Clinical Decision Support Tool Effective For Early Breast Cancer Treatment

A new simulation model-based decision tool may be able to support discussion about genomic testing and early breast cancer treatment due to its integrative abilities, according to a recent study on the model’s development and efficacy in patients (J Clin Oncol. 2021; JCO2100651. doi:10.1200/JCO.21.00651).

Industry-independent decision tools are needed to integrate clinicopathologic features, comorbidities, and genomic information for women with node-negative, invasive, hormone receptor–positive, early-stage breast cancer.

Jinani Jayasekera, PhD, Department of Oncology, Georgetown University Medical Center, Washington, DC, and colleagues estimated and compared the 10-year risk of distant recurrence, breast cancer–specific mortality, other-cause mortality, and life-years gained with chemoendocrine versus endocrine therapy using an adapted extant Cancer Intervention and Surveillance Modeling Network simulation model.

Outcomes for 1512 patient subgroups based on all possible combinations of age, tumor size, grade, and comorbidity level were simulated, with and without 21-gene recurrence scores. Clinical trials, US cohort studies, registry, and claims data were used to determine model inputs.

When compared to endocrine therapy, chemotherapy in a woman aged 65-69 years with an intermediate-grade tumor that is 2 cm or smaller, and mild comorbities provides a 1.3% absolute reduction in 10-year distant recurrence risk, with 0.23 life-years gained. There is a 28% probability of having a recurrence score between 16 and 20, an 18% probability of a recurrence score between 21 and 25, and an 11% probability of a recurrence score of 26 or higher in a woman with these tumor features.

Chemoendocrine therapy reduces 10-year distant recurrence risk to 1% with 0.20 life-years gained if testing is done and the woman’s recurrence score is between 16 and 20. These results are comparable to those achieved with out testing.

“Our validated clinical decision tool is flexible, readily adaptable to include new therapies, and can support discussions about genomic testing and early breast cancer treatment,” concluded Dr Jayasekera and colleagues.—Marta Rybczynski