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Track 3

DR LOVE: Cliff, can you comment on the data presented at the 2007 San Antonio meeting evaluating the Oncotype DX^® assay for patients with node-positive disease?

DR HUDIS: In 2007, Kathy Albain and colleagues at SWOG presented confirmatory results from a different cohort of patients — postmenopausal women with node-positive disease who were randomly assigned to tamoxifen with or without CAF (Albain 2007; [3.1]).

The one caution is that the numbers in Kathy’s trial are small. The absolute differences in the number of events between the patients who did and those who did not receive chemotherapy in the various cohorts of high, intermediate and low are barely in double digits. Thus, one can be forgiven for being extremely conservative in terms of broadly interpreting those data, but they’re consistent with the other retrospective data set. For this patient, it would give me the courage to use the test.

DR LOVE: For this patient with node-positive disease, did you recommend Oncotype DX?

DR MOSS: Yes. This patient did not want to receive adjuvant chemotherapy if it was at all reasonable to avoid it. I ordered the Oncotype DX and her score was 19, falling in the intermediate range. The fact that it was not in the high-risk range gave me the reassurance I needed to not administer chemotherapy.

DR LOVE: Bob, what kind of hormonal therapy did she receive?

DR MOSS: She was started on anastrozole and has continued on that without any problems.

DR LOVE: Skip, how do you approach the patient who completes five years of adjuvant therapy with an aromatase inhibitor and does not experience problems with arthralgias (3.2)?

DR BURRIS: Based on their prognostic factors, I say to some patients, “We will continue to follow the literature. For now, I am planning on keeping you on this indefinitely.” For some patients, you feel as if even five years is too much. It’s a lengthy discussion. Until more data are available, I’ll often let the patient be the primary driver of the decision.

DR FOX: We invite every patient who is so inclined to participate in NSABP-B-42 (3.3). If they decline participation, we discontinue the aromatase inhibitor. The reason for doing that is based on the experience that some of us went through with tamoxifen. The tendency was to prescribe it ad infinitum for patients, particularly those with a high risk of recurrence, without having established that it was advisable.