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Comment & Response
February 13, 2020

Use of the 21-Gene Recurrence Score to Predict Clinical Outcomes in Early Breast Cancer—Reply

Author Affiliations
  • 1Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
JAMA Oncol. Published online February 13, 2020. doi:10.1001/jamaoncol.2019.6712

In Reply Lee’s assertion that clinical outcomes cannot be compared between the National Surgical Adjuvant Breast and Bowel Project (NSABP) B20 trial and the Trial Assigning Individualized Options for Treatment (TAILORx) reflects a fundamental misunderstanding of the methods and major findings of our report1 describing clinical outcomes in 1389 women with a recurrence score (RS) of 26 to 100 assigned to receive chemoendocrine therapy in the TAILORx trial. We did not compare outcomes in these 2 cohorts in the results but rather the estimated outcomes had the TAILORx cohort received endocrine therapy alone rather than chemoendocrine therapy based on the chemotherapy treatment effect observed in the NSABP B20 trial. Our intention was not to prove the use of the Oncotype DX RS assay (Genomic Health) in predicting chemotherapy benefits that had already been established in prior cohorts and informed current practice guidelines but rather to provide information regarding potential chemotherapy benefits that could be realized in such a population treated with contemporary therapies.

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