A real but modest reduction in recurrence rates seen in the ATLAS and ATTOM trials for 10 years of tamoxifen compared with 5 years of treatment [ 4, 5], but this was not apparent until after 10 years of follow-up.
Most of this benefit seemed to accrue late, and there were only modest reductions in recurrence rates during the 5 extra years of tamoxifen and a more impressive carryover benefit during the 5 years of follow-up after completion of 10 years of tamoxifen (Table 6).
However, current adjuvant chemotherapy provides only limited protection against liver recurrence and modest survival benefit; thus, the association between CXCR4 and liver recurrence/overall survival observed in this study might not be significantly altered with current adjuvant therapies.
Relapses occurring after 5 years of adjuvant tamoxifen are highest among the highly-proliferative/high-ERS tumors although their risk of recurrence is modest in the first 5 years on tamoxifen.
Frequent expression of CXCR4 and its ability to promote liver metastasis in PAC may explain the well-known, but poorly understood, predilection for PAC to metastasize to liver and why adjuvant chemotherapy provides only modest protection against liver recurrence.
Our findings suggest that patients with highly proliferative (high MKS or high GGI) and high-ER breast cancers (high expression of ER-related genes both adopted from Oncotype DX or from PAM50) have the highest absolute risk for late relapse tumors, despite the fact that their risk of recurrence is modest in the first 5 years on tamoxifen.
Usually, treatment strategies fail or procure rather modest improvement and consequently, locoregional recurrence, distant metastases, and second primary tumors are frequent.
The right eye at the moment (4 months from the end of therapy) shows a modest reduction of dimension of recurrence, between still accompained by a subtotal retinal detachment.
The impact for recurrence risk counseling is modest but important to the individuals receiving this information.
