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Molecular Assays to Determine Optimal Duration of Adjuvant Endocrine Therapy in Breast Cancer

  • Breast Cancer (WJ Gradishar, Section Editor)
  • Published:
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Opinion statement

Hormone receptor (HR) positive breast cancer has a high propensity for late recurrences that might be prevented with longer durations of endocrine therapy (ET). However, trials evaluating extended adjuvant ET have produced somewhat conflicting results. Additionally, ET is associated with not only day to day side effects that can impact quality of life, but more detrimental effects that can cause significant morbidity. Although patients with higher stage disease are at greater risk of late recurrences, even patients with stage 1 disease have a significant risk of recurrence after 5 years. Current guidelines recommend extending therapy for patients with node-positive disease, but recommendations for patients with node-negative disease are less clear. This has led to the development of various genomic tests to aid oncologists in further individualizing their approach when it comes to deciding which subpopulation of patients with HR-positive breast cancer may benefit from extending their endocrine therapy beyond 5 years. There are several assays that are prognostic of recurrences years 6 to 10 following diagnosis. Additionally, the breast cancer index has been shown to be predictive of extended ET in patients who have completed 5 years of tamoxifen. None of the available assays are, to date, predictive of recurrence after 10 years. Genomic testing is not appropriate for all patients, especially if the results will not predict the choice of further treatment. Ultimately, genomic testing should help facilitate shared decision making between the patient and oncologist.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI, 53705, USA

    Apoorva Anandan

  2. Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin Carbone Cancer Center, Madison, WI, USA

    Marina Sharifi & Ruth O’Regan

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  1. Apoorva Anandan
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  2. Marina Sharifi
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Correspondence to Apoorva Anandan.

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This article is part of the Topical Collection on Breast Cancer

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Anandan, A., Sharifi, M. & O’Regan, R. Molecular Assays to Determine Optimal Duration of Adjuvant Endocrine Therapy in Breast Cancer. Curr. Treat. Options in Oncol. 21, 84 (2020). https://doi.org/10.1007/s11864-020-00788-y

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