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      The Role of Multigene Assays in Addressing Treatment Heterogeneity for Breast Cancer

      research-article
      Author(s): *
      Publication date (Electronic):
      Journal: Biomedicine Hub
      Publisher: S. Karger AG
      Keywords: Breast cancer, Treatment heterogeneity, Chemotherapy, Multigene assay

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          Abstract

          Breast cancer has a complex biology with heterogeneous treatment approaches that have changed significantly over the last two decades. The MAGIC survey provides valuable insight into worldwide treatment recommendations for early breast cancer patients and the clinical and pathologic criteria used for these decisions. The overall findings indicate that there is substantial heterogeneity in how patients are treated and a substantial uncertainty in treatment recommendations for a large proportion of patients, highlighting an unmet need for broadly available markers, such as multigene assays, that can help to make more informed treatment decisions by predicting a patient's likelihood of benefit from adjuvant chemotherapy.

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          Tamoxifen and chemotherapy for lymph node-negative, estrogen receptor-positive breast cancer.

          N. Wolmark, A DeCillis, J Dignam … (1997)
          The B-20 study of the National Surgical Adjuvant Breast and Bowel Project (NSABP) was conducted to determine whether chemotherapy plus tamoxifen would be of greater benefit than tamoxifen alone in the treatment of patients with axillary lymph node-negative, estrogen receptor-positive breast cancer. Eligible patients (n = 2306) were randomly assigned to one of three treatment groups following surgery. A total of 771 patients with follow-up data received tamoxifen alone; 767 received methotrexate, fluorouracil, and tamoxifen (MFT); and 768 received cyclophosphamide, methotrexate, fluorouracil, and tamoxifen (CMFT). The Kaplan-Meier method was used to estimate disease-free survival, distant disease-free survival, and survival. Reported P values are two-sided. Through 5 years of follow-up, chemotherapy plus tamoxifen resulted in significantly better disease-free survival than tamoxifen alone (90% for MFT versus 85% for tamoxifen [P = .01]; 89% for CMFT versus 85% for tamoxifen [P = .001]). A similar benefit was observed in both distant disease-free survival (92% for MFT versus 87% for tamoxifen [P = .008]; 91% for CMFT versus 87% for tamoxifen [P = .006]) and survival (97% for MFT versus 94% for tamoxifen [P = .05]; 96% for CMFT versus 94% for tamoxifen [P = .03]). Compared with tamoxifen alone, MFT and CMFT reduced the risk of ipsilateral breast tumor recurrence after lumpectomy and the risk of recurrence at other local, regional, and distant sites. Risk of treatment failure was reduced after both types of chemotherapy, regardless of tumor size, tumor estrogen or progesterone receptor level, or patient age; however, the reduction was greatest in patients aged 49 years or less. No subgroup of patients evaluated in this study failed to benefit from chemotherapy. Findings from this and other NSABP studies indicate that patients with breast cancer who meet NSABP protocol criteria, regardless of age, lymph node status, tumor size, or estrogen receptor status, are candidates for chemotherapy.
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            The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2-) breast cancer: When might multigene assays be of value?

            Matti Aapro, Michelino de Laurentiis, Dan Rea … (2017)
            A modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions.
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              Breast cancer: estimated incidence, mortality and prevalence, 2012

              (2012)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Biomed Hub
                Journal ID (iso-abbrev): Biomed Hub
                Journal ID (publisher-id): BMH
                Title: Biomedicine Hub
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH-4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Electronic): 2296-6870
                Publication date Collection: Nov-Dec 2017
                Publication date (Electronic): 21 November 2017
                Publication date PMC-release: 21 November 2017
                Volume: 2
                Issue: Suppl 1
                Pages: 29-31
                Affiliations
                Clinique de Genolier, Breast Center, Genolier, Switzerland
                Author notes
                *Dr. Matti Aapro, Genolier Cancer Center, Route du Muids 3, CH-1272 Genolier (Switzerland), E-Mail maapro@ 123456genolier.net
                Article
                Publisher ID: bmh-0002-0029
                DOI: 10.1159/000481247
                PMC ID: 6945949
                SO-VID: 1441d93c-5721-4786-8736-968fcbefcb85
                Copyright © Copyright © 2017 by S. Karger AG, Basel
                License:

                This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                Date received : 19 June 2017
                Date accepted : 13 July 2017
                Date: 2017
                Page count
                References: 4, Pages: 3
                Categories
                Subject: Commentary

                Keywords: breast cancer,treatment heterogeneity,chemotherapy,multigene assay
                Data availability:
                Keywords: breast cancer, treatment heterogeneity, chemotherapy, multigene assay

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