at San Antonio this year…to be continued in my newsletter. Please sign up to get all these and more updates via the Contact page.