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Biomarkers for Adjuvant Endocrine and Chemotherapy in Early-Stage Breast Cancer

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7 Extended Endocrine Therapy For ER Receptor-positive HER2-negative Breast Cancer Oncotype DX, EndoPredict, Prosigna, Ki67, or IHC4 Recommendation 1.23 ➤ If a patient has node-negative breast cancer and has had 5 years of endocrine therapy without evidence of recurrence, there is insufficient evidence to use Oncotype DX, EndoPredict, Prosigna, Ki67, or IHC4 tests to guide decisions about extended endocrine therapy. (Moderate recommendation; EB-I) BCI Recommendation 1.24 ➤ If a patient has node-negative or node-positive with 1–3 positive nodes breast cancer and has been treated with 5 years of primary endocrine therapy without evidence of recurrence, the clinician may offer BCI test to guide decisions about extended endocrine therapy with either tamoxifen, an AI, or a sequence of tamoxifen followed by AI. (Moderate recommendation; EB-I) Recommendation 1.25 ➤ If a patient has node-positive breast cancer with more than 3 positive nodes and has been treated with 5 years of primary endocrine therapy without evidence of recurrence, there is insufficient evidence to use BCI test to guide decisions about extended endocrine therapy with either tamoxifen, an AI, or a sequence of tamoxifen followed by AI. (Strong recommendation; EB-I) Clinical Treatment Score post-5 Years (CTS5) Recommendation 1.26 ➤ If a patient is postmenopausal and had invasive breast cancer and is recurrence free after 5 years of adjuvant endocrine therapy, the CTS5 web tool may be used to calculate the estimated risk of late recurrence (recurrence between years 5–10), that could assist in decisions about extended endocrine therapy. (Moderate recommendation; EB-I)

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