A large retrospective analysis of patients with early hormone receptor-positive, HER2-negative breast cancer shows that the intermediate-risk group continues to relapse steadily over time, with 10-year invasive disease-free survival of 73.8%.
What was known
Endocrine therapy, alone or with abemaciclib or ribociclib, is the current standard for patients with intermediate- or high-risk hormone receptor-positive, HER2-negative breast cancer. The NATALEE trial showed that adding three years of ribociclib to endocrine therapy improves 4-year invasive disease-free survival by 4.9%. Real-world data on long-term relapse risk were lacking to guide the prescription of new adjuvant drugs.
What this work adds
This is a retrospective analysis of 8,825 patients with early hormone receptor-positive, HER2-negative breast cancer, recruited from five adjuvant GEICAM trials (1999-2010) and the El Álamo IV registry (diagnosed between 2002 and 2005). Patients were grouped into three risk cohorts: high (stage III), intermediate (T0-2N1, T3N0 or T2N0 with grade 3, or grade 2 with elevated Ki-67) and low.
Main results
20.0% of patients were in the high-risk cohort, 36.0% in the intermediate and 44.0% in the low. With a median follow-up of 10.7 years, 10-year invasive disease-free survival was 53.8%, 73.8% and 84.0% respectively; overall survival was 66.7%, 84.6% and 91.9%. In the intermediate cohort, invasive and distant relapse rates increased steadily, as did mortality.
What it means
The authors conclude that intermediate-risk patients have 10-year invasive disease-free survival of 73.8% and overall survival of 84.6%, with a progressive rise in relapses that persists over time, unlike the two-peak pattern in high-risk disease. They note that further follow-up of the NATALEE trial is needed to determine the true benefit of adjuvant ribociclib in this group and to decide the best endocrine strategy.
Reading from the breast unit
This is a study by the Spanish cooperative group GEICAM, which brings together numerous breast units. Its retrospective data, drawn from its trials and the El Álamo IV registry, provide a useful long-term reference to contextualize decisions on intensified endocrine therapy in the intermediate-risk group.
Reference: Servitja S, Carrasco E, Andrés R, Rodríguez-Lescure Á, Martín M, Ruiz-Borrego M, et al. Outcomes of Hormone receptor-positive/HER2-negative early breast cancer patients by risk of recurrence groups focusing on the intermediate-risk group: Retrospective analysis from GEICAM studies. Breast Cancer Research, 2026. DOI
