The RxPONDER trial (NCT01272037) evaluated the benefit of chemotherapy followed by endocrine therapy versus endocrine therapy alone in patients who had an Oncotype DX Recurrence Score (RS) <25. A previous analysis of RxPONDER after a median follow-up of 5 years reported that invasive disease-free survival (IDFS) and distant disease-free survival (DDFS) differed by menopausal status [1]. In the current study, Dr Kevin Kalinsky (Emory University Winship Cancer Institute, GA, USA) reported updates on IDFS and DDFS with follow-up of 6.1 years, as well as distant recurrence-free intervals (DRFI), and post-hoc analyses in premenopausal women. DRFI was defined as time to distant recurrence or death from breast cancer [2].
Consistent with the results from the previous analysis, postmenopausal women continued to not have any IDFS or DDFS benefit with adjuvant chemotherapy, whereas premenopausal women continued to benefit from adjuvant chemotherapy, with a 5-year absolute benefit for IDFS and DDFS of 4.9% and 2.5%, respectively. In line with these results, chemotherapy improved in premenopausal patients (absolute 5-year benefit 2.4%) and not in postmenopausal patients. In premenopausal patients with RS 0–13, the absolute benefit was 2.3%; in premenopausal patients with RS 14–25, the benefit was 2.8%.
Among the premenopausal patients, 12.4% had micro-metastatic disease. Post-hoc analysis showed a trend for chemotherapy benefit for those with micro-metastatic disease (HR 0.44, absolute 5-year benefit 7.3%). However, only 22 IDFS events were present. In premenopausal patients (1,403) with macro-metastases (pN1), the absolute 5-year benefit of chemotherapy was 4.8%.
“This update of RxPONDER confirms that postmenopausal women with RS<25 do not benefit from adjuvant chemotherapy,” concluded Dr Kalinsky. “In addition, premenopausal women with RS<25 continue to benefit from adjuvant chemotherapy resulting in a 44–46% decrease in IDFS, DRFS, and DRFS events.”
- Kalinsky K, et al. N Eng J Med 2021;385(25):2336–2347.
- Kalinsky KM, et al. Updated results from a phase 3 randomized clinical trial in participants (pts) with 1-3 positive lymph nodes (LN), hormone receptor-positive (HR+) and HER2-negative (HER2-) breast cancer (BC) with recurrence score (RS) < 25 randomized to endocrine therapy (ET) +/- chemotherapy (CT): SWOG S1007 (RxPONDER). GS2-07, SABCS 2021 Virtual Meeting, 7–10 December.
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Table of Contents: SABCS 2021
Featured articles
Early-Stage Breast Cancer
Aromatase inhibitors outperform tamoxifen in premenopausal women
Concurrent taxane plus anthracycline most beneficial in reducing risk of breast cancer
Reduced risk of recurrence with ovarian suppression plus tamoxifen/exemestane
Metformin does not improve outcomes in patients with early-stage breast cancer
Omitting sentinel lymph node biopsy improves arm symptoms
HR-positive/HER2-negative Breast Cancer
Addition of palbociclib to standard endocrine therapy does not improve outcome in adjuvant treatment
The SERD elacestrant improves outcomes for patients unresponsive to endocrine therapy
Consistent overall survival benefit of ribociclib in advanced breast cancer
Premenopausal women benefit from adjuvant chemotherapy next to endocrine therapy
Promising anti-tumour activity of the CDK7-inhibitor samuraciclib plus fulvestrant
ctDNA is prognostic and predictive for response to ribociclib plus letrozole
Early switch to fulvestrant plus palbociclib beneficial for patients with ESR1 mutation
Triple-Negative Breast Cancer
Single-cell spatial analysis can predict response to neoadjuvant immunotherapy
Neoadjuvant pembrolizumab plus chemotherapy benefits event-free survival in TNBC
Early use of ctDNA testing can identify likelihood of relapse in TNBC
Pembrolizumab plus chemotherapy benefits patients with combined positive score ≥10
Neratinib plus trastuzumab plus fulvestrant shows encouraging clinical activity
Phase 1–3 Trials
Datopotamab deruxtecan shows promising anti-tumour activity
Trastuzumab deruxtecan outperforms trastuzumab emtansine
Nivolumab plus ipilimumab serve promising dual checkpoint inhibition
Entinostat plus exemestane improves progression-free survival in Chinese patients
Efficacy of pyrotinib plus capecitabine confirmed in previously treated patients
Basic and Translational Research
Using genomics to match treatments improves outcomes
Loss of ASXL1 tumour suppressor promotes resistance to CDK4/6 inhibitors
Inducers of ferroptosis are potential drugs to target p53-mutated TNBC cells
MAPK-pathway alterations are associated with resistance to anti-HER2 therapy
Genomic signatures of DCIS define biology and correlate with clinical outcomes
BRCA2 linked to inferior outcomes with CDK4/6 inhibitors plus endocrine therapy
Miscellaneous
Olaparib is well tolerated as an additional treatment
Race effects the likelihood to develop lymphoedema following breast cancer treatment
Sentinel lymph node staging is non-inferior to complete axillary lymph node dissection
One in 7 breast cancers detected during screening are overdiagnosed
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