Deal or no-dal.

Now that breast cancer staging incorporates genomic risk scores, it’s time we start learning to apply them to patients with nodal disease. Let’s start at the beginning: SWOG-8814 randomized postmenopausal, hormone receptor-positive, (1-3) node-positive patients to tamoxifen +/- chemo, and the 2009 initial pub reported a disease-free survival benefit with the addition of chemo. Soon after, the first author had the good idea to use all those banked tissue specimens to churn out another quick pub by seeing if Oncotype Dx scores could predict outcomes. Indeed, just like in node-negative patients, the unplanned retrospective subset of low-risk (scores <18) patients did just as good sans chemo, while high risk (scores >30) patients fared significantly better with the addition of chemo, and intermediate risk (scores 18-30) patients were a crap shoot. We say all of that to say, there’s now an open phase 3 RxPONDER trial randomizing hormone receptor-positive, node-positive patients with Oncotype DX scores <25 to endocrine therapy +/- chemo. Why a cut-off of 25? The best we can tell, it’s TAILORx-made to hedge its bets based on the highest random score cut-off that saw no significant benefit with chemo in Table 2. So here’s to hoping there’s few recurrences in either case.