The DBCG89D trial randomized high-risk early breast cancer patients to adjuvant CMF (cyclophosphamide, methotrexate and fluorouracil) or CEF (cyclophosphamide, epirubicin and fluorouracil). Prosigna assays were performed by researchers with no access to clinical data. Time to distant recurrence (DR) was the primary endpoint, time to recurrence (TR) and overall survival (OS) secondary. Among the 980 Danish patients enrolled, Prosigna results were obtained in 686. Continuous ROR score was associated with DR for CMF (adjusted hazard ratio (HR) 1.20, 95% CI 1.09–1.33), and for CEF (HR 1.04, 95% CI 0.92–1.18), P_interaction = 0.06. DR was significantly longer in CEF compared to CMF treated patients with Her2-enriched tumors (HR 0.58, 95% CI 0.38–0.86), but not in patients with luminal tumors. Heterogeneity of treatment effect was significant for TR and OS. In this prospective-retrospective analysis, patients with Her2-enriched breast cancer derived substantial benefit from anthracycline chemotherapy whereas anthracyclines are not an essential component of chemotherapy for patients with luminal subtypes. The benefit of CEF vs. CMF correlated with increasing ROR Score.

DBCG89D 试验将高危早期乳腺癌患者随机分配至辅助 CMF（环磷酰胺、甲氨蝶呤和氟尿嘧啶）或 CEF（环磷酰胺、表柔比星和氟尿嘧啶）。 Prosigna 检测是由无法获得临床数据的研究人员进行的。远处复发时间（DR）是主要终点，复发时间（TR）和总生存期（OS）是次要终点。在入组的 980 名丹麦患者中，有 686 名获得了 Prosigna 结果。连续 ROR 评分与 CMF 的 DR 相关（调整后的风险比 (HR) 1.20，95% CI 1.09–1.33）和 CEF 的 DR（HR 1.04，95% CI） 0.92–1.18), P_相互作用= 0.06。与 CMF 治疗的 Her2 富集肿瘤患者相比，CEF 治疗的 DR 显着更长（HR 0.58，95% CI 0.38–0.86），但管腔肿瘤患者则不然。 TR 和 OS 的治疗效果异质性显着。在这项前瞻性回顾性分析中，富含 Her2 的乳腺癌患者从蒽环类化疗中获得了实质性益处，而蒽环类药物并不是管腔亚型患者化疗的重要组成部分。 CEF 相对于 CMF 的优势与 ROR 分数的增加相关。