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Adjuvant chemotherapy provides small absolute 8-year DMFS benefit in high-risk HR+ HER2- breast cancerTrial shows limited chemotherapy benefit for some early breast cancer

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Key Takeaway
Note that absolute 8-year DMFS benefit for adjuvant chemotherapy was small in high-risk HR+ HER2- breast cancer subgroups.

This randomized controlled trial included 868 patients over 50 years old with primary stage I-II hormone receptor positive (HR+) HER2-negative (HER2-) breast cancer and a clinical high/genomic low-risk assessment. The study performed an exploratory subgroup analysis comparing adjuvant chemotherapy (ACT) to no adjuvant chemotherapy (no ACT) over a follow-up period of 8.7 years.

Primary outcomes focused on 8-year distant metastasis free survival (DMFS). In the no ACT group, 8-year DMFS was 87.9% for tumors larger than 2 cm (95%CI: 82.9-91.6%), 91.3% for grade 3 tumors (95%CI: 84.0-95.4%), and 89.6% for patients with nodal involvement (95%CI: 84.2-93.3%).

The absolute 8-year DMFS benefit for ACT versus no ACT in these high-risk subgroups was small: 1.2% for tumors larger than 2 cm, -2.2% for grade 3 tumors, and 0.7% for patients with nodal involvement. Safety and tolerability data were not reported.

As an exploratory subgroup analysis, the results are limited by the small absolute benefit observed in high-risk subgroups. The findings confirm the prognostic performance of the 70-gene signature in patients with high-risk features such as larger tumors, grade 3 tumors, and 1-3 involved lymph nodes.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in risk prediction by confirming the prognostic performance of the 70-gene signature in patients with high-risk features like larger tumors and grade 3 tumors. While prior evidence noted that integrating clinical and genomic data may improve progression risk prediction in advanced breast cancer, this study specifically quantifies the modest absolute benefit of adjuvant chemotherapy in high-risk subgroups.

For many women diagnosed with early-stage breast cancer, the decision to undergo chemotherapy is a heavy one. It is often used to lower the risk of the cancer returning. However, a new look at data from a large trial involving 868 patients suggests that for some specific groups, the actual benefit of chemotherapy might be very small.

Researchers looked at women over age 50 with early-stage, hormone-positive breast cancer. They specifically looked at patients who had high-risk features, such as tumors larger than 2 centimeters or tumors that had spread to nearby lymph nodes. In these groups, the difference in survival rates between those who received chemotherapy and those who did not was very small, ranging from less than 1 percent to a negligible difference.

It is important to note that this was an exploratory analysis, meaning it is a deep dive into specific groups rather than a primary study. While the results show that certain genetic markers can help predict how a patient might do, the actual benefit of chemotherapy in these high-risk subgroups was small. Patients should talk to their doctors to understand how these findings apply to their specific diagnosis.

What this means for you:
Some patients with high-risk features may see very small benefits from chemotherapy based on specific genetic markers.

Common questions

Who is this finding for?

This finding involves women over age 50 with early-stage, hormone-positive, HER2-negative breast cancer. Specifically, it looks at patients who have high-risk features, such as tumors larger than 2 cm, grade 3 tumors, or involvement of 1 to 3 lymph nodes.

How much benefit did chemotherapy provide in high-risk cases?

In the high-risk subgroups, the absolute benefit of chemotherapy was very small. For tumors larger than 2 cm, the benefit was 1.2%. For grade 3 tumors, the benefit was -2.2%. For those with lymph node involvement, the benefit was 0.7%.

Is this a definitive rule for treatment?

No, this was an exploratory subgroup analysis. This means it is a specific look at a subset of a larger trial. Because the results are from an exploratory analysis, you should talk to your doctor to decide the best treatment for your specific situation.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up600.0 mo
PublishedOct 2026
View Original Abstract ↓
BACKGROUND: Adjuvant chemotherapy (ACT) can be safely omitted in patients above 50 years of age with stage I-II hormone receptor positive (HR+) HER2-negative (HER2-) breast cancer and a low-risk 70-gene signature (MammaPrint®). However, the contribution of the 70-gene signature in high-risk subgroups by nodal involvement, grade 3 or larger tumors, has not been reported, which may complicate clinical decision making for these patients. PATIENTS AND METHODS: Patients above 50 years enrolled in the MINDACT trial with primary stage I-II HR + HER2- breast cancer and a clinical high/genomic low-risk were selected for this exploratory analysis. In the MINDACT trial, these patients were randomized at enrollment based on their risk assessment method for the decision to receive ACT or not. Eight-year distant metastasis free survival (DMFS) was the primary endpoint. RESULTS: Median follow-up was 8.7 years. Of the 868 clinical high/genomic low-risk MINDACT patients, 490 (56.5%) patients had tumors larger than 2 cm, 232 (26.7%) had grade 3 tumors and 406 (46.8%) had 1-3 involved lymph nodes. 8-year DMFS in the no ACT group was 87.9% (95%CI: 82.9-91.6%) in patients with tumors larger than 2 cm; 91.3% (95%CI: 84.0-95.4%) with grade 3 tumors and 89.6% (95%CI: 84.2-93.3%) with nodal involvement. Absolute 8-year DMFS benefit for ACT versus no ACT was 1.2%; -2.2% and 0.7% respectively. CONCLUSIONS: This exploratory subgroup analysis of the MINDACT trial confirms the prognostic performance of the 70-gene signature in patients with high-risk features such as larger tumors, grade 3 tumors and 1-3 involved lymph nodes.
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