Patient-centered simulations to assess the usefulness of the 70-gene signature for adjuvant chemotherapy administration in early-stage breast cancer
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From the MINDACT trial, Cardoso et al. did not demonstrate a significant efficacy for adjuvant chemotherapy (CT) for women with early-stage breast cancer presenting high clinical and low genomic risks. Our objective was to assess the usefulness of the 70-gene signature in this population by using an alternative endpoint: the number of Quality-Adjusted Life-Years (QALYs), i.e., a synthetic measure of quantity and quality of life.
Based on the results of the MINDACT trial, we simulated a randomized clinical trial consisting of 1497 women with early-stage breast cancer presenting high clinical and low genomic risks. The individual preferences for the different health states and corresponding decrements were obtained from the literature.
The gain in terms of 5-year disease-free survival was 2.8% (95% CI from − 0.1 to 5.7%, from 90.4% for women without CT to 93.3% for women with CT). In contrast, due to the associated side effects, CT significantly reduced the number of QALYs by 62 days (95% CI from 55 to 70 days, from 4.13 years for women without CT to 3.96 years for women with CT).
Our results support the conclusions published by Cardoso et al. by providing additional evidence that the 70-gene signature can be used to avoid overtreatment by CT for women with high clinical risk but low genomic risk.
Keywords70-gene signature Breast cancer Patient-centered outcomes Stratified medicine Adjuvant chemotherapy
- 95% CI
95% confidence interval
Adjuvant breast cancer trial
Cyclophosphamide, methotrexate, and fluorouracil
Distant metastasis-free survival
Early-stage breast cancer
Epirubicin followed by cyclophosphamide, methotrexate, fluorouracil
European organisation for research and treatment of cancer
Fluorouracil, epirubicin, and cyclophosphamide
FEC60 followed by docetaxel
Health-related quality of life
Microarray in node-negative disease may avoid chemotherapy
National epirubicin adjuvant trial
Taxotere as adjuvant chemotherapy trial
This work was supported by the Cancer National Institute (INCa, MAP-MARKER, No. 2013-137).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
This article does not contain any studies with animals performed by any of the authors.
For this type of study formal consent is not required.
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