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Breast: Adjuvant chemotherapy and genomic assays

Free question published 26 October 2026

BreastAdjuvant chemotherapy and genomic assays

A 62-year-old postmenopausal woman has had breast-conserving surgery for a 19 mm, grade 2, strongly ER-positive, HER2-negative invasive ductal carcinoma with negative sentinel nodes (pN0). A 21-gene recurrence score (Oncotype DX) returns a value of 17. She is fit and asks whether she needs chemotherapy in addition to endocrine therapy. What is the most appropriate recommendation?

  1. AEndocrine therapy alone, omitting chemotherapy
  2. BCapecitabine plus endocrine therapy
  3. CChemotherapy alone without endocrine therapy
  4. DAnthracycline-taxane chemotherapy followed by endocrine therapy
  5. ERepeat the recurrence score on a second tumour block

Why A is correct

TAILORx showed that in women with HR-positive, HER2-negative, node-negative breast cancer and a 21-gene recurrence score of 11 to 25, endocrine therapy alone was non-inferior to chemoendocrine therapy for invasive disease-free survival. This 62-year-old (over 50) with a recurrence score of 17 can safely omit chemotherapy and receive endocrine therapy alone.

And why the others are not

  • BIncorrect. Capecitabine is not a recognised adjuvant option for this low-intermediate-risk ER-positive node-negative disease.
  • CIncorrect. Endocrine therapy is the backbone for ER-positive disease and should not be omitted in favour of chemotherapy.
  • DIncorrect. Chemotherapy adds no benefit over endocrine therapy alone for an intermediate recurrence score in this age group, while adding toxicity.
  • EIncorrect. A valid recurrence score of 17 falls clearly in the 11-25 range; repeating the assay is unnecessary.

Source TAILORx - 21-gene recurrence score to guide chemotherapy in node-negative breast cancer — Sparano JA, Gray RJ, Makower DF, et al. Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. N Engl J Med. 2018;379(2):111-121.

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