Abstract
Postmenopausal women with early breast cancer are at an ongoing risk of relapse, even after successful surgery and treatment of the primary tumor. The treatment of breast cancer has changed in the past few years because of the discovery of prognostic and predictive biomarkers that allow individualized breast cancer treatment. However, it is still not clear how to identify women that are at high risk of a late recurrence. Clinical parameters are good prognostic markers for early recurrence, but only nodal status and, to a lesser extent, tumor size have proven to be strong prognostic markers for late recurrence. Multi-gene signatures have become widely used for the prediction of overall recurrence risk and tailoring administration of adjuvant chemotherapy, but only a few have been shown to be prognostic for late (distant) relapse. There is a need to accurately identify women who may benefit from extended endocrine therapy but also those who may be spared any additional treatment. Recent results from large clinical trials have shown that the research is going in the right direction, and these results might help to optimize extended endocrine therapy for patients with early breast cancer. However, further research is needed to select individual biomarkers or multi-gene signatures that offer identification of late recurrence specifically and thus justify routine use of these tests in the clinical setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-015-0516-0) contains supplementary material, which is available to authorized users.
Highlights
Breast cancer is the most common cancer in women, and over 1.6 million cases are diagnosed annually [1]
In both the univariate and bivariate analyses, the risk of recurrence (ROR) score added significant prognostic information for late distant recurrence in all patients and was more predictive in nodenegative and node-negative/Human epidermal growth factor (HER2)-negative patients than clinical factors alone [36]. The results of this analysis indicated that the ROR score is able to identify women who are at sufficiently low risk of late distant recurrence, even if they have node-positive disease, and who might be spared additional endocrine therapy and overtreatment
It is important to accurately identify women at high risk of late recurrence as some of them may be spared extended endocrine therapy whereas others may benefit from further treatment
Summary
Breast cancer is the most common cancer in women, and over 1.6 million cases are diagnosed annually [1]. The ROR score was evaluated in the ABCSG-8 (Austrian Breast and Colorectal Cancer Study Group 8) trial, in which postmenopausal women with early breast cancer were randomly assigned to receive tamoxifen or anastrozole for 5 years [35] In this large analysis, the ROR score added significant prognostic value beyond that of clinical parameters for distant recurrence in the overall population and all subgroups. Two thousand one hundred and thirtyseven postmenopausal women who did not have a recurrence in the first 5 years after diagnosis were included in the analysis In both the univariate and bivariate analyses (adjusted for clinical parameters), the ROR score added significant prognostic information for late distant recurrence in all patients and was more predictive in nodenegative and node-negative/HER2-negative patients than clinical factors alone [36]. It has been become clear that CTCs are a powerful marker for the prediction of early metastatic disease, not many studies have addressed the use of CTCs for the identification of late relapse and this area of research needs further investigation
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