Does a very high Oncotype score influence your approach to adjuvant treatment in a patient with ER positive breast cancer?

This is a very intriguing question that has a simple answer. There is no data on choice or aggressiveness of chemotherapy and resulting benefit in patients with higher oncotype recurrence score. What regimen to use remains a judgement call, but for most patients with ER+/node negative tumors with a high recurrence score, 4 cycles of TC would be most appropriate. It is hard to justify more aggressive regimens, like dose dense ACT for example in those patients.

It is very true that in breast cancer we tend to overtreat because we somehow believe more chemotherapy may be better, when in fact the hazard ratio for recurrence may not be affected much with the addition of more chemotherapy. Additional absolute risk reduction remains small in many ...

I agree with @Dr. First Last that Oncotype scores facilitate decisions about chemotherapy versus not but they do not inform us as to what regimen to choose. However, I often treat women with high recurrence scores with ddAC-T in the absence of data that we can forgo dose dense anthracycline administration in high risk populations. The ABC data demonstrated inferiority of TC x 6 when compared with anthracycline-taxane containing regimens (TaxAC) and no significant differences in treatment effect by stratification variables (protocol, hormone receptor status or # of LNs). Granted the effect was least pronounced for the node-negative subset but the data still supported the anthracycline containing regimen across all subsets. Ultimately, of cou...