The goal of chemotherapy is to eliminate cancer cells that may have migrated away from the tumor area. The decision to prescribe it depends on several factors: the size of the tumor, its grade (speed of growth of diseased cells) and lymph node involvement. It can be prescribed preoperatively to reduce the size of the tumor and allow conservative treatment. But two-thirds of tumors currently diagnosed have a size less than 2 cm, without lymph node involvement. The benefit of chemotherapy may then be modest, but not the side effects. It is in this context that new parameters have been highlighted.
There are tests capable of identifying the presence, in tumor cells, of genes associated with a character of severity. “When these genes are present, chemotherapy is required”, specifies Prof. Joseph Gligorov. “We can also identify women with tumors, certainly small, but with genetic factors pejorative family relationships. Tests also make it possible, in the face of a given tumor, to assess the probable effectiveness of chemotherapy. “ These new approaches aim to reserve this heavy treatment for women who really need it. And therefore to avoid it to others.
Four prognostic tests currently available
These tests are not always necessary. For two-thirds of patients, traditional criteria (size, lymph nodes, grade, profile, etc.) already make it possible to determine the need or not for chemotherapy.
But for a third of them, the decision is not easy to make and these so-called “genetic signature” tests then reveal all their interest. Four prognostic tests are currently available: Mammaprint, Oncotype DX, Pam50 and Endopredict. They are generally reimbursed within the framework of a global envelope allocated to health establishments, pending the end of their assessment.
Better controlled side effects
“Today, the implementation of chemotherapy is the consequence of a well-reasoned decision, taken during a multidisciplinary meeting bringing together the surgeon, the oncologist and the radiotherapist”, explains Prof. Gligorov. If chemotherapy is necessary, an infusion will be given every three weeks, for three or six months depending on the case. New, very powerful antivomitives dramatically reduce nausea, and side effects are better controlled. The risk of cardiac toxicity is well taken into account thanks to a check-up before chemo and personalized monitoring.
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