Hope S. Rugo, MD
The Formal discussant of this presentation, Hope S. Rugo, MD, of the University of California, San Francisco, said, “Tailoring treatment to biology results in incremental improvements in outcome.”
She continued: “This analysis gives us excellent data on the natural history of mostly hormone receptor–positive, stage T1b breast cancers. [They are] the best data we have. Most of these cancers are both clinical and genomic low-risk based on MINDACT classifications. The majority of discordant cases were also luminal B, HER2-positive, or basal, and we do treat these tumors. The benefit of chemotherapy is difficult to assess in this analysis, given the low numbers of patients and few events. There was a very small benefit [of chemotherapy] in HER2-negative tumors.”
Dr. Rugo concluded: “Tumor biology is critical, but treatment decisions must take into account risk vs benefit, given the excellent outcomes overall. It is not clear how much genomic analysis in small tumors helps us with clinical decision-making, in light of the heterogeneous clinical features of this population.” ■
DISCLOSURE: Dr. Rugo reported no conflict of interest.
A large subset analysis of the MINDACT trial suggests that oncologists may be undertreating women with small (< 1 cm) node-negative breast tumors, which are clinically considered to be low risk but can be genomically high risk. About one in four women with small node-negative breast tumors <...