LWBK1006-24 LWW-Govindan-Review December 12, 2011 19:15
Chapter 24•Cancer of the Breast 345Answer 24.30. The answer is C.
The OncotypeDX assay classifies patients by expression of 16 cancer-
related genes (normalized to the expression of five reference genes) into
low-, intermediate-, and high-risk groups. In NSABP B-20, the addition of
chemotherapy to tamoxifen did not improve distant recurrence-free sur-
vival at 10 years in patients with a low or intermediate recurrence score.
However, in patients with a high recurrence score, the distant recurrence-
free survival at 10 years improved from 60% to 82% with the addition
of CMF.Answer 24.31. The answer is D.
DFS was improved by 24%, and time to contralateral breast cancer was
reduced by 43%. Although OS was not improved in the entire study
population (p=.08), analysis of patients with known ER+disease did
find a significant improvement in survival. (See text: Adjuvant Endocrine
Therapy. See also Coombes RC, Hall E, Gibson LJ, et al. A random-
ized trial of exemestane after two to three years of tamoxifen therapy
in postmenopausal women with primary breast cancer. N Engl J Med.
2004;350:1081–1092; Coombes R, Paridaens R, Jassem J, et al. First
mature survival analysis of Intergroup Exemestane Study: A randomized
trial in disease-free patients with early breast cancer randomized to con-
tinue tamoxifen or switch to exemestane following an initial 2–3 years of
adjuvant tamoxifen. Proc Am Soc Clin Oncol. 2006;24:9s.)Answer 24.32. The answer is C.
Despite the crossover effects after the trial was unblinded, the most recent
update of the combined analysis continued to show a similar impact on
DFS (∼50%), distant DFS (∼50%), and OS (∼30%). Among 875 patients
randomized to trastuzumab and chemotherapy, there were 22 cases of
congestive heart failure but no cardiac deaths. In the control arm there
was only one case of CHF, and one cardiac death was reported. (See text:
Adjuvant Trastuzumab. See also Romond EH, Perez EA, Bryant J, et al.
Trastuzumab plus adjuvant chemotherapy for operable HER2-positive
breast cancer. N Engl J Med. 2005;353:1673–1684.)Answer 24.33. The answer is D.
The relative benefits of chemotherapy are independent of age, ER status,
and use of hormonal therapy, although the absolute benefits will differ
according to baseline risk.Answer 24.34. The answer is B.
Approximately 12 studies have evaluated the incorporation of the tax-
anes, either sequentially or concurrently, into anthracycline-based adju-
vant therapy. Although most studies report an improved outcome, no
clearly superior regimen has emerged. In the E1199 trial, no difference
was identified with docetaxel or paclitaxel administered weekly or every
3 weeks.