How Useful Are Genomic Analyses for Patients With Metastatic Breast Cancer?
Posted: Friday, January 7, 2022
According to Fabrice André, MD, PhD, of Gustave Roussy Cancer Campus, Villejuif, France, and colleagues, multigene sequencing may be used as a therapeutic decision tool to improve outcomes in patients with HER2-negative metastatic breast cancer harboring genomic alterations in the I/II tiers of the ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT). (This scale defines clinical evidence–based criteria to prioritize genomic alterations as markers to select patients for targeted therapies.) The results of the multicenter phase II SAFIR02-BREAST trial, as well as the pooled analysis of this trial with the SAFIR-PI3K trial, were presented during the 2021 San Antonio Breast Cancer Symposium (SABCS; Abstract GS1-10).
“[Our] findings suggest that genomics should be a part of the pathway of care, but it has no impact if the results are not interpreted using a validated framework of actionability of the gene alterations identified,” commented Dr. André in an SABCS press release.
Next-generation sequencing and single nucleotide polymorphism array were performed on samples from 1,462 patients. Those with stable disease who presented an actionable genomic alteration after undergoing six to eight cycles of chemotherapy were randomly assigned to receive appropriate targeted therapies matched to their genomic alteration (n = 157) or maintenance chemotherapy (n = 81).
The median durations of progression-free survival were 9.1 and 2.8 months with targeted therapy and maintenance chemotherapy, respectively, in patients with an ESCAT I/II genomic alteration (n = 115; P < .001); however, in the overall population, the durations did not seem to significantly differ (P = .109). Targeted therapies did not appear to be effective when matched to alterations that did not rank as ESCAT I/II; thus, ESCAT classification seems to be predictive of the benefit of targeted therapies matched to genomic alterations (interaction test, P = .004). The investigators identified 21 gene amplifications or deletions that may be associated with metastatic evolution, poor prognosis, and drug resistance or sensitivity.
Disclosure: For full disclosures of the study authors, visit sabcs.org.
