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1yr
Defining recurrence in early-stage breast cancer

One of the main clinical goals for patients with early-stage breast cancer is to reduce the risk of disease recurrence and death. Clinical practice guidelines suggest use of endocrine therapy in the adjuvant setting to reduce these risks. However, many women diagnosed with hormone receptor–positive, human epidermal growth factor receptor 2–negative, node-positive, early-stage breast cancer will experience disease recurrence despite the effectiveness of standard endocrine therapy.

Recurrence data from clinical trials can be confusing. Clinical trials of breast cancer therapies can select different recurrence endpoints, including distant disease-free survival, disease-free survival, progression-free survival, recurrence-free survival, recurrence-free interval, and local recurrence rates.

In some helpful cases, study investigators will report the incidences and locations of recurrence events. However, even these outcome terms may not share the same definition between studies. A few examples from different trials define recurrence-free survival as either locoregional or distant recurrence, distant relapse, or recurrence and death . This illustrates how different measures or changing measurement definitions can make it challenging to analyze data between studies, as well as to highlight why recurrence endpoints require explanation whenever they’re presented.

What is the most important measure of recurrence to you and your patients? How do you counsel your patients on their risk of recurrence and plan future therapeutic decision-making?

  • 1yr
    I consider distant disease free survival as the most important parameter. If the cancer recurs at a distant site the disease is now treatable but likely incurable. I explain to my patients that our goal is for the cancer to never come back and that hopefully you will never need to deal with this menace again. We have a # of effective tools that we can use to accomplish this goal
  • 1yr
    In my opinion ANY recurrence- ipsi/contralateral or distant recurrence are ALL important. However- most important one among these are distant disease free survival and OS. I recommend self breast exam and eval for any new findings as well look for nay hints on PE or lab work.
  • 1yr
    distant disease free survival or OS is the best measure of efficacy, since distant metastases are what are life limiting for pts
  • 1yr
    I look at Distant recurrence free survival or time to metastasis - this measures survival in a reliable way
  • 1yr
    Yes, these endpoints can be confusing and hard to relate to. The most important parameter to me is if the tumor recurs. If it recurs and is metastatic (ie bones, liver , lungs etc) it will likely take their lives. We do have better treatments now and can keep these patients alive for a long time but it is a major QOL , financial, mental toll.
  • 1yr
    biomarker recurrence and/or ctDNA recurrence requires imaging+tissue confirmation.
    I understand that ctDNA testing may affect how we look at the recurrence but till we know what to do and how that would affect outcomes it is too early for the decision making.
  • 2yr
    MOlecular recurrence (Signatera) may be evidence of disease, but the clinically most importnat factor is measurable disease identified in an organ via imaging techniques.
  • 2yr
    Pathologic evidence of distant metastasis is the most important indicator for patients and their doctors. Also, site of metastasis may be important for prognosis. Discussing the stage, including LN status, margins, and biomarkers all play important roles in determining type of adjuvant systemic therapy that would be offered to patients.
  • 2yr
    New findings on PET or CT utside breast such as lymph nodes, brain or bone Mets. We discuss risk of recurrence based on prognostication and stratification by genetics ki67 etc and monitoring for disease w scans and sometimes cell free dna
  • 2yr
    Distant recurrence is most important because that means pt has metastatic disease and those pts do less well over time compared to a local in-breast or regional recurrence. Risk of recurrence depends on tumor size, nodal status, biomarkers and Oncotype. I counsel pts about symptoms associated with recurrence and to alert me if those develop. I check basic blood work--- cbc, cmp but I do not order tumor markers.
  • 2yr
    The most important measure of recurrence for me and my patients is the node status as well as tumor size and to some degree Ki67 score. I counsel my patients on their risk of recurrence and plan future therapeutic decision-making based on the aforementioned parameters.
  • 2yr
    Few things, most important lymph nodes, size, rapidity of growth versus neglected tumor, Oncotpye DX, mutlifocal disease. However will offer pts AI and CDK4 if eligible, currently Verzenio approved but Kisqali has more inclusions of early stage. Also 5 verus 10 years and use Breast cancer Index. Last awaiting trials that no chemo is needed and AI with CDK4 is enough, also new SERD oral.
  • 2yr
    the most important recurrence is distant metastases occurs at a outside of the breast. the risk factors of recurrence includes lymph node involvement, ER/PR/Her status.
  • 2yr
    Distal recurrence is what matters the most, independent on the location of recurrence. Ultimately, OS is what should be tracked and what will ultimately determine if an option becomes a standard of care. If a recurrence can be cured by a simple surgery or XRT, does it really matter to prevent it?
  • 2yr
    riskof recurrence depends on subtype of breast cancer ,overall survival is paramount since that seems to be hard to show in any adjuvant clinical trial ,clinical relevance is of time to distant metastasis
  • 2yr
    Distant recurrence is the most important to me. That is because distant recurrence equals metastatic disease and that is a reason for shortened survival. Long term risk beyond 5 yrs is real. Risk accumulates over time. So persistence with hormonal therapy is important and so is participation in SERD long term trials as well.
  • 2yr
    While distant disease recurrence is the most concerning, I usually discuss local recurrence distant recurrence and second primaries with my patients. We discuss the role of surgery and radiation in treating local disease. You discuss the role of adjuvant chemotherapy (if applicable) and endocrine therapy for reducing risk of local and distant recurrence. For most patients distant recurrence is the most important parameter to consider. However, for some patients, the risk of local recurrence and having to undergo another surgery is just as important
  • 2yr
    The most meaningful recurrence is recurrence that occurs at a site outside of the breast. This means that the patient is metastatic, and this will affect their longevity. I consult patients on the risk of recurrence based on lymph node positive disease at time of diagnosis, and also discuss risk based on receptors, including if the patient is triple negative. This all impacts my treatment because it depends on these markers as to which treatments would be used in the future.
  • 2yr
    i would say staging is important as is the subtype of cancer be it triple negative, her2, HR positive. i counsel them on risk of recurrence based on current statistics for their stage and biomarker status. we discuss monitoring for symptoms of recurring and keeping up with mammograms for imaging. i usually do not recommend routine bloodwork or scans or tumor markers in the absence of symptoms

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