Implications of ARTIC: Is This the Beginning of a Climate Change?
Menée notamment à partir d'échantillons tumoraux fixés au formaldéhyde et inclus en paraffine après prélèvement sur 748 patientes atteintes d'un cancer du sein de stade I-IIa sans envahissement ganglionnaire, cet essai de phase III évalue la performance d'un système de classification, basé sur l'âge des patientes et l'expression de 27 gènes, pour prédire le bénéfice d'une radiothérapie après une chirurgie conservatrice
Advances in systemic, surgical, and radiotherapy treatments, as well as in imaging, have led to significant improvements in breast cancer outcomes. These have set the stage for investigating efforts to de-escalate therapy and minimize toxicities while maintaining high overall cure rates.1,2 Genomic assays have allowed clinicians to spare a large number of patients with breast cancer from receiving chemotherapy, because these genomic tools have significantly advanced our ability to predict distant recurrence and chemotherapy benefit in individual patients with invasive disease.3 Indeed, assays such as the 21-gene recurrence score and 70-gene signature are widely used in standard clinical practice.4,5 Attention has thus turned to minimizing radiotherapy adverse effects by attempting to spare patients from receiving regional nodal irradiation, boost treatment, or radiotherapy altogether. To varying degrees, radiotherapy is associated with skin erythema; desquamation; fatigue; breast fibrosis; lymphedema; and cardiac, lung, and rib injury; as well as secondary malignancies.6 Retrospective studies suggest that genomic assays may assess risk for locoregional recurrence (LRR) and potentially predict radiotherapy benefit in patients with invasive breast cancer or ductal carcinoma in situ; therefore, there is potential to use genomic assays to spare such patients from receiving radiotherapy.7-9 These data have led to current prospective clinical trials (eg, Regional Radiotherapy in Biomarker Low Risk Node Positive Breast Cancer [TAILOR-RT; Canadian Cancer Trials Group MA.39] and EXamining PErsonalised Radiation Therapy for Low-risk Early Breast Cancer [EXPERT]; ClinicalTrials.gov identifier: NCT02889874) that ask whether genomic assays may be routinely used to make local therapy decisions.
Journal of Clinical Oncology , éditorial en libre accès, 2018