https://doi.org/10.55788/e4b6f35d
“Clinicopathologic features have not been able to successfully stratify patients with breast cancer into low- and high-risk categories of recurrence after they receive radiotherapy following breast conserving surgery,” explained Dr Pat Whitworth (Nashville Breast Cancer Center, TN, USA). A clinically meaningful biomarker could fill this gap.
The 7-gene DCIS biosignature score combines 7 biomarkers and 4 clinicopathologic factors and has been validated as a prognostic tool for ipsilateral breast tumour recurrence (IBTR) and as a predictor for radiotherapy benefit in patients with breast cancer [1]. A central pathology review and biosignature testing was performed on formalin-fixed paraffin embedded tissue at a CLIA-certified lab (Laguna Hills, CA). The biosignature reported a “decision score” and residual risk subtype status. The current study included 926 patients from 4 cohorts with a pre-defined DCIS biosignature risk group of either low-risk (37%), elevated-risk (43%), or residual-risk (20%) to analyse the 10-year IBTR-rate [2]. The low-risk group had a decision score of ≤2.8, the elevated-risk group had a decision score of >2.8 without residual risk subtype, and the residual-risk group had a decision score of >2.8 with residual risk subtype.
IBTR-risk was reduced in the elevated-risk group (4.9% vs 20.6%) and the residual-risk group (14.7% vs 42.1%) but not in the low-risk group (4.8% vs 5.6%) if patients received radiotherapy after breast-conserving surgery compared with patients who had not received radiotherapy after surgery. Importantly, the risk of recurrence after radiotherapy was significantly higher in the residual-risk group compared with the elevated-risk group (P<0.001).
Furthermore, in the elevated-risk group, endocrine therapy reduced the risk of IBTR significantly, regardless of whether patients received radiotherapy (HR 0.34; P=0.023). This was not the case in the residual-risk group (HR 0.76; P=0.46) or in the low-risk group (HR 0.65; P=0.41). If patients in the elevated-risk group had received radiotherapy, the administration of endocrine therapy still trended towards a significant reduction in the IBTR rate (HR 0.40; P=0.059).
In summary, 3 risk groups were identified by means of the 7-gene DCIS biosignature. In the low-risk group, IBTR was not significantly reduced after radiotherapy and/or endocrine therapy, whereas in the elevated-risk group IBTR was reduced. In the residual-risk group, radiotherapy reduced the IBTR rate, but endocrine therapy had no effect.
- Wärnberg F, et al. Cancers. 2021;13(23):6103.
- Whitworth P, et al. Assessing the benefit of adjuvant endocrine therapy in patients following breast-conserving surgery with or without radiation stratified by a 7-gene predictive DCIS biosignature. Abstract 502, ASCO 2022 Annual Meeting, 3‒7 June, Chicago, IL, USA.
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Table of Contents: ASCO 2022
Featured articles
Breast Cancer
Sacituzumab govitecan meets primary endpoint
Shaky OS results of palbociclib in ER-positive/HER2-negative breast cancer
Practice-changing results of T-DXd in HER2-low breast cancer
SET2,3 to inform on chemotherapy decisions in ER-positive breast cancer
Metastasis-directed therapy fails in oligometastatic breast cancer
Analysis by residual cancer burden further clarifies effect of pembrolizumab
Contribution of metastatic therapies on mortality reduction in breast cancer
Radiotherapy may be omitted in breast cancer patients
Promising data for ribociclib after progression on ET plus CDK4/6 inhibitors in HR-positive/HER2-negative metastatic breast cancer
7-gene biosignature: Benefits of endocrine therapy and radiotherapy in breast cancer risk groups
Lung Cancer
Additional tiragolumab does not help patients with untreated small cell lung cancer
Success for serplulimab plus chemotherapy in small cell lung cancer
Adagrasib safe and clinically active in non-small cell lung cancer
Long-term benefits of combined immunotherapy over chemotherapy in non-small cell lung cancer
Effect of KRAS mutations and PD-L1 expression on therapy response in non-small cell lung cancer
Melanoma
First results on distant metastasis-free survival in stage II melanoma
Higher response rates for concurrent triple therapy versus sequential therapy in melanoma
Genitourinary Cancers
Exploratory treatment options fail in ccRCC
Adjuvant everolimus did not benefit high-risk renal cell carcinoma
Cabozantinib fails as first-line maintenance therapy in urothelial cancer
177Lu-PSMA-617 is a valid treatment option for PSMA-positive mCRPC
Enzalutamide performs well in metastatic hormone-sensitive prostate cancer
Haematologic Malignancies
Autologous stem cell transplantation plus RVd improves PFS in multiple myeloma
Novel first-line treatment option for mantle cell lymphoma
Promising results for novel CAR-T therapy in relapsed/refractory multiple myeloma
Gastrointestinal Cancers
Panitumumab beats bevacizumab in RAS wildtype left-sided metastatic colorectal cancer
Spectacular results for dostarlimab in mismatch repair deficient rectal cancer
Triplet chemotherapy beats doublet chemotherapy in colorectal cancer liver metastases
To resect or not to resect primary tumours in stage IV colon cancer?
Novel treatment option for KRAS wildtype pancreatic cancer
Gynaecological Cancers
Primary results of rucaparib in ovarian cancer
Trabectedin not superior to chemotherapy in recurrent epithelial ovarian cancer
Encouraging results of relacorilant in ovarian cancer
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Bacterial decolonisation effective against radiation dermatitis
New standard-of-care for cisplatin-ineligible locally advanced head and neck squamous cell carcinoma
Ifosfamide is likely to be the go-to therapy in recurrent Ewing sarcoma
Dabrafenib plus trametinib candidates for standard-of-care in BRAF V600-mutated paediatric low-grade glioma
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