The 76-gene signature defines high-risk patients that benefit from adjuvant tamoxifen therapy

Y Zhang, Anieta Sieuwerts, M McGreevy, G Casey, T Cufer, A Paradiso, N Harbeck, PN Span, DG Hicks, J Crowe, RR Tubbs, GT Budd, J Lyons, FCGJ Sweep, M Schmitt, F Schittulli, R Golouh, D Talantov, YX Wang, John Foekens

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Abstract

Purpose To assess the benefit from adjuvant systemic tamoxifen therapy in breast cancer risk groups identified by the previously established prognostic 76-gene signature. Methods In 300 lymph node-negative (LNN), estrogen receptor-positive (ER+) breast cancer patients (136 treated with adjuvant tamoxifen, 164 having received no systemic adjuvant therapy), distant metastasis-free survival (DMFS) as a function of the 76-gene signature was determined in a multicenter fashion. Results In 136 tamoxifen-treated patients, the 76-gene signature identified a group of patients with a poor prognosis [hazard ratio (HR), 4.62; P = 0.0248]. These patients showed a 12.3% absolute benefit of tamoxifen in 10-year DMFS (HR, 0.52; P = 0.0318) compared with untreated high-risk patients. This represented a 71% increase in relative benefit compared with the 7.2% absolute benefit observed for all 300 patients without using the gene signature. In the low-risk group there was no significant 10-year DMFS benefit of tamoxifen. Conclusions The 76-gene signature defines high-risk patients who benefit from adjuvant tamoxifen therapy. Although we did not study the value of chemotherapy in this study, low-risk patients identified by the 76-gene signature have a prognosis good enough that chemotherapy would be difficult to justify. The prognosis of these patients is sufficiently good, in fact, that a disease-free benefit for tamoxifen therapy is difficult to prove, though benefits in terms of loco-regional relapse and a reduction in risk for contralateral breast cancer might justify hormonal therapy in these patients.
Original languageUndefined/Unknown
Pages (from-to)303-309
Number of pages7
JournalBreast Cancer Research and Treatment
Volume116
Issue number2
Publication statusPublished - 2009

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