Surveillance After Treatment of Localized Breast Cancer: Time for Reappraisal?
Menée auprès de 1 087 patientes incluses dans un essai multicentrique de phase III comparant deux chimiothérapies adjuvantes suivies du zolédronate pour un cancer du sein de stade précoce et à haut risque de récidive, cette étude évalue l'association entre la présence de cellules tumorales circulantes deux ans après la chimiothérapie et la survie sans maladie ou la survie globale des patientes
Evidence-based guidelines recommend surveillance after treatment of localized breast cancer including history, physical examination, and annual mammography (1,2). Laboratory tests including circulating tumor markers and imaging studies beyond mammography are not recommended in asymptomatic patients, although these recommendations are based on clinical trials done in an era when diagnostic, imaging and therapeutic options were limited (3). Recently, the U.S. Food and Drug Administration (FDA) granted regulatory approval for apalutamide in the treatment of nonmetastatic castration-resistant prostate cancer based on the endpoint of metastasis-free survival (4), and use of an integral biomarker (serum prostate-specific antigen [PSA]) to select men at high risk for developing metastasis and lacking distant disease based on standard diagnostic imaging (5). This paradigm provides a tenable model for evaluating a similar strategy in nonmetastatic breast cancer.
Journal of the National Cancer Institute , commentaire en libre accès, 2017