Last year, researchers presented a new tool capable of identifying patients who can go without chemotherapy in the treatment of breast cancer.
Are we approaching the end of routine chemotherapy for women with breast cancer? While each year in France, 59,000 new cases are detected and 12,000 women die from it, new medical progress suggests the possibility of a personalized and therefore more effective treatment for women under 50 affected by cancer. breast.
An encouraging first attempt
Last year, at the annual meeting of the American Society of Clinical Oncology (ASCO), researchers presented very promising results from the initial TAILORx study.
This had demonstrated that in women with hormone-dependent breast cancer without HER2 receptor (i.e. without possible targeted treatment), nor lymph node involvement (50% of cancers are), the achievement of a test called Oncotype DX Breast Recurrence Score (in French: genetic recurrence score) could make it possible to avoid chemotherapy and to be satisfied with hormone therapy after surgery.
According to the authors, the integration of this tool could reduce the need for chemotherapy by 70% in women with breast cancer. This has been called personalized treatment.
Even better results
This year, on the occasion of the 2019 edition of the ASCO, the authors of the study unveil new promising results, also published in the New England Journal of Medicine. They say the Oncotype DX Breast Recurrence Score test could not only help identify more young women who may be chemotherapy-free, but also help identify those who could benefit from more effective anti-estrogen therapy.
“Last year’s TAILORx results provided clinicians with high-quality data that allowed them to make personalized treatment recommendations for women,” said Joseph Sparano, lead author of the study.
An accurate recurrence score
More precisely, this tool makes it possible to assign a genetic recurrence score (RS) from 0 to 100 by analyzing the anomalies which may concern 21 breast tumor genes. In patients who have a score of 0 to 10, for example, it has been a long time since chemotherapy has been given in addition to hormone therapy. On the other hand, in those who have a score of 26 to 100, chemo is systematic. The question therefore arose in women who have an intermediate score, between 11 and 25.
For this new analysis, the researchers based themselves on the results obtained during the first study, namely the clinical risk genetic recurrence score of the 9,427 women participating in the TAILORx trial.
The researchers therefore investigated the association between age at diagnosis and the benefit of chemotherapy in the group of younger women (50 years or younger) with a genetic recurrence score between 16 and 25. They found that chemotherapy had no benefit for them!
Consideration of the age factor
The researchers then explored the association between age at diagnosis and the benefit of chemotherapy in this group, to determine whether integrating recurrence score and clinical risk helped identify premenopausal women who might benefit. more effective anti-estrogen therapy. This revealed a benefit for women aged 46 to 50 who were premenopausal but not for those postmenopausal, and a trend towards chemotherapy for women aged 41 to 45.
In contrast, no benefit was found in women 40 years of age or younger who were at a lower risk of developing premature menopause as a result of chemotherapy.
“With this new analysis, it is clear that women aged 50 or younger with a recurrence score between 16 and 20 and at low clinical risk do not require chemotherapy. “Clinical risk information helps identify premenopausal women at higher clinical risk who may benefit from suppression of ovarian function and more aggressive anti-estrogen therapy,” concludes Joseph Sparano.
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