Recurrence Score impacts treatment decisions in hormone receptor-positive, Her2- negative patients with early breast cancer in a real-world setting – results of the IRMA trial

Background Patients with hormone receptor-positive (HR+), Her2-negative (Her2-) early breast cancer (eBC) with a high risk of relapse often undergo chemotherapy. However, only a few patients will gain benefit from chemotherapy, since classical tumor characteristics (grading, tumor size, lymph node involvement, Ki67) are prognostic but not predictive of efficacy. Thus, many patients are often overtreated. The IRMA trial aims at selecting patients that have a high genomic risk of relapse to undergo chemotherapy and thereby personalize treatment recommendation by assessing the recurrence score (RS) in a real-world setting.

Materials and Methods Patients with HR+/Her2- eBC with 0 – 3 pathologic lymph nodes who underwent primary surgical treatment at the Department for Womens’ Health of Tubingen University were eligible for the study. In total, 245 patients underwent RS assessment. At first, therapy recommendation was determined without knowledge of the RS result. Then, therapy recommendation was assessed with awareness of the RS result.

Results Without knowledge of the RS result, 92/245 patients (37.55 %) would have received chemotherapy. After RS assessment 56/245 patients (22.86 %) were advised to undergo chemotherapy. Chemotherapy was waived in 47/92 patients (51.09 %) that were initially recommended to receive it. Chemotherapy was added in 11/153 patients (7.19 %) that were recommended to not receive it initially.

Summary RS assessment is a key tool for individualizing treatment recommendation. It serves to identify the patients that will likely benefit from chemotherapy due to their genomic risk, thereby reducing under- and overtreatment.

Publication History

Article published online:
21 June 2022