Treat better: this is the objective of the Institut Curie. A genomic test, being tested, makes it possible to know whether chemotherapy is necessary in the prevention of recurrence of breast cancer.
After surgery for a tumor in the breast, chemotherapy can prevent recurrence. But the Institut Curie wants to avoid unnecessary treatments. The tests that predict its effectiveness are not yet supported by Health Insurance. To assess the benefits, both from an economic and health standpoint, Institut Curie is launching a prospective study.
Get out of the gray area
8 public and private medical centers will participate in this work on 200 patients. At the head of the research group, Prof. Roman Rouzier, head of the senology department at the Institut Curie. At the origin of his project, a finding: when the tumor is aggressive, adjuvant chemotherapy – administered after surgery – is obvious.
Thanks to the analysis of the tumors, “we are able to tell if your risk of relapse within 10 years is 6 or 20%. Obviously we act differently: when the risk is 6%, we focus on hormone therapy, explains Professor Roman Rouzier, contacted by Why actor. When the risk is 25%, we focus on chemotherapy. You should know that today, without using the test, there is a gray area which means that we very probably prescribe a little too much chemotherapy. To assess the aggressiveness of a tumor, and therefore the value of chemo, several tests are available.
Listen…Prof. Roman Rouzier, head of the senology department (Institut Curie): ” Today, when a tumor is removed, it is analyzed. We check a few things. This test is part of the tests that assess a number of criteria, which we pass to the prognosis. “
A medico-economic interest
The study launched by Professor Rouzier will attempt to precisely define the usefulness of the PAM50-Prosigna test in the decision to treat or not chemotherapy treatment for women operated on for early-stage cancer. But the work will also measure the confidence that practitioners have in this device, and the emotional state of patients confronted with this decision-making.
Listen…Prof. Roman Rouzier : ” The medico-economic gain, it is evaluated by studies, and it is that which one carries out at the Institut Curie. Several elements enter into the balance: chemotherapy avoided, chemotherapy in addition, the cost of chemotherapy … “
On paper, the test could be very interesting financially. Its cost is 2,118 euros. That of chemos was valued at 13,000 euros, taking into account generic molecules. According to an impact study carried out by Prof. Rouzier in 2013, reimbursing genomic tests would have resulted in savings of 44 million euros on 53,000 patients diagnosed. But it could also, and above all, avoid heavy treatment for a patient. And this interest in the quality of life is at the heart of medical practice.
“The impact has been assessed. We know that chemotherapy means that the patient will have to stop her professional activity for 6 months on average. So you can imagine the benefit of not doing unnecessary treatments, says Roman Rouzier. Chemotherapy brings real benefit in breast cancer, but it must be done wisely. “
But it is still necessary that the Health Insurance agrees to take charge of the genomic tests. And that’s the whole problem: not every patient is able to pay 2,000 euros, and not all complementary health care providers agree to do so. Result: these devices are not deployed on French territory.
Listen…Prof. Roman Rouzier : ” In France, where there is no reimbursement, it is not deployed. Somewhere, we must not: if we want a fair approach to medicine, we must not only people who can afford these tests. “
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