Evaluating the Clinical Utility of Circulating Tumor Cells in Metastatic Breast Cancer—Is Not Worse Good Enough?
Mené sur 755 patientes atteintes d'un cancer métastatique du sein HR+ ERBB2- (âge médian : 63 ans), cet essai français de phase III évalue l'efficacité, du point de vue de la survie sans progression, d'un traitement de première ligne (chimiothérapie ou hormonothérapie) dont le choix est basé sur le nombre de cellules tumorales circulantes par rapport à un traitement de première ligne dont le choix est laissé au clinicien
Recent decades have brought meaningful improvements in outcomes for patients with metastatic hormone receptor–positive, ERBB2-negative breast cancer. Discovery of effective adjuncts to hormonal therapy has improved quality of life and survival in the endocrine-sensitive and resistant settings. Several randomized trials and meta-analyses demonstrate the benefit of modern hormonal therapy–based treatments over traditional cytotoxic chemotherapy approaches. Although practice guidelines routinely recommend initial hormone-based therapy, many clinicians and patients struggle to defer chemotherapy in those with symptomatic or high-burden disease. We assume that some patients might be better served by up-front chemotherapy, but which patients? Without predictive biomarkers, we are left with our clinical knowledge, experience, and intuition. Patients are left with uncertainty, doubt, and fear.
JAMA Oncology , éditorial, 2019