A 42-year-old premenopausal woman with ER+/HER2- pT2N1M0 breast cancer has an Oncotype DX recurrence score of 28. According to the TAILORx trial, what is the recommended adjuvant systemic treatment?
- A Endocrine therapy alone
- B Chemotherapy alone followed by endocrine therapy
- C Chemotherapy plus endocrine therapy based on age-related benefit ✓
- D Observation with surveillance only
Explanation
The TAILORx trial established that for patients with Oncotype DX scores 11-25, endocrine therapy alone is non-inferior to chemoendocrine therapy in postmenopausal women. However, a pre-specified subgroup analysis showed that premenopausal women aged ≤50 years with scores 16-25 derived absolute chemotherapy benefit of approximately 1.6% at 9 years. In premenopausal patients with scores in the intermediate range, age-related chemotherapy benefit informs the decision rather than the score alone. A score of 28 falls in the high range (>25) mandating chemoendocrine therapy regardless of menopausal status.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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