新研究表明精准医学进展能够改善乳腺癌治疗

　　2016年10月24日，美国癌症学会（ACS）官方期刊《癌症》在线发表密歇根大学、安娜堡退伍军人事务医疗中心、埃默里大学、南加利福尼亚大学、斯坦福大学医学中心的研究报告《早期乳腺癌复发评分法的化疗决策与患者经验》，展示了如何利用精准医学方法（肿瘤基因组检测）帮助乳腺癌患者减少过度治疗，将化疗的作用最大化。

　　癌症领域的大多数精准医学研究都针对参与临床研究的患者，几乎没有研究对于医生如何利用生物标记物检测结果来推荐化疗方案以及如何根据患者的经历进行检测和最终决策进行研究。

　　该研究发现医生建议和最终治疗决策与病情检查结果高度相关，表明肿瘤基因组检测能够帮助医生辨别哪些患者能够从化疗中获益最大，哪些患者可以安全地停止化疗治疗。

　　该研究调查了在2013～2014年接受乳腺癌治疗的3880例女性，总共有1527例I/II期、雌/孕激素受体阳性、HER2阴性乳腺癌患者回复了该调查问卷，778例接受了21基因复发评分（RS）检测，进行疾病复发风险以及雌激素受体阳性乳腺癌患者化疗效果的评估。

　　结果发现，47.2%的患者被建议不进行化疗，40.5%的患者被建议进行化疗。患者得到的建议与RS结果有相关性：几乎所有高评分（31～100）的患者都得到了化疗建议（86.9%～96.5%），而大多数检测低风险评分（0～18）的患者都得到不进行化疗的建议（65.9%～78.2%）。同时，大多数检测高评分的患者最终接受了化疗治疗（87.0%、91.1%、100%），而得到低分数的患者几乎无人接受化疗（2.9%、9.5%、26.6%）。在检测和治疗方面不存在种族之间的实质性差别。大部分患者对于RS评分和化疗选择比较满意。

　　因此，作者认为大多数医生按照专业指南的建议，对患者进行肿瘤基因组检测，也发现一些患者接受的检测并没有按照专业指南进行，例如大约13%淋巴结呈乳腺癌阳性的女性进行了肿瘤基因组检测，而目前来说仍然不知道这部分患者是否能够从检测和建议中获益。

　　作者还建议，肿瘤学研究组织还需要做更多的工作帮助患者了解这些检测的目的、如何进行结果解读、这些结果对于她们的乳腺癌治疗有什么意义。

Cancer. 2016 Oct 24. [Epub ahead of print]

Chemotherapy decisions and patient experience with the recurrence score assay for early-stage breast cancer.

Friese CR, Li Y, Bondarenko I, Hofer TP, Ward KC, Hamilton AS, Deapen D, Kurian AW, Katz SJ.

University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan; Emory University, Atlanta, Georgia; University of Southern California, Los Angeles, California; Stanford University Medical Center, Palo Alto, California.

BACKGROUND: The 21-gene recurrence score (RS) assay stratifies early-stage, estrogen receptor-positive breast cancer by recurrence risk. Few studies have examined the ways in which physicians use the RS to recommend adjuvant systemic chemotherapy or patients' experiences with testing and decision making.

METHODS: This study surveyed 3880 women treated for breast cancer in 2013-2014; they were identified from the Los Angeles County and Georgia Surveillance, Epidemiology, and End Results registries (response rate, 71%). Women reported chemotherapy recommendations, the receipt of chemotherapy, testing experiences, and decision satisfaction. Registries linked the tumor data, RS, and surveys. Regression models examined factors associated with chemotherapy recommendations and receipt by the RS and subgroups.

RESULTS: There were 1527 patients with stage I/II, estrogen receptor/progesterone receptor-positive, human epidermal growth factor 2-negative disease: 778 received an RS (62.6% of patients with node-negative, favorable disease, 24.3% of patients with node-negative, unfavorable disease, and 13.0% of patients with node-positive disease; P < .001). Overall, 47.2% of the patients received a recommendation against chemotherapy, and 40.5% received a recommendation for it. RS results correlated with recommendations: nearly all patients with high scores (31-100) received a chemotherapy recommendation (86.9%-96.5% across clinical subgroups), whereas the majority of the patients with low-risk results (0-18) received a recommendation against it (65.9%-78.2% across subgroups). Most patients with high RSs received chemotherapy (87.0%, 91.1%, and 100% across subgroups), whereas few patients with low scores received it (2.9%, 9.5%, and 26.6% across subgroups). There were no substantial racial/ethnic differences in testing or treatment. Women were largely satisfied with the RS and chemotherapy decisions.

CONCLUSIONS: Oncologists use the RS to personalize treatment, even for those with node-positive disease. High satisfaction and an absence of disparities in testing and treatment suggest that precision-medicine advances have improved systemic breast cancer treatment.

KEYWORDS: adjuvant; breast neoplasms; chemotherapy; genomics; health services; surveys and questionnaires

PMID: 27775837

DOI: 10.1002/cncr.30324