Using RxPONDER Findings to Inform Testing and Treatment Approaches in Node-Positive Breast Cancer

Genomic Testing in Node-Positive Disease

Main Discussion Topics:

• Interpretation of RxPONDER trial results for node-positive patients
• Differing approaches to premenopausal vs postmenopausal patients with node-positive disease
• Role of clinical judgment in treatment decisions

Key Points for Physicians:

• RxPONDER data showed that postmenopausal women with 1 to 3 positive nodes and low recurrence scores can safely avoid chemotherapy.
• Premenopausal women with positive nodes showed small but statistically significant chemotherapy benefit, requiring a nuanced approach.
• Clinical factors beyond age (proximity to menopause, family menopause history) should inform decisions.

Notable Insights:

• Treating all premenopausal patients with node-positive disease with chemotherapy regardless of recurrence score represents a “leap back to 1990.”
• For patients 45 to 50 years old who are perimenopausal, genomic testing still provides valuable information for shared decision-making.

Clinical Significance: Genomic testing remains valuable in node-positive disease but requires integration with clinical judgment and patient preferences, particularly for premenopausal patients for whom benefit may be modest.