A 42-year-old woman with ER-positive, HER2-negative invasive ductal carcinoma (pT2N1M0) has undergone breast-conserving surgery. Her Oncotype DX Recurrence Score is 22. According to the TAILORx trial findings, which of the following best guides her adjuvant systemic therapy?

• A Endocrine therapy alone is non-inferior to chemoendocrine therapy in women aged ≤50 with RS 16–25
• B Chemotherapy must be added because node-positive disease overrides recurrence score
• C RS 22 places her in the high-risk category requiring combination chemotherapy
• D For women ≤50 with RS 16–25 and node-positive disease, chemotherapy provides significant benefit ✓

Explanation

The TAILORx trial showed that endocrine therapy alone was non-inferior to chemoendocrine therapy for node-negative, ER+/HER2- patients with RS 11–25, except for women aged ≤50 with RS 16–25 who derived chemotherapy benefit. This patient is node-positive (N1), and while TAILORx specifically addressed node-negative disease, the RxPONDER trial extended findings to 1–3 positive nodes; for premenopausal N1 patients with RS ≤25, chemotherapy still provides benefit. Option A is incorrect because it conflates TAILORx node-negative data with node-positive settings.

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.