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Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer
Sparano JA, Gray RJ, Makower DF, Pritchard KI, et al. (2018). New England Journal of Medicine. PubMed 29860917 · DOI 10.1056/NEJMoa1804710 · PubMed record
What kind of source: Randomized noninferiority trial (TAILORx), scores 11 to 25. Where it sits in the summary: Established. Back to the summary
What it says, in plain language
The main TAILORx result. Women with node-negative disease and a midrange score (11 to 25) were randomized to endocrine therapy alone or chemotherapy plus endocrine therapy. Overall, adding chemotherapy did not improve outcomes. In women over 50, no benefit was seen; in women 50 or younger with scores 16 to 25, some benefit was seen.
Source access: the full text was read as a PubMed Central author manuscript. It is linked rather than reproduced because redistribution is not permitted for this copy. Open the PubMed record and follow its PMC link.
The exact words we relied on
“Endocrine therapy was noninferior to chemoendocrine therapy in the analysis of invasive disease-free survival (hazard ratio for invasive disease recurrence, second primary cancer, or death [endocrine vs. chemoendocrine therapy], 1.08; 95% confidence interval, 0.94 to 1.24; P=0.26).” — PMID:29860917, Abstract, Results
“The chemotherapy benefit for invasive disease-free survival varied with the combination of recurrence score and age (P=0.004), with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25.” — PMID:29860917, Abstract, Results
“The results of our trial suggest that the 21-gene assay may identify up to 85% of women with early breast cancer who can be spared adjuvant chemotherapy, especially those who are older than 50 years of age and have a recurrence score of 25 or lower, as well as women 50 years of age or younger with a recurrence score of 15 or lower.” — PMID:29860917, Discussion (PMC author manuscript)
“A greater treatment effect from adjuvant chemotherapy has been noted in younger women, which may be at least partly explained by an antiestrogenic effect associated with premature menopause induced by chemotherapy.” — PMID:29860917, Discussion (PMC author manuscript)
How these quotes were checked
Follow the passage links above to the included paper or public source record.
Full text, author manuscript. The publicly available PMC author manuscript was retrieved on 2026-09-08 and read. Abstract quotes were checked against the cached PubMed record; body-text quotes were checked by exact string match against that manuscript. An author manuscript can differ in wording from the final journal version.
Limits of this source
Node-negative disease only. The age finding came from a secondary analysis, which the authors call exploratory. Women with scores of 26 or more all received chemotherapy, so the trial did not test chemotherapy against no chemotherapy at high scores.
Review
Reviewed by Sarah Kiselycznyk · September 10, 2026. Review scope and verification method: How we researched this.