Stefania Morganti1,2, Antonio Marra1,2,3, Edoardo Crimini1,2, Paolo D'Amico1,2,4,5, Paola Zagami1,2, Giuseppe Curigliano6,7. 1. Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, Milan, Italy. 2. Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy. 3. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. 4. Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA. 5. Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA. 6. Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, Milan, Italy. giuseppe.curigliano@ieo.it. 7. Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy. giuseppe.curigliano@ieo.it.
Abstract
PURPOSE: Despite advances in adjuvant therapeutic strategies, many patients with hormone receptor (HR)-positive/HER2-negative early breast cancer (EBC) experience disease recurrence, even many years after primary surgery. The aim of this review is: (i) to point out the current clinical, pathological, and genomic features that contribute to define the risk of recurrence in HR-positive EBC, (ii) to explore the potential role of liquid biopsy-based assays for refining risk assessment, and (iii) to discuss future perspectives and innovative strategies to optimize risk stratification and select patients for treatment escalation. METHODS: We searched PubMed, EMBASE and Scopus to review the current evidence about risk stratification in patients with HR-positive EBC, and to identify studies deemed to have the highest scientific value. RESULTS: Risk stratification of HR-positive/HER2-negative relies on traditional clinicopathological features (age, menopausal status, tumor size, nodal status, tumor grading, HR expression level, and proliferation markers), along with newly developed genomic scores, which accurately predict risk of recurrence and survival. Multiparametric scores including both clinicopathological and genomic variables have the highest prognostication power, even if comparative studies have not defined which one should be preferred. In parallel, liquid biopsy-based showed to be a valuable tool to identify high risk patients. CONCLUSION: The most appropriate definition of "high" and "low" risk HR-positive EBC is still unclear. Accordingly, treatment escalation/de-escalation depending on recurrence risk remains challenging. Implementation of new tools for risk stratification, such as liquid biopsy-based assays, as well as development of novel treatment strategies are strongly warranted.
PURPOSE: Despite advances in adjuvant therapeutic strategies, many patients with hormone receptor (HR)-positive/HER2-negative early breast cancer (EBC) experience disease recurrence, even many years after primary surgery. The aim of this review is: (i) to point out the current clinical, pathological, and genomic features that contribute to define the risk of recurrence in HR-positive EBC, (ii) to explore the potential role of liquid biopsy-based assays for refining risk assessment, and (iii) to discuss future perspectives and innovative strategies to optimize risk stratification and select patients for treatment escalation. METHODS: We searched PubMed, EMBASE and Scopus to review the current evidence about risk stratification in patients with HR-positive EBC, and to identify studies deemed to have the highest scientific value. RESULTS: Risk stratification of HR-positive/HER2-negative relies on traditional clinicopathological features (age, menopausal status, tumor size, nodal status, tumor grading, HR expression level, and proliferation markers), along with newly developed genomic scores, which accurately predict risk of recurrence and survival. Multiparametric scores including both clinicopathological and genomic variables have the highest prognostication power, even if comparative studies have not defined which one should be preferred. In parallel, liquid biopsy-based showed to be a valuable tool to identify high risk patients. CONCLUSION: The most appropriate definition of "high" and "low" risk HR-positive EBC is still unclear. Accordingly, treatment escalation/de-escalation depending on recurrence risk remains challenging. Implementation of new tools for risk stratification, such as liquid biopsy-based assays, as well as development of novel treatment strategies are strongly warranted.
Authors: H J Burstein; G Curigliano; S Loibl; P Dubsky; M Gnant; P Poortmans; M Colleoni; C Denkert; M Piccart-Gebhart; M Regan; H-J Senn; E P Winer; B Thurlimann Journal: Ann Oncol Date: 2019-10-01 Impact factor: 32.976
Authors: Hongchao Pan; Richard Gray; Jeremy Braybrooke; Christina Davies; Carolyn Taylor; Paul McGale; Richard Peto; Kathleen I Pritchard; Jonas Bergh; Mitch Dowsett; Daniel F Hayes Journal: N Engl J Med Date: 2017-11-09 Impact factor: 91.245
Authors: Joseph A Sparano; Robert J Gray; Della F Makower; Kathleen I Pritchard; Kathy S Albain; Daniel F Hayes; Charles E Geyer; Elizabeth C Dees; Matthew P Goetz; John A Olson; Tracy Lively; Sunil S Badve; Thomas J Saphner; Lynne I Wagner; Timothy J Whelan; Matthew J Ellis; Soonmyung Paik; William C Wood; Peter M Ravdin; Maccon M Keane; Henry L Gomez Moreno; Pavan S Reddy; Timothy F Goggins; Ingrid A Mayer; Adam M Brufsky; Deborah L Toppmeyer; Virginia G Kaklamani; Jeffrey L Berenberg; Jeffrey Abrams; George W Sledge Journal: N Engl J Med Date: 2018-06-03 Impact factor: 91.245
Authors: Prudence A Francis; Olivia Pagani; Gini F Fleming; Barbara A Walley; Marco Colleoni; István Láng; Henry L Gómez; Carlo Tondini; Eva Ciruelos; Harold J Burstein; Hervé R Bonnefoi; Meritxell Bellet; Silvana Martino; Charles E Geyer; Matthew P Goetz; Vered Stearns; Graziella Pinotti; Fabio Puglisi; Simon Spazzapan; Miguel A Climent; Lorenzo Pavesi; Thomas Ruhstaller; Nancy E Davidson; Robert Coleman; Marc Debled; Stefan Buchholz; James N Ingle; Eric P Winer; Rudolf Maibach; Manuela Rabaglio-Poretti; Barbara Ruepp; Angelo Di Leo; Alan S Coates; Richard D Gelber; Aron Goldhirsch; Meredith M Regan Journal: N Engl J Med Date: 2018-06-04 Impact factor: 91.245