Dose intensification of chemotherapy for early breast cancer in the age of de-escalation
A partir de données portant sur 37 298 patientes atteintes d'un cancer du sein de stade précoce et incluses dans 26 essais, cette méta-analyse évalue l'intérêt, pour réduire le risque de récidive et la mortalité spécifique, d'intensifier les doses d'une chimiothérapie adjuvante à base d'antracycline et de taxane, soit par une administration plus fréquente, soit par une administration séquentielle des deux médicaments
60 years ago, the first randomised trial of adjuvant chemotherapy for breast cancer began.Although the overall results were negative, the study did demonstrate a benefit in premenopausal women, especially those with nodal involvement. Henceforth began a race to eliminate clinically occult metastases and improve cure rates. This ambitious but worthy goal at times led to massive overtreatment, as was the case with myeloablative chemotherapy followed by autologous stem-cell rescue. Fortunately, major strides in molecular subtyping of breast cancer have substantially improved our ability to assess risk of disease recurrence, develop and use safer and more effective targeted therapies, and move towards an era of biologically rational treatment recommendations. Recent results from TAILORx represent a milestone achievement in reducing unnecessary exposure to cytotoxic chemotherapy in those who will be unlikely to derive benefit, marking the entry into an era of de-escalation, where treatment is customised to a patient's risk to avoid overtreatment. So how are we to assimilate information from the meta-analysis by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) in The Lancet, which seemingly contradicts this “less is more” approach, with its results demonstrating, rather convincingly, that increasing the dose intensity of adjuvant chemotherapy will benefit patients? (...)
The Lancet , commentaire, 2018