Adjuvant! Online is an online tool for health professionals that is used to help determine the potential benefits of treatment in the adjuvant breast cancer setting. Based on information entered into the online model on an individual and their tumor characteristics, including patient age, tumor size, nodal involvement, and histologic grade, clinicians can estimate the risk of negative outcomes without systemic adjuvant therapy, the reduction of risk when using therapy, as well as potential adverse effects associated with therapy. These estimates can be printed out and used in consultations with patients and aid in making clinical decisions. To illustrate the utility of Adjuvant! Online, the following patient can be used as an example.
A 46‑year‑old premenopausal woman presents with a 1.4-cm ductal tumor in her left breast. After surgical evaluation, it is determined that she has 1 micrometastasis in an axillary lymph node. The patient’s tumor is ER positive, PgR positive, and HER2 negative; the S phase is low; and the tumor is classified as grade 1. Based on hormone receptor expression alone, this patient has a high likelihood of responding to endocrine therapy. The addition of chemotherapy may also have modest benefit in terms of reducing the risk of recurrence. Therefore, the optimal treatment strategy to take for this patient—that is, whether or not this patient should receive hormonal therapy alone or if chemotherapy should be added—is a question that can be answered through the use of Adjuvant! Online.
Inputting this patient’s data into Adjuvant! Online determined that she has a good prognosis with endocrine therapy (Figure 2).
Figure 2. Adjuvant! Online patient report.
In the absence of additional therapy, approximately 18 out of 100 otherwise identical patients receiving only local therapy would relapse. Because this patient is strongly hormone receptor positive, it is probable for her to get a recommendation for antihormone therapy. Using endocrine therapy alone, results in 7 out of 100 women remaining alive and without cancer. The use of chemotherapy instead of antihormone therapy shows a similar effect: 8 out of 100 women will remain alive and without cancer. However, if the combination of chemotherapy and endocrine therapy is utilized, 12 out of 100 women will remain alive and without cancer.
An important caveat to this case is that although the case description revealed a single micrometastasis, she was entered into Adjuvant! Online as having node-negative disease.
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