BCI Shows Promise of Personalized Endocrine Therapy in Breast Cancer

Marie-France Jilderda, MD, PhD Candidate Surgical Oncology at Leiden University Medical Center in the Netherlands.

New research presented at the San Antonio Breast Cancer Symposium 2024 between December 10 to December 13 suggests that the Breast Cancer Index (BCI) may help identify a subset of postmenopausal women with HR-positive, node-negative breast cancer at minimal risk of recurrence.

Marie-France Jilderda, MD, PhD Candidate Surgical Oncology at Leiden University Medical Center in the Netherlands explained in an interview with The American Journal of Managed Care® (AJMC®) how this could allow these patients to consider shorter or less intensive endocrine therapy, potentially reducing treatment-related adverse effects.

This transcript was lightly edited for clarity.

Transcript

AJMC: What are the potential benefits and risks of omitting or shortening adjuvant endocrine therapy for patients with low-risk who were identified by the BCI?

Jilderda: Endocrine therapy is associated with adverse effects that can significantly impact patients’ quality of life, including hot flashes, joint and bone pain, and weight gain. Patients identified as ‘Minimal Risk’ using the adjusted BCI model could potentially be spared the unwanted adverse effects of endocrine therapy by the omission or shortening. However, further validation is needed to validate the BCI test for guiding clinical decision making in this setting before this new application is available.

How does the use of BCI impact health care costs, both directly and indirectly? Are there cost-effectiveness analyses that support its use in clinical practice?

The adjusted BCI model identified about 20% of early-stage, hormone receptor positive breast cancer patients who are at minimal risk of 10-year distant recurrence. These patients may be eligible for de-escalation of endocrine therapy, which may lead to overall reduced costs for their treatment. Cost-effectiveness analyses, to my knowledge, have not been performed to compare the costs of using the BCI vs the potential endocrine therapy that is spared.

What future research is necessary to further validate the BCI and explore its potential applications in other patient populations?

We aim to further validate the adjusted BCI model and add to the current body of evidence through additional research prior to availability.