The Value of Genomic Profiling for Women With Breast Cancer

Findings from 2 studies presented at the San Antonio Breast Cancer Symposium highlight the value of genomic profiling for women with breast cancer. The PROMIS study found that women 50 years and younger with early-stage breast cancer and an intermediate recurrence score (RS) can avoid chemotherapy, while the FLEX study may identify the genomic underpinnings for morbidity and mortality disparities for African American women with breast cancer.

In the PROMIS abstract,¹ researchers presented a subanalysis of the PROMIS data set, which previously showed that the MammaPrint 70-gene signature provided actionable results for patients with an RS by the 21-gene assay. The subanalysis explored the impact of the 70-gene signature on clarifying adjuvant chemotherapy decisions for patients who are 50 years or younger. An intermediate RS is 18 to 30.

"Understanding how patient age may affect possible benefit from chemotherapy is a critically important question that has needed further exploration and clarification," William Audeh, MD, MS, chief medical officer, Agendia, said in a statement.

The poster showed that for most patients aged 50 or younger who have an RS of 16 to 25, chemo-endocrine therapy is the preferred treatment. MammaPrint was able to identify low-risk patients who may not need chemotherapy. More than half (56%) of patients assessed as having a high clinical risk with an RS of 18 to 20 were found to be low risk by MammaPrint and can potentially avoid chemotherapy. In addition, 30% of patients with a high clinical risk and an RS of 21 to 25 were found to be low risk by MammaPrint and can potentially avoid chemotherapy.

The FLEX study² is an ongoing, prospective trial evaluating tumor specimens collected from patients who have stage I-III breast cancer. They all received MammaPrint and BluePrint molecular subtyping assays. The subanalysis included 263 African American women and 300 white women.

The African American women in the study were predominantly high risk according to MammaPrint and had basal-type breast cancer according to BluePrint. They had a “distinct transcriptional profile…characterized by dysregulation of cell proliferation and metabolism” compared with white patients.

“These data highlight how inclusion in genomic research can provide needed information on [breast cancer] patients with [African American] ancestry,” the authors concluded.

1. Tsai M, Soliman H, Lo S, et al. Treatment recommendations in ER+ patients ≤ 50 years: Comparison of the 21-gene assay and 70-gene signature in the PROMIS study. Presented at the 2019 San Antonio Breast Cancer Symposium; San Antonio, Texas; December 7-10, 2019. Abstract P2-14-11.

2. Nunes R, Sharma D, Blumencranz LE, et al. Racial disparities in breast cancer: identifying predisposing clinical and molecular features associated with African American patients. Presented at the 2019 San Antonio Breast Cancer Symposium; San Antonio, Texas; December 7-10, 2019. Abstract P2-10-08.

References