touchMEETING HIGHLIGHTS
Precision oncology – predicting future risk in early breast cancer (eBC)
Learning Objectives
After watching this activity, participants should be better able to:
- Describe the importance of genomic assays in informing treatment decisions in eBC, and explain how they can help tailor treatment strategies to achieve optimal long-term outcomes and avoid adjuvant chemotherapy when not needed
- Explain what is meant by a grade A recommendation for genomic testing in the context of ESMO guidelines for eBC, how this is achieved, and how this can impact shared decision-making
- Discuss the findings of recent clinical studies conducted by the Technical University of Munich (TUM)11 and the Phase III UNIRAD12 study, showing how EndoPredict® can provide a risk assessment in eBC in terms of long-term recurrence and survival of patients
Overview
Predicting the likelihood of recurrence in breast cancer is an essential part of the treatment decision-making process and key to providing appropriate patient-centric follow-up.1,2 EndoPredict® is a 2nd generation multigene expression test that predicts the likelihood of distant recurrence3,4 and the potential chemotherapy benefit5 in individuals with ER+/HER2- eBC, using a combination of their clinical and molecular characteristics,6,7 The test has been validated in more than 3000 patients, within a population of node positive and negative patients, both pre- and postmenopausal.3-10 The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines provide key recommendations and algorithms for managing patients with eBC, including using genomic signatures.2 In this activity, leading oncology experts Dr Thomas Bachelot, Centre Léon Bérard Lyon, and Dr Evelyn Klein, Technical University Munich, discuss the impact of local genomic testing on treatment decisions and long-term outcomes in eBC, the clinical evidence supporting the use of gene expression assays in eBC, recent testing updates in the ESMO guidelines, and their real-world experiences with testing.
References
- Geurts YM, et al. Patterns and predictors of first and subsequent recurrence in women with early breast cancer. Breast Cancer Res Treat. 2017;165:709–20.
- Loibl S, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35:159–82. Available at https://www.esmo.org/guidelines/guidelines-by-topic/esmo-clinical-practice-guidelines-breast-cancer/early-breast-cancer (accessed 26 June 2024).
- Filipits M, et al. A New Molecular Predictor of Distant Recurrence in ER-Positive, HER2-Negative Breast Cancer Adds Independent Information to Conventional Clinical Risk Factors. Clin Cancer Res. 2011;17:6012–20.
- Sestak I, et al. Prediction of chemotherapy benefit by EndoPredict in patients with breast cancer who received adjuvant endocrine therapy plus chemotherapy or endocrine therapy alone. Breast Cancer Res Treat. 2019;176:377–86.
- Filipits M, et al. Prediction of Distant Recurrence using EndoPredict among Women with ER+, HER2- Node- Positive and Node-Negative Breast Cancer Treated with Endocrine Therapy Only. Clin Cancer Res. 2019;25:3865–72.
- Dubsky P, et al. The EndoPredict score provides prognostic information on late distant metastases in ER+/HER2- breast cancer patients. Br J Cancer. 2013;109:2959–64.
- Dubsky P, et al. EndoPredict improves the prognostic classification derived from common clinical guidelines in ER-positive, HER2-negative early breast cancer. Ann Oncol. 2013;24:640–7.
- Constantinidou A, et al. Clinical Validation of EndoPredict in Pre-Menopausal Women with ER-Positive, HER2-Negative Primary Breast Cancer. Clin Cancer Res. 2022;28:4435–43.
- Buus R, et al. Comparison of EndoPredict and EPclin With Oncotype DX Recurrence Score for Prediction of Risk of Distant Recurrence After Endocrine Therapy. J Natl Cancer Inst. 2016;108:djw149.
- Sestak I, et al. Comparison of the Performance of 6 Prognostic Signatures for Estrogen Receptor-Positive Breast Cancer. A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol. 2018;4:545–53.
- Klein E, et al. Long-term prospective outcome data using EndoPredict as risk stratification and chemotherapy decision biomarker in hormone receptor-positive, HER2-negative early breast cancer. Breast Cancer Res Treat. 2024;Online ahead of print. DOI: 10.1007/s10549-024-07346-2.
- Penault-Llorca F, et al. Prognostic value of EndoPredict test in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative primary breast cancer screened for the randomized, double-blind, phase III UNIRAD trial. ESMO Open. 2024;9:103443.
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