Sisyphean Efforts: Establishing the Correct Risk-Benefit Balance for Adjuvant Therapies
A partir de données portant sur 4 105 patientes atteintes d'un cancer du sein opérable et incluses dans 5 essais cliniques internationaux entre 1978 et 1985, cette étude analyse les caractéristiques des patientes et de la tumeur associées à un risque de récidive, à la survie sans progression et à la survie globale (durée médiane de suivi : 24 ans)
It is estimated that the annual breast cancer incidence has increased from 600,000 to 1.6 million worldwide, almost three-fold from 1980 through 2010.1 This imposes a major increased burden on patients, families, and health care systems, and extensive resources will be required for management of different oncologic therapies at primary diagnosis, as well as for the 20% to 30% of patients who experience relapse. However, fine-tuned diagnostics, prognostication, therapy prediction, and adjuvant therapy will reduce the risk of dying as a result of breast cancer. The prognosis for breast cancer has improved markedly in many countries over the last decades, in large part because of prospective randomized adjuvant studies, early diagnosis, improved diagnostic precision, and fine-tuning of surgery and radiotherapy, together with multidisciplinary team management. Research strategies have also revealed altered geno- and phenotypic characteristics during tumor progression.2-4 We believe systemic therapy cures patients by eradicating micrometastases from primary breast cancers, which are likely, on average, to be less heterogeneous compared with the later occurring macrometastases. Although not proven, this may explain why adjuvant systemic therapies and radiotherapy at time of primary diagnosis may be curative, whereas the same drugs and schedules in the metastatic setting are not.5-10 [...]
Journal of Clinical Oncology , éditorial en libre accès, 2016