Gene Signature Technique Boosts Survival in Breast Cancer

Using a gene signature technique to customize chemotherapy for patients with early triple negative breast cancer may be a promising strategy to increase disease-free survival. The study was published in the journal The BMJ ().

An aggressive form of breast cancer, triple negative breast cancer has a higher chance of death and recurring following normal treatment. Therefore, there is an urgent need for better chemotherapeutic techniques.

‘High-risk triple negative breast cancer patients benefit significantly from intensive chemotherapy, with 3-year disease-free survival rates at 91% compared to 81% for standard care. #breastcancer #personalizedmedicine #medindia’

Multigene Signatures in Triple Negative Breast Cancer Treatment

There are few validated multigene signatures for triple negative breast cancer. Multigene signatures are tests that examine genes in a tumor sample to predict a patient's response to chemotherapy and the likelihood that their cancer will return.

Chinese researchers therefore set out to determine if it would be possible to personalize treatment for patients with operable triple negative breast cancer by employing a multigene RNA signature.

The trial enrolled 504 female patients aged 18-70 years at seven cancer centres in China who had undergone surgery for early stage triple-negative breast cancer between January 2016 and July 2023.

Patients classified by the signature as being at high risk were randomised to receive intensive chemotherapy or standard chemotherapy. Patients at low risk also received standard chemotherapy.

Multigene Signatures Lead to Improved Survival in Breast Cancer Treatment

After an average follow-up period of 45 months, three year disease-free survival was significantly better among participants at high risk who received the more intensive treatment than in those receiving standard care (91% v 81%). However, the result for the three year overall survival rate was less certain (98% v 91%).

Patients classified as being at low risk had significantly higher rates of disease-free survival, recurrence-free survival, and overall survival than patients at high risk receiving the same standard chemotherapy.

As expected, intensive chemotherapy carried a higher risk of serious adverse events, but there were no treatment related deaths.

The researchers acknowledge several limitations, such as the open-label design (where both health providers and patients are aware of the treatment being given), and note that the findings may not apply to other populations.

However, they say this trial "marks a pivotal advance, showing for the first time the feasibility of using multigene signatures to tailor individualised adjuvant therapy for patients with operable triple negative breast cancer."

"In addition, this study provides independent external validation of the prognostic value of the integrated signature in a uniformly treated population," they conclude.

How can this risk score be used to improve practice, ask Australian researchers in a linked editorial?

"A validated predictive test could enhance treatment decisions for many patients, perhaps to guide selection of neoadjuvant chemotherapies such as anthracyclines and platinum agents alongside novel treatments," they explain.

"Hopefully this score, and others, will contribute to a future in which treatment is more personalised, more targeted, and less reliant on conventional cytotoxic chemotherapy for people with this difficult subtype of breast cancer," they conclude.

Reference:

1. Intensive chemotherapy versus standard chemotherapy among patients with high risk, operable, triple negative breast cancer based on integrated mRNA-lncRNA signature (BCTOP-T-A01): randomised, multicentre, phase 3 trial - (https:www.bmj.com/content/387/bmj-2024-079603)

Source: Eurekalert