A 45-year-old woman is found to have a BRCA2 pathogenic variant. Her lifetime risk of breast cancer is estimated at 70%. She elects risk-reducing bilateral mastectomy. Regarding the Oncotype DX Recurrence Score (RS), which statement is MOST accurate regarding its clinical utility?

• A RS predicts benefit from adding chemotherapy to endocrine therapy in ER+/HER2- node-positive disease when 4+ nodes involved
• B RS is validated for use in HER2+ breast cancers
• C RS scores above 31 indicate endocrine therapy alone is sufficient
• D RS <26 in postmenopausal ER+/HER2- N0 patients identifies a group where chemotherapy adds no survival benefit per the TAILORx trial ✓

Explanation

The TAILORx trial demonstrated that postmenopausal women with ER+/HER2-/node-negative breast cancer and an Oncotype DX RS of 0-25 derive no benefit from adding chemotherapy to endocrine therapy. For premenopausal women, an RS of 0-15 also showed no benefit. RS is only validated for ER+/HER2- breast cancer, not HER2+ disease. RS >25 indicates chemotherapy benefit. The cutoff for definite chemotherapy benefit is RS ≥26.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.