102 Novel Prognostic and Predictive Locoregional Biosignature for Risk Stratification of Early-Stage Hormone Receptor–Positive Breast Cancer

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement42nd Annual Miami Breast Cancer Conference® - Abstracts
Volume 39
Issue 4
Pages: 42-43

102 Novel Prognostic and Predictive Locoregional Biosignature for Risk Stratification of Early-Stage Hormone Receptor–Positive Breast Cancer

102 Novel Prognostic and Predictive Locoregional Biosignature for Risk Stratification of Early-Stage Hormone Receptor–Positive Breast Cancer

Background

The role of adjuvant therapy for patients with early-stage, hormone receptor–positive (HR+) invasive breast cancer (IBC) following breast-conserving surgery (BCS) has been the subject of the ongoing investigation. Past studies have heavily relied on risk stratification based on clinicopathological features and have failed to identify a true low-risk population that can omit adjuvant therapy without increasing the risk of locoregional recurrence (LRR). Integration of molecular markers using a multiomic approach offers the potential to enhance risk assessment through tumor biology assessment. This study evaluates the use of multiomic biosignatures to predict LRR risk and radiation therapy (RT) and endocrine therapy (ET) benefits for early-stage HR+/HER2-negative (HER2–) IBC.

Materials and Methods

A total of 782 patients with IBC (T1/2N0/1M0, HR+, HER2–) treated with BCS (1986-2022) were identified from a multi-institutional cohort. Two biosignatures were developed that calculate individualized results for the prognosis, decision score (DS), and prediction of RT benefit, RT score (RTS) on 10-point scales. The association between 10-year LRR risk, the biosignatures, the benefit of RT and ET, and the interaction between RTS and RT was assessed using multivariable Cox proportional hazards analysis (MVA).

Results

The median age of the cohort was 64 years, with a median follow-up of 11 years. Overall, 78% (n = 610) of the patients received RT and 39% (n = 307) received ET with 31% (n = 242) of the total receiving both ET and RT. With the inclusion of biosignatures (DS/RTS), MVA found age older than 50 years (HR, 2.4; P <.001) was associated with increased LRR as were increasing DS (continuous HR, 3.3; P <.001) and RTS (interaction with RT P <.001, HR, 3.5), while receipt of RT had HR, 0.2 (P <.001) and ET had HR, 0.7 (P = .17). In patients 50 years or older, excluding N1 disease, (n = 630), increasing DS (continuous) was associated with increasing LRR risk HR, 4.0 per 5 units (P <.001) and RTS and RT interaction was significant (P <.001). For 22% of patients (n = 141) with categorical (LRS ≤4), average 10-year LRR risks were 5% or more for patients treated with/without ET and with/without RT, where ET (P = .85) and RT (P = .97) were not associated with LRR risk.

Conclusion

The biosignatures were prognostic for LRR risk and predictive for RT benefit and identified a clinically low 10-year LRR risk group. This initial cross-validation indicates that the test may be a useful tool to aid in the assessment of the benefit of adjuvant therapy in early-stage HR+/HER2– IBC.

Articles in this issue

40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
TPS 43 ADELA: A Double-Blind, Placebo-Controlled, Randomized Phase 3 Trial of Elacestrant + Everolimus vs Elacestrant + Placebo in ER+/HER2– Advanced Breast Cancer Patients With ESR1-Mutated Tumors Progressing on Endocrine Therapy
TPS 43 ADELA: A Double-Blind, Placebo-Controlled, Randomized Phase 3 Trial of Elacestrant + Everolimus vs Elacestrant + Placebo in ER+/HER2– Advanced Breast Cancer Patients With ESR1-Mutated Tumors Progressing on Endocrine Therapy
45 A Phase 3 Randomized Study of Adjuvant Sacituzumab Tirumotecan Plus Pembrolizumab vs Treatment of Physician’s Choice in Patients With Triple-Negative Breast Cancer Who Received Neoadjuvant Therapy and Did Not Achieve a Pathological Complete Response at Surgery
45 A Phase 3 Randomized Study of Adjuvant Sacituzumab Tirumotecan Plus Pembrolizumab vs Treatment of Physician’s Choice in Patients With Triple-Negative Breast Cancer Who Received Neoadjuvant Therapy and Did Not Achieve a Pathological Complete Response at Surgery
46 Neoadjuvant Pembrolizumab or Placebo Plus Chemotherapy Followed by Adjuvant Pembrolizumab or Placebo for High-Risk, Early-Stage Triple-Negative Breast Cancer: Overall Survival and Subgroup Results From the Phase 3 KEYNOTE-522 Study
46 Neoadjuvant Pembrolizumab or Placebo Plus Chemotherapy Followed by Adjuvant Pembrolizumab or Placebo for High-Risk, Early-Stage Triple-Negative Breast Cancer: Overall Survival and Subgroup Results From the Phase 3 KEYNOTE-522 Study
48 Prevalence of “HER2 Ultra-Low” Among Advanced Breast Cancer Patients With Historical IHC0 Status
48 Prevalence of “HER2 Ultra-Low” Among Advanced Breast Cancer Patients With Historical IHC0 Status
49 Clinical Characteristics and Treatment Persistence in US Patients With HR+/HER2–, Node-Positive Early Breast Cancer Treated With Abemaciclib: Real-World Study From First Year After Approval
49 Clinical Characteristics and Treatment Persistence in US Patients With HR+/HER2–, Node-Positive Early Breast Cancer Treated With Abemaciclib: Real-World Study From First Year After Approval
52 Correlation and Prediction of Complete Pathologic Response Rates and Ki-67 in Patients Receiving Neoadjuvant Immunotherapy for Triple-Negative Breast Cancer
52 Correlation and Prediction of Complete Pathologic Response Rates and Ki-67 in Patients Receiving Neoadjuvant Immunotherapy for Triple-Negative Breast Cancer
53 Comparison of Surgical Complications With Direct-to-Implant vs Tissue Expander Reconstruction After Wise Pattern Skin-Sparing Mastectomy
53 Comparison of Surgical Complications With Direct-to-Implant vs Tissue Expander Reconstruction After Wise Pattern Skin-Sparing Mastectomy
54 The Treatment of Breast Cancer With Percutaneous Thermal Ablation: Results of the THERMAC Trial
54 The Treatment of Breast Cancer With Percutaneous Thermal Ablation: Results of the THERMAC Trial
55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?
55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?
56 Paternal vs Maternal Inheritance of a BRCA Mutation: Is There a Difference in Presentation and Stage of Breast Cancer at Diagnosis?
56 Paternal vs Maternal Inheritance of a BRCA Mutation: Is There a Difference in Presentation and Stage of Breast Cancer at Diagnosis?
57 Tumor Morphology Concordance in Multifocal/Multicentric Triple- Negative and HER2+ Breast Cancers
57 Tumor Morphology Concordance in Multifocal/Multicentric Triple- Negative and HER2+ Breast Cancers
59 Are Choosing Wisely Guidelines Applicable to Patients With a High Ki-67 Proliferation Index and Magee Equation Score?
59 Are Choosing Wisely Guidelines Applicable to Patients With a High Ki-67 Proliferation Index and Magee Equation Score?
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