{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T20:50:53Z","timestamp":1782334253524,"version":"3.54.5"},"reference-count":25,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"6","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Precis Oncol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Randomized trials have not demonstrated clear benefit from anthracyclines for patients with hormone receptor\u2013positive, human epidermal growth factor receptor 2\u2013negative (HER2\u2212) early breast cancer (EBC). The MammaPrint 70-gene signature, specifically the High-Risk 1 (H1) and High-Risk 2 (H2) subgroups, was evaluated in predicting benefit from anthracycline- and taxane-based chemotherapy (AC-T) compared with taxane\/cyclophosphamide (TC) in hormone receptor\u2013positive HER2\u2212 EBC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS<\/jats:title>\n                    <jats:p>This analysis used prospectively collected real-world data from patients enrolled in the FLEX study with stage I-III hormone receptor\u2013positive HER2\u2212 EBC, MammaPrint High-Risk, and BluePrint Luminal B tumors who received adjuvant AC-T or TC. Inverse probability of treatment weighting (IPTW) was performed to balance clinical characteristics between treatment groups. The association between the chemotherapy regimen and 3-year invasive disease-free survival (IDFS) was assessed using Kaplan-Meier estimates and Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Among patients with H1 cancers (n = 1,106), 3-year IDFS did not differ between AC-T and TC (95.9%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      95.9%; adjusted hazard ratio [HRs], 1.14 [95% CI, 0.64 to 2.06];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .70). By contrast, patients with H2 cancers (n = 153) demonstrated significantly improved 3-year IDFS with AC-T versus TC (100%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      94.8%; adjusted HRs, 0.10 [95% CI, 0.01 to 0.75]; absolute benefit 5.2%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .025). A significant treatment-by-MammaPrint interaction demonstrated that AC-T benefit increased with higher genomic risk (adjusted HRs, 0.09 [95% CI, 0.01 to 0.85];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .036). Clinical and pathologic variables did not predict anthracycline benefit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Patients with MammaPrint H2 tumors had a clinically meaningful benefit from anthracycline-containing chemotherapy, whereas patients with H1 tumors did not derive more benefit from AC-T than from TC despite overlapping high-risk features. These findings support the use of MammaPrint to inform chemotherapy regimen selection and warrant further validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/po-25-01285","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T20:00:08Z","timestamp":1782331208000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Prediction of Anthracycline Benefit in Hormone Receptor\u2013Positive, Human Epidermal Growth Factor Receptor 2\u2013Negative Early-Stage Breast Cancer by the MammaPrint 70-Gene Signature for Patients Enrolled in the FLEX Study"],"prefix":"10.1200","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct03053193","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Joyce","family":"O'Shaughnessy","sequence":"first","affiliation":[{"name":"Baylor University Medical Center, Texas Oncology, Sarah Cannon Research Institute, Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8080-7960","authenticated-orcid":true,"given":"Adam M.","family":"Brufsky","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakhshanda","family":"Layeequr Rahman","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia R.","family":"Osborne","sequence":"additional","affiliation":[{"name":"Texas Oncology, Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7711-8627","authenticated-orcid":true,"given":"Reshma","family":"Mahtani","sequence":"additional","affiliation":[{"name":"Miami Cancer Institute, Baptist Health South Florida, Miami, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7681-6872","authenticated-orcid":true,"given":"Ahmed","family":"Elkhanany","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4922-2195","authenticated-orcid":true,"given":"Cathy Lynne","family":"Graham","sequence":"additional","affiliation":[{"name":"Piedmont Cartersville Breast, Carterville, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Brown","sequence":"additional","affiliation":[{"name":"Comprehensive Breast Care, Troy, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linsey P.","family":"Gold","sequence":"additional","affiliation":[{"name":"Comprehensive Breast Care, Troy, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Johnson","sequence":"additional","affiliation":[{"name":"Legacy Health System, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7375-4346","authenticated-orcid":true,"given":"Danilo","family":"Giffoni","sequence":"additional","affiliation":[{"name":"London Regional Cancer Program, London, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3125-6474","authenticated-orcid":true,"given":"J. Jaime","family":"Alberty-Oller","sequence":"additional","affiliation":[{"name":"Kings County Hospital Center, Brooklyn, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshini","family":"Ramaswamy","sequence":"additional","affiliation":[{"name":"Medical Affairs, Agendia Inc, Irvine, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1155-8582","authenticated-orcid":true,"given":"Raquel","family":"Weber","sequence":"additional","affiliation":[{"name":"Medical Affairs, Agendia Inc, Irvine, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9635-0256","authenticated-orcid":true,"given":"Nicole","family":"Chmielewski-Stivers","sequence":"additional","affiliation":[{"name":"Medical Affairs, Agendia Inc, Irvine, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4242-6213","authenticated-orcid":true,"given":"Andrea R.","family":"Menicucci","sequence":"additional","affiliation":[{"name":"Medical Affairs, Agendia Inc, Irvine, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7790-7466","authenticated-orcid":true,"given":"William","family":"Audeh","sequence":"additional","affiliation":[{"name":"Medical Affairs, Agendia Inc, Irvine, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00285-4"},{"key":"e_1_3_10_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2019.01.012"},{"key":"e_1_3_10_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.71.4147"},{"key":"e_1_3_10_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.00028"},{"key":"e_1_3_10_6_2","first-page":"100158","article-title":"Anthracycline-free or short-term regimen as adjuvant chemotherapy for operable breast cancer: A phase III randomized non-inferiority trial","volume":"11","author":"Da YK","year":"2021","unstructured":"Da YK, Liu XY, Chen L, et al: Anthracycline-free or short-term regimen as adjuvant chemotherapy for operable breast cancer: A phase III randomized non-inferiority trial. 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