New research presented at the San Antonio Breast Cancer Symposium 2024 reveals promising potential for personalizing endocrine therapy duration using the Breast Cancer Index (BCI) in postmenopausal women with hormone receptor-positive breast cancer.
The study, led by researchers at Leiden University Medical Center, demonstrates that BCI testing can identify approximately 20% of patients with early-stage, hormone receptor-positive, node-negative breast cancer who have minimal risk of distant recurrence over 10 years. This finding could significantly impact treatment approaches for thousands of breast cancer patients.
Clinical Implications for Patient Care
"Endocrine therapy is associated with adverse effects that can significantly impact patients' quality of life, including hot flashes, joint and bone pain, and weight gain," explains Marie-France Jilderda, MD, PhD Candidate in Surgical Oncology at Leiden University Medical Center. Patients identified as 'Minimal Risk' through the adjusted BCI model could potentially avoid these side effects through shortened or omitted endocrine therapy.
Treatment De-escalation Potential
The ability to identify patients at minimal risk of recurrence opens new possibilities for treatment de-escalation. This approach could lead to:
- Reduced exposure to treatment-related adverse effects
- Improved quality of life for eligible patients
- Potential cost savings in overall treatment
Economic Considerations
While the economic impact of implementing BCI testing requires further study, the potential for reduced endocrine therapy duration in approximately one-fifth of patients suggests possible cost benefits. However, formal cost-effectiveness analyses comparing BCI testing against potential endocrine therapy savings have not yet been conducted.
Future Research Directions
Before implementing BCI-guided treatment decisions in clinical practice, additional validation studies are necessary. The research team at Leiden University Medical Center plans to further validate the adjusted BCI model to strengthen the existing evidence base.
The findings represent a significant step toward more personalized breast cancer treatment, potentially allowing clinicians to tailor endocrine therapy duration based on individual patient risk profiles. However, Dr. Jilderda emphasizes that further validation is required before this new application becomes available for routine clinical use.
