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The Role of Oncotype DX® Recurrence Score in Predicting Axillary Response After Neoadjuvant Chemotherapy in Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Oncotype DX® recurrence score (RS) is well-recognized for guiding decision making in adjuvant chemotherapy; however, the predictive capability of this genomic assay in determining axillary response to neoadjuvant chemotherapy (NCT) has not been established.

Methods

Using the National Cancer Data Base (NCDB), we identified patients diagnosed with T1-T2, clinically N1/N2, estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER +/HER2 −) invasive ductal carcinoma of the breast between 2010 and 2015. Patients with an Oncotype DX® RS who received NCT were included. RS was defined as low (< 18), intermediate (18–30), or high (> 30). Unadjusted and adjusted analyses were performed to determine the association between axillary pathologic complete response (pCR) and RS.

Results

This study included a total of 158 women. RS was low in 56 (35.4%) patients, intermediate in 62 (39.2%) patients, and high in 40 (25.3%) patients. The majority of patients presented with clinical N1 disease (89.2%). Axillary pCR was achieved in 23 (14.6%) patients. When stratifying patients with axillary pCR by RS, 11 (47.8%) patients had a high RS, 6 (26.1%) patients had an intermediate RS, and 6 (26.1%) patients had a low RS. Comparing cohorts by RS, 27.5% of patients with high RS tumors had an axillary pCR, compared with only 9.7% in the intermediate RS group, and 10.7% in the low RS group (p = 0.0268).

Conclusion

Our findings demonstrate that Oncotype DX® RS is an independent predictor of axillary pCR in patients with ER +/HER2 − breast cancers receiving NCT. A greater proportion of patients with a high RS achieved axillary pCR. These results support Oncotype DX® as a tool to improve clinical decision making in axillary management.

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Author notes

  1. Dr. Jaime Pardo and Dr. Betty Fan share first authorship of this work.

Authors and Affiliations

  1. Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA

    Jaime A. Pardo MD, Betty Fan DO, Alessandra Mele MD, Stephanie Serres MD PHD, Monica G. Valero MD, Isha Emhoff MD MPH, Amulya Alapati MD & Ted A. James MD MHCM

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  1. Jaime A. Pardo MD
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Correspondence to Ted A. James MD MHCM.

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Dr. Ted James is a scientific consultant for Perimeter Medical. Jaime A. Pardo, Betty Fan, Alessandra Mele, Stephanie Serres, Monica G. Valero, Isha Emhoff, and Amulya Alapati have no disclosures to declare.

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Pardo, J.A., Fan, B., Mele, A. et al. The Role of Oncotype DX® Recurrence Score in Predicting Axillary Response After Neoadjuvant Chemotherapy in Breast Cancer. Ann Surg Oncol 28, 1320–1325 (2021). https://doi.org/10.1245/s10434-020-09382-w

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