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Classification et signatures moléculaires des cancers du sein en 2017

Molecular taxonomy and signatures of breast cancer in 2017

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Oncologie

Résumé

Les cancers du sein sont subdivisés selon leur degré d’expression des récepteurs hormonaux et du gène HER2. La classification moléculaire a bouleversé cette conception simpliste en mettant en lumière de multiples profils de pronostics différents. C’est dans ce contexte, et devant la nécessité d’employer des traitements ciblés que sont nées les signatures moléculaires. Bien qu’elles diffèrent par les méthodes employées (qRT-PCR, microarray ou dérivés type n-counter), elles ont les mêmes objectifs: calculer un score pronostique, fondé sur les niveaux d’expression de gènes impliqués dans la cancérogenèse, et si possible prédire la réponse au traitement. Applicables essentiellement aux tumeurs luminales RE+, elles ont prouvé leur valeur pronostique dans de vastes essais prospectifs, et les experts souhaitent les intégrer dans la décision thérapeutique, actuellement établie sur les critères clinicopathologiques. Par ailleurs, comparativement aux coûts d’une chimiothérapie, les signatures moléculaires apportent un réel bénéfice financier et permettent d’équilibrer la balance bénéfice/risque en diminuant le recours à des traitements agressifs parfois inefficaces.

Abstract

Breast cancers are best classified according to their level of hormone receptors and HER2 gene expression. Molecular classification has modified this simplistic taxonomy highlighting multiple profiles with different prognosis. It is in this context, and given the need to use targeted therapies, that molecular signatures were developed. Although they differ in methods (qRT-PCR, micro-array, or derivatives), molecular signatures endorse the same objectives: calculate a prognostic score based on the levels of gene expression involved in carcinogenesis, and, if possible, predict response to treatment. Applicable mainly to luminal ERpositive tumors, molecular signatures have proven their prognostic value in large prospective clinical trials and experts now look forward to integrate them in the therapeutic decision, which is currently based on clinico-pathological criteria. Furthermore, compared to the cost of chemotherapy, molecular signatures provide a real financial benefit and help to equilibrate the risk–benefit balance by reducing the use of aggressive treatments that are sometimes ineffective.

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Authors and Affiliations

  1. Département de pathologie, Gustave-Roussy Cancer Campus, F-94805, Villejuif Cedex, France

    N. Joyon & M. Lacroix-Triki

  2. Département de pathologie, centre Jean-Perrin, F-63011, Clermont-Ferrand, France

    F. Penault-Llorca

Authors
  1. N. Joyon
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  2. F. Penault-Llorca
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  3. M. Lacroix-Triki
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Correspondence to M. Lacroix-Triki.

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Joyon, N., Penault-Llorca, F. & Lacroix-Triki, M. Classification et signatures moléculaires des cancers du sein en 2017. Oncologie 19, 64–70 (2017). https://doi.org/10.1007/s10269-017-2700-6

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  • DOI: https://doi.org/10.1007/s10269-017-2700-6

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