Publication: npj Breast Cancer, Article number: (2026)

Authors: Sonya Reid; Lindsay Venton; Jennifer G. Whisenant; Anne E. Weidner; Jennifer Wei; Harshini Ramaswamy; Christa Dreezen; Nicole Chmielewski-Stivers;Andrea R. Menicucci; William Audeh; Tuya Pal

Title: FLEX: From Genomic Profiling to Real-World Insights in 30,000 Patients with Early-Stage Breast Cancer

Abstract:

We compared clinicopathologic features, MammaPrint and BluePrint molecular subtype, and outcomes by race among females with hormone receptor-positive (HR+), HER2- early-stage breast cancer (EBC). Of 1018 participants with HR+ HER2- EBC enrolled from two registries (BEST and FLEX), 509 White females were propensity score matched 1:1 to 509 Black females based on age and/or menopausal status. MammaPrint classified tumors as High-Risk or Low-Risk; and together with BluePrint, classified tumors as Luminal A-Type, Luminal B-Type, or Basal-Type. Recurrence-free survival (RFS) was analyzed by race and molecular subtype. Cox proportional hazards models assessed association of clinicopathologic features with outcomes. Basal-Type tumors were more prevalent among Black vs White participants (11.0% vs 4.8%, p < 0.001). Independent of race, participants with Basal-Type tumors had lower 3-year RFS (83.7%) compared to Luminal B-Type (93.7%) and Luminal A-Type (96.5%, p < 0.0001). Multivariate analysis revealed that participants with High-Risk, Luminal B- and Basal-Type tumors had significantly worse 3-year outcomes compared to Low-Risk Luminal A-Type, after controlling for race and potential confounders. Genomic classification identified higher proportions of High-Risk HR+ HER2- EBC among Black participants. Molecular subtype was independently prognostic of 3-year survival, supporting the prognostic and potentially predictive importance of genomic testing to reduce racial survival disparities among Black females with EBC.

Article by npj Breast Cancer under the terms of the Creative Commons Attribution 4.0 International License.