SIOG 2014

Adjuvant chemotherapy in elderly ER HER2- breast cancer patients

Dr Etienne Brain - Institut Curie, Paris, France

That’s a study whose name is ASTER 70s and it addresses the added value of chemotherapy in addition to endocrine treatment for early breast cancer. The main goal is to try to better select the women with standard and the most frequent form of breast cancer who really deserve chemotherapy, based on a genomic tool. So that’s a trial which uses a genomic tool, a modern tool, to better select and which really tries to organise the indication of chemotherapy.

What are the important considerations in these circumstances?

We know that the most important group of women are elderly women who have this phenotype, ER positive and HER2 negative disease. Among them, most of them derive a great benefit from endocrine treatment but some of them may derive a higher benefit from chemotherapy in addition. Hopefully with this type of trial we’ll be able to select better our patients later.

What are the potential genomic prognosticators that you could use?

We use a genomic grade, which is a different way to assess the histological grade, but on paraffin with a selection of genes. Only those with a high genomic grade are going to be randomised between both therapies, with or without chemo. Actually it addresses a question of competing risk for mortality because we know that there is an increased incidence of comorbidity according to age and severity and incidence and that competes with the cancer prognosis. It’s very important to prioritise the health status, what we treat when we care about these elderly women with breast cancer.

Could this predict the outcome of different kinds of chemotherapies?

So far only chemotherapy by itself because chemotherapy is really something which is not very specific in terms of action; that’s not at all the case with the new biological [?? 2:22] that we develop. So it’s the philosophy of the trial.

What should doctors take home from this work in progress?

The first point is that it’s a programme which is going very well: 2000 women to be screened for genomic rate, of them 800 will be randomised with most completing the programme in less than two years, so that’s great, great information that we can run such very large trials in the elderly population. The second point is that we really need to have different endpoints in these trials. In these endpoints we combine geriatric items and quality of life, all these items which are so important to the elderly population as the functional status, to maintain indefinitely.