Do you use gene expression profiling for premenopausal women with hormone receptor positive breast cancer with 1-3 positive lymph nodes?

I do use gene expression profiling in premenopausal women with 1-3 nodes positive.

Premenopausal women represented 33% of all women in MINDACT (NEJM, 2016) (about 2100, a substantial number) and more than half of these premenopausal women had low genomic risk (and therefore a median 5 year distant disease free survival of about 95%).

Nodal status did not affect this risk number in MINDACT. Women with node positive disease and low genomic risk who did not receive chemotherapy had the same 5 year DDFS benefit as those with node negative disease who did not receive chemotherapy.

These clinical data speak for themselves, and suggest we are overtreating premenopausal women with node positive breast cancer with low genomic risk when we give them che...

I seldom use them in this setting unless it's a micrometastasis or I am otherwise concerned about chemotherapy. These patients were the minority in MINDACT re Mammaprint, were not included at all in TailoRx re Oncotype Dx, and the node+ trials that tested Prosigna re ROR score were limited to postmenopausal women. One of the take-home points from TailoRx is that one size does not fit all and the interpretation of these tests may vary by clinical subsets.