Genomic Testing in Breast Cancer: Clinical Applications and Best Practices

Discover essential insights on breast cancer awareness, prevention, and treatment options to empower your health journey.

Discover essential insights on breast cancer awareness, prevention, and treatment options to empower your health journey.

Panelists discuss how community practitioners face challenges with genomic testing due to working across multiple hospitals with different medical oncology groups who may have varying preferences for assays, emphasizing the importance of communication, established algorithms, and leveraging partnerships with testing companies.

Panelists discuss how they primarily use the 21-gene assay (Oncotype DX) for estrogen receptor–positive (ER+), HER2-negative (HER2–) breast cancers with minimal nodal disease due to its robust data from multiple trials, whereas other assays such as the Breast Cancer Index (BCI) are better for evaluating extended endocrine therapy benefits.

Panelists discuss how clinical factors such as nodal status influence genomic testing decisions, referencing the TAILORx and RxPONDER trials whose data demonstrated that chemotherapy benefit varies based on recurrence score and menopausal status, highlighting the need for nuanced shared decision-making rather than strict cutoffs.

Panelists discuss how the RSClin tool provides more personalized information by combining recurrence scores with clinicopathological data, offering patients specific predictions about their prognosis and potential chemotherapy benefit rather than general outcomes for patients with similar scores.

Panelists discuss how the RxPONDER trial data transformed breast cancer treatment by demonstrating that postmenopausal women with 1 to 3 positive lymph nodes and low recurrence scores could safely avoid chemotherapy, while highlighting the controversy about chemotherapy benefit in premenopausal patients where clinical judgment and nuanced assessment of menopausal status remain crucial.

Panelists discuss how the TAILORx trial data were transformative for estrogen receptor–positive breast cancer by establishing clearer thresholds for chemotherapy benefit, while raising important questions about whether younger patients with intermediate scores benefit from chemotherapy itself or from the ovarian suppression it causes.

Panelists discuss how genomic testing informs real clinical scenarios, demonstrating that for a 64-year-old healthy woman with a single positive lymph node, the 21-gene assay would guide treatment decisions, with cardiac assessment influencing whether anthracycline-based chemotherapy would be used if her score was high.

Panelists discuss how genomic assays have become essential tools in modern breast cancer treatment, preventing overtreatment by enabling customized treatment plans that determine not only whether patients need chemotherapy but also which specific agents they should receive and whether treatment should be given before or after surgery.