Genomic testing,a type of medical test that identifies changes in chromosomes, genes, or proteins, could allow many patients with early breast cancer to safely avoid chemotherapy. This is the preliminary conclusion from a new trial, reported in Amsterdam, The Netherlands, at the European Cancer Congress 2013 this week. [1] The results illustrate that more research is urgently needed to compare and validate the growing number of genomic tests becoming available in oncology.
The MINDACT trial is investigating whether a 70-gene profile called MammaPrint? the only FDA-cleared IVDMIA breast cancer recurrence assay developed by Agendia, can select the right patients for treatment with chemotherapy in addition to surgery and hormone treatment. More than 6,600 patients in 9 countries are taking part.
Miguel Martin, Head of the Medical Oncology Service,Hospital General Universitario Greogorio Mara??n, Madrid, Spain, and a spokesman ofESMO -The European Society for Medical Oncology, said: ?What makes the MINDACT trial noteworthy is that [this] it is the first prospective trial aimed at demonstrating that, based on the genomic assessment of risk, a significant proportion of breast cancer patients can be spared chemotherapy without a detrimental effect on distant relapse-free survival.?
….Based on the genomic assessment of risk, a significant proportion of breast cancer patients can be spared chemotherapy without a detrimental effect on distant relapse-free survival…
The study shows that the genomic test and standard assessment methods produced different risk assessments for 31% of patients. ?This means that almost one out of three patients could change their adjuvant therapy due to genomic testing,? Martin noted.
Final study results not yet available
Final results from the trial will not be available for several years, Martin added. ?We must wait until the final results of the MINDACT trial are available to confirm that genomic testing with MammaPrint can help some patients avoid chemotherapy without harm. However, if the final results of the MINDACT trial are positive, that means that non-therapeutically effective chemotherapy and its side-effects can be avoided in a significant proportion of patients.?
Over-treatment
MammaPrint is one of several genetic tests being evaluated for tailoring breast cancer treatment. ?Many oncologists are already using genomic tests in their everyday practice to select patients for adjuvant chemotherapy. This reflects a growing awareness among oncologists that we are over-treating many early stage breast cancer patients with chemotherapy,? Martin explained.
Usefulness and standard of care
“Studies to compare and evaluate these different tests would help ensure greater numbers of European women receive the most appropriate therapy for their individual cancer. For many oncologists, especially in the USA, genomic testing has already proven its usefulness and is the standard of care for node-negative breast cancer patients in whom chemotherapy would be an option according to former traditional criteria,” Martin explained. ?However, it appears that in Europe there is still a high degree of scepticism about the usefulness of genomic platforms, and more research comparing and validating those tests would help overcome this barrier to more personalised treatment in breast cancer.?
For more information
[1] Rutgers E, Piccart-Gebhart MJ, Bogaerts J, Delaloge S, Van ‘t Veer LJ, Rubio IT, Viale G, et al. Baseline results of the EORTC 10041/MINDACT TRIAL (Microarray In Node 0-3 positive Disease may Avoid ChemoTherapy). On behalf of the MINDACT TRANSBIG Studygroup, [Abstract 2062, ECC2013, Monday 30 September 2013, Hall 4, 14:00-16:30, Poster Session: Breast Cancer – Early Disease].
Photo: Miguel Martin, M.D., Head of the Medical Oncology Service, Hospital General Universitario Greogorio Mara??n, Madrid, Spain. Photo Courtesy: Miguel Martin, M.D.
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