Response to neoadjuvant chemotherapy and the 21-gene Breast Recurrence Score test in young women with estrogen receptor-positive early breast cancer

Tal Sella, Shari I. Gelber, Philip D. Poorvu, Hee Jeong Kim, Laura Dominici, Yaileen D. Guzman-Arocho, Laura Collins, Kathryn J. Ruddy, Rulla M. Tamimi, Jeffrey M. Peppercorn, Lidia Schapira, Virginia F. Borges, Steven E. Come, Ellen Warner, Craig Snow, Debbie M. Jakubowski, Christy A. Russell, Eric P. Winer, Shoshana M. Rosenberg, Ann H. Partridge

Research output: Contribution to journalArticlepeer-review


Purpose: The 21-gene Breast Recurrence Score test predicts benefit from adjuvant chemotherapy in estrogen receptor-positive, HER2-negative (ER+/HER2−) breast cancer (BC). We examined whether the 21-gene assay predicts response to neoadjuvant chemotherapy (NCT). Methods: We identified patients with stage I–III ER+/HER2− BC treated with NCT from the Young Women’s Breast Cancer Study, a prospective cohort of women diagnosed with BC at age ≤40 years. The 21-gene assay was performed on tumor specimens removed prior to NCT either as part of clinical care or retrospectively for research. Pathological complete response (pCR) was defined as ypT0/is ypN0. The relationship between Recurrence Score result and pCR was evaluated using logistic regression modeling. Results: 76 women received NCT for ER+/HER2− BC and were eligible for this analysis. Median age at diagnosis was 37 years (range 24–40). Scores ranged between 5 and 77 with 50% >25 and 5% <11. Median Recurrence Score result was significantly higher among tumors achieving pCR vs. non-pCR response (61.5 vs. 23, pwilcoxon = 0.0005). pCR rate in patients with scores >25 was 21% (8/38) vs. 5% in patients with scores <25 (2/38) (p = 0.09), with both pCRs in the <25 group in patients with scores between 21 and 25. In multivariable analysis, only Recurrence Score result was significantly associated with pCR (OR: 1.07, 95%CI 1.01-1.12, p = 0.01). Conclusions: In young women with ER+/HER2− BC who received NCT, higher pretreatment Recurrence Score result was associated with an increased likelihood of pCR. Gene expression profile assays may have a role in decision making in young women in need of neoadjuvant therapy.

Original languageEnglish (US)
Pages (from-to)157-165
Number of pages9
JournalBreast Cancer Research and Treatment
Issue number1
StatePublished - Feb 2021


  • 21-gene Breast Recurrence Score
  • Neoadjuvant chemotherapy
  • Pathological complete response
  • Young women

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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