In a large clinical trial, postmenopausal women with hormone receptor (HR) -positive, human epidermal growth factor receptor 2 (HER2) -negative breast cancer that metastasized to three lymph nodes and had a recurrence score of 21 genes If found (RS) 25 or less, you can safely skip chemotherapy and receive endocrine therapy only after breast cancer surgery.The results are published in New England Journal of Medicine..
The first results of the S1007, an RxPONDER study conducted by the SWOG Cancer Research Network, are: cancer A clinical trial group funded by the National Cancer Institute (NCI), which is part of the National Health Institute, was reported at the San Antonio Breast Cancer Symposium last December. These findings are now being enhanced with additional data and analysis.
Researchers led by Dr. Kevin Kalinsky, a breast cancer oncologist at the Winship Cancer Institute at Emory University, a SWOG researcher, compared rates of invasive disease-free survival (IDFS). woman Patients enrolled in the study who survived without recurrence of cancer or secondary invasive primary cancer 5 years after treatment assignment. Examination of the entire study population showed no clinically relevant or statistically significant improvement in IDFS. chemical treatment followed by Endocrine therapy Compared to women who received only hormone therapy.
However, looking only at premenopausal women, who make up about one-third of the patients who participated in the trial, a clear difference was seen. Among premenopausal women, those who received chemotherapy had a 40% relative improvement in IDFS compared to women who received only endocrine therapy. In contrast, women on trial after menopause did not benefit from chemotherapy.
“These are clinically meaningful and influential data,” says Kalinsky. “As we saw Postmenopausal female With 1 to 3 positive nodules, RS 0 to 25 may safely avoid adjuvant chemotherapy without compromising IDFS. This saves tens of thousands of women the time, money, and potentially harmful side effects that may be associated with chemotherapy. However, premenopausal patients with positive lymph nodes and an RS of 0-25 are more likely to benefit from chemotherapy. “
In premenopausal patients, the 5-year IDFS rate was 89.0% in women who received endocrine therapy alone, compared to 93.9% in women who received chemotherapy plus endocrine therapy. In postmenopausal patients, the 5-year IDFS rate was 91.9%, but 91.3%, which was not statistically significant.
The 21 gene recurrence score test measures the expression level of a panel of 21 specific genes in tumor tissue to indicate the overall risk of a woman having breast cancer recurrence. Scores range from 0 to 100, and scores below 25 are considered to indicate a low or moderate risk of recurrence.
HR +, HER2-About one-third of women diagnosed with breast cancer have already spread the cancer to the lymph nodes at the time of diagnosis. These women, whose cancer is known as a positive lymph node metastasis, are more likely to have the cancer come back after treatment.
Data from a previous SWOG study, S8814, and retrospective analysis of biological samples benefit from the addition of chemotherapy to endocrine therapy for women with cancer with these characteristics using 21 gene RS. It was suggested that it could be predicted. The analysis showed that women with an RS of less than 18 did not benefit from the addition of chemotherapy, whereas women with an RS of 31 or higher lived longer when receiving chemotherapy.
The RxPONDER trial clearly answers the question of whether RS can be used to predict whether women with HR +, HER-, and lymph node-positive breast cancer will benefit from chemotherapy. It was carried out to try. Researchers at 632 institutions in nine countries enrolled 5,083 women with RS of 25 or less for the cancer, half with chemotherapy and subsequent post-surgery endocrine therapy, and the other half with post-surgery endocrine therapy. Randomly assigned to dosing only.
As a secondary endpoint, the team analyzed remote disease-free survival (DDFS) in these patients and found a 42% relative improvement with premenopausal female chemotherapy, but postmenopausal female chemistry. There was no difference in DDFS due to the therapy. DDFS, unlike IDFS, describes only distant recurrence of cancer or death, not local or local recurrence of breast cancer or new invasive primary cancer.
In the additional post-mortem analysis reported in the paper, researchers grouped premenopausal patients receiving chemotherapy into four groups by increasing the RS of 21 genes.
they again, Premenopausal female People under the age of 50 and those with the lowest RS score benefited from receiving chemotherapy in addition to endocrine therapy.
“These data will further help us to personalize the discussion of the risks and benefits of chemotherapy with up to three premenopausal patients. Lymph node RS is 25 or less. “
The results of further analysis of RxPONDER data will be reported at the 2021 San Antonio Breast Cancer Symposium on December 8.
21 gene assays that inform the benefits of chemotherapy in lymph node-positive breast cancer, New England Journal of Medicine (2021).
Provided by SWOG Cancer Research Network
Quote: Chemotherapy obtained on December 1, 2021 from https: //medicalxpress.com/news/2021-12-group-breast-cancer-patients-chemo.html (December 1, 2021) ) To identify the group of breast cancer patients who can skip
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Researchers identify groups of breast cancer patients who can skip chemotherapy
Source link Researchers identify groups of breast cancer patients who can skip chemotherapy