The question of can we identify subgroups that we can omit or do shorter therapy, the answer is we can. And certainly nodal status and tumor size and grade are some of those. Like particularly node-negative patients, let’s say with grade one or two tumors and tumor size is less than two centimeters, those are the prime candidates to not extend the therapy, particularly if a genomic profiling test doesn’t put them in a high-risk category...
The question of can we identify subgroups that we can omit or do shorter therapy, the answer is we can. And certainly nodal status and tumor size and grade are some of those. Like particularly node-negative patients, let’s say with grade one or two tumors and tumor size is less than two centimeters, those are the prime candidates to not extend the therapy, particularly if a genomic profiling test doesn’t put them in a high-risk category. And also, if a predictive test like the BCI shows not much benefit from endocrine therapy. So this is the sort of low-hanging fruit. But after that, there’s all these permutations. You may have more risk based on nodal status and tumor grade, but if the BCI test, for example, says that you don’t get much benefit from endocrine therapy, then you won’t expect a lot of absolute risk. The genomic classifiers, the predictors of local recurrence, and the predictive biomarkers. And as I said before, we may be able in the future to use also ctDNA to make a decision that if your ctDNA is negative, let’s observe you until we find out if it changes for whatever reason. But the majority of the patients probably will not change.
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