Patient-centered simulations to assess the usefulness of the 70-gene signature for adjuvant chemotherapy administration in early-stage breast cancer

• Published in: Breast cancer research and treatment Vol. 174; no. 2; pp. 537 - 542
• Main Authors: Caruana, Emmanuel, Foucher, Yohann, Tessier, Philippe, Frenel, Jean-Sébastien, Classe, Jean-Marc, Dantan, Etienne
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2019; Springer; Springer Nature B.V
• Subjects: Adjuvant chemotherapy; Breast cancer; Cancer genetics; Cancer research; Cancer therapies; Cancer treatment; Chemotherapy; Clinical trials; Decision making; Epidemiology; Gene expression; Genes; Health; Medical prognosis; Medical research; Medicine; Medicine & Public Health; Metastasis; Oncology; Patients; Quality of life; Risk factors; Survival analysis; Womens health; Patient-centered outcomes; Adjuvant chemotherapy; Breast cancer; 70-gene signature; Stratified medicine
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-018-05107-6

Purpose
From the MINDACT trial, Cardoso et al. did not demonstrate a significant efficacy for adjuvant chemotherapy (CT) for women with early-stage breast cancer presenting high clinical and low genomic risks. Our objective was to assess the usefulness of the 70-gene signature in this population by using an alternative endpoint: the number of Quality-Adjusted Life-Years (QALYs), i.e., a synthetic measure of quantity and quality of life.
Methods
Based on the results of the MINDACT trial, we simulated a randomized clinical trial consisting of 1497 women with early-stage breast cancer presenting high clinical and low genomic risks. The individual preferences for the different health states and corresponding decrements were obtained from the literature.
Results
The gain in terms of 5-year disease-free survival was 2.8% (95% CI from − 0.1 to 5.7%, from 90.4% for women without CT to 93.3% for women with CT). In contrast, due to the associated side effects, CT significantly reduced the number of QALYs by 62 days (95% CI from 55 to 70 days, from 4.13 years for women without CT to 3.96 years for women with CT).
Conclusion
Our results support the conclusions published by Cardoso et al. by providing additional evidence that the 70-gene signature can be used to avoid overtreatment by CT for women with high clinical risk but low genomic risk.