In honor of World Cancer Day on Feb. 4, the Breast International Group (BIG) emphasized the importance of wide-scale cooperation in efforts to advance cancer research.
“None of BIG’s achievements would be possible without the willingness to work together,” stated a press release highlighting some of the clinical trials that are supported by BIG, an international not-for-profit based in Brussels, Belgium, representing more than 50 research groups from around the world.
This year’s World Cancer Day theme is “Together, all our actions matter.”
“To test new treatments with enough patients to be confident about the results, clinical research should not be limited to one institution, or even one country,” the release stated. “The single strongest opportunity for success comes from combining resources and multi-disciplinary expertise from around the globe to establish research priorities, improve collaboration, and reduce unnecessary duplication of effort to generate results more quickly.”
Specifically, the release details four “de-escalation” clinical trials being conducted in people with breast cancer. The overarching aim of such trials is to determine whether the length and/or amount of specific treatments can be reduced — or completely omitted — without affecting the risk of the cancer coming back or affecting patients’ quality of life.
The general idea is that reducing treatments would spare patients from potential side effects, which might be warranted if there is no difference in the efficacy of treatments.
One trial called MINDACT (NCT00433589), which was carried out in nine European countries, showed that a tumor genomic test (MammaPrint) could identify individuals classified as high clinical risk with early stage breast cancer whose tumors were unlikely to return following surgery.
Nearly half of these individuals could avoid chemotherapy, and its associated side effects, while individuals at a higher likelihood of cancer recurrence could undergo chemotherapy to prevent the cancer from returning. Follow-up data, released last year, confirmed these results.
Another BIG trial is EXPERT (NCT02889874), which is testing whether some individuals with low-risk early breast cancer could be spared radiation therapy after breast-conserving surgery. Similar to MINDACT, a genomic test is being used to determine the risk of cancer returning. In individuals at low risk of recurrence, the combination of standard radiation therapy and hormone therapy is being compared with hormone therapy alone. EXPERT is currently recruiting participants, 50 or older, in Australia, New Zealand, and Taiwan, and is expected to run in a total of nine countries globally.
Results from another study (NCT00470236), conducted in 11 countries, showed that individualized radiation therapy for people with ductal carcinoma in situ (DCIS) of the breast reduces recurrence after surgery. DCIS occurs when cancer-like cells grow in the breast’s milk ducts. While DCIS itself is not considered an invasive cancer, it can progress to invasive cancer if left untreated.
After breast-conserving surgery, higher radiation doses to the part of the breast where the DCIS was found (termed a radiation “boost”), in addition to radiation therapy of the entire breast, significantly reduced the risk of recurrence in individuals with higher-risk DCIS, according to data presented last year at the San Antonio Breast Cancer Symposium (publication number GS2-04, page 197). Specifically, after five years, 97% of participants given the boost were recurrence-free, as compared to 93% of participants who didn’t get the boost. Both groups had more than 800 participants.
Another trial, called DECRESCENDO (NCT04675827), is expected to begin enrolling participants soon in 12 countries. In this trial, clinicians will identify patients with lymph node-negative, hormone receptor-negative, HER2-positive breast cancer who are suitable for chemotherapy de-escalation based on how they respond to pre-surgical treatment. Individuals whose tumors show a complete response following surgery will receive only anti-HER2 treatment and be spared further chemotherapy.
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