Practice Changing Potential of TAILORx: A Retrospective Review of the National Cancer Data Base from 2010 to 2015
Uncertainty regarding chemotherapy benefit among breast cancer patients with intermediate Oncotype Dx® recurrence scores (RS; 11–25) led to the TAILORx study. We evaluated chemotherapy use in patients with intermediate RS to determine practice change potential based on the TAILORx results.
National Cancer Data Base patients with hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative, N0 breast cancer were identified and were divided into three groups: Group A, ≤ 50 years of age (RS 11–15); Group B, ≤ 50 years of age (RS 16–25); and Group C, > 50 years of age (RS 11–25). Demographic and clinical factors were compared using Chi square tests and Poisson regression models to determine predictors of chemotherapy receipt.
Overall, 37,087 patients met the inclusion criteria, with 6.3% in Group A and 11.7% in Group C having received chemotherapy that may have been avoided based on TAILORx. The majority of Group B (64.7%) did not receive chemotherapy, whereas TAILORx showed potential benefit from treatment. Chemotherapy use decreased over time for all intermediate RS patients. T2 tumors, high grade, and treatment before 2012 increased the likelihood of chemotherapy receipt among both groups. Younger patients with the lower intermediate RS (Group A) were more likely to receive chemotherapy if they had treatment at community or comprehensive centers, whereas moderate grade was also a significant factor to receive chemotherapy in Group B. Significant factors in older patients (Group C) were Black race, estrogen receptor-positive/progesterone receptor-negative, and moderate/high grade.
The most potential impact of TAILORx findings on practice change is for patients ≤ 50 years of age with RS of 16–25 who did not receive chemotherapy but may benefit. These findings may serve as a baseline for future analysis of practice patterns related to TAILORx.
The authors wish to acknowledge the support of the Biostatistics Shared Resource Facility and National Cancer Institute Cancer Center Support Grant P30 CA196521-01, Icahn School of Medicine at Mount Sinai, for analysis and interpretation of data and preparation of the manuscript.
LDLC conceptualized the study; LDLC and EP designed the study; LDLC and SR drafted the initial manuscript; and MR and KP performed data collection and analysis. All authors reviewed, revised, and approved the final manuscript as submitted, and agree to be accountable for all aspects of this work.
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