TAILORx, cont.

Headline: TAILORx is back for more ASCO glory. Last year we learned that women with intermediate Oncotype DX risk scores of 11-25 can safely forgo chemotherapy, with the notable exception of women <50 years with higher intermediate scores of 16-25. Here the authors recognize that Oncotype scores don’t come to us in a vacuum. This secondary analysis of the TAILORx cohort (n=9427) assigns a dichotomized clinical risk score to each woman to see if this adds predictive power to Oncotype DX. Clinical low risk tumor = grade 1 ≤3 cm, grade 2 ≤2 cm, or grade 3 ≤1 cm. Clinical high risk tumor = anything else. Indeed, women with high clinical risk had significantly more distant recurrences at 9 years whether they had high (>26) or intermediate (11-26) Oncotype scores and whether they did or did not receive chemo. Reminder: all with high Oncotype scores received chemo and half with intermediate scores received chemo. More enlightening, among women <50 years old with intermediate Oncotype scores, distant recurrence was the same with or without chemo if the clinical risk was low (<5%), but distant recurrence was significantly lower with chemo if the clinical risk was high (12 → 6%). TBL: Easy clinical risk stratification based on tumor size and grade can help decipher which women <50 with intermediate Oncotype DX scores will likely benefit from chemo. | Sparano, N Engl J Med 2019