An ASCO panel has reviewed and endorsed the recommendations of Cancer Care Ontario on the role of patient and disease factors in selecting adjuvant therapy for women with early-stage breast cancer. After making minor revisions, the panel recommends:

• For making decisions regarding adjuvant therapy, nodal status, tumor size, estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) status, tumor grade, and lymphovascular invasion are relevant.

• Oncotype DX score and Adjuvant! Online may be used as risk stratification tools.

• Age, menopausal status, and medical comorbidities should be considered.

• Chemotherapy should be considered for patients with positive lymph nodes, ER-negative disease, HER2-positive disease, Adjuvant! Online mortality greater than 10%, grade 3 lymph node–negative tumors (T >5 mm), triple-negative (ER-negative, PgR-negative, HER2-negative) tumors, lymphovascular invasion positivity, or estimated distant relapse risk of greater than 15% at 10 years based on Oncotype DX recurrence score (RS).

• Chemotherapy may not be beneficial or required for small node-negative tumors (T <5 mm) without high-risk features or for patients with HER2-negative, strongly ER-positive, and PgR-positive cancer with micrometastatic nodal disease, T less than 5 mm, or Oncotype DX RS with an estimated distant relapse risk of less than 15% at 10 years.

Citation: Henry NL, Somerfield MR, Abramson VG, et al. Role of patient and disease factors in adjuvant systemic therapy decision making for early-stage, operable breast cancer: American Society of Clinical Oncology endorsement of Cancer Care Ontario guideline recommendations. [Published online ahead of print March 21, 2016]. Clin Oncol. doi:10.1200/JCO.2015.65.8609.