A 52-year-old woman is found to have a 2.8 cm IDC of the left breast with 3 of 12 axillary nodes positive, ER+/PR+/HER2−. The Oncotype DX recurrence score returns 18. According to the TAILORx trial results, the recommended adjuvant systemic therapy is:
- A Endocrine therapy alone, as recurrence score ≤25 confers equivalent outcome to chemoendocrine therapy in postmenopausal women ✓
- B Chemotherapy alone without endocrine therapy
- C Trastuzumab plus endocrine therapy
- D Endocrine therapy plus CDK4/6 inhibitor without chemotherapy
Explanation
TAILORx established that for hormone receptor–positive, HER2-negative, node-negative breast cancer, an Oncotype DX recurrence score of 0–25 in women ≥50 years does not benefit from adjuvant chemotherapy; endocrine therapy alone is sufficient. For node-positive disease, RxPONDER (SWOG S1007) later addressed this group, but the principle of recurrence score guiding chemotherapy sparing in low-intermediate risk postmenopausal patients remains central. Options B and C are incorrect because the patient's HER2 is negative ruling out trastuzumab and chemotherapy alone lacks endocrine benefit. Option D describes a strategy for metastatic/high-risk early disease, not a low recurrence-score scenario.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.