Patient-Centered Simulations to Assess the Usefulness of the 70-Gene Signature for Adjuvant Chemotherapy Administration in Early-Stage Breast Cancer
Résumé
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Mots clés
Stratified medicine
Randomized Controlled Trials as Topic
Quality-Adjusted Life Years
Quality of Life
Patient-centered outcomes
Neoplasm Staging
Humans
Gene Regulatory Networks
Female
Disease-Free Survival
Computer Simulation
Adjuvant
Chemotherapy
Breast Neoplasms
Breast cancer
Immunologic
Adjuvants
Adjuvant chemotherapy
70-gene signature
Domaines
Sciences du Vivant [q-bio]Origine | Fichiers produits par l'(les) auteur(s) |
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