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how molecular signatures help in the choice of treatment



In the treatment of breast cancer, chemotherapy does not always produce significant results. Hence, the importance of being able to assess the relevance of the use of these treatments, sometimes unnecessarily used in this disease when their toxic side effects are known. For this, physicians need to know two elements, prognostic of the evolution of the disease, that are predictive of the usefulness of this or that treatment.

Today, this assessment helps with molecular signatures – or genomics – that, by identifying genes that are expressed in a patient's tumor, allow to say whether it is appropriate to prescribe chemotherapy. This analysis of tumor genes allows to show that there is a good response to this treatment.

"Know which patients need chemotherapy"

"The challenge is finding out which patients need chemotherapy because they have a poorer prognosis, but who need it most because this chemotherapy will be effective at home," explains Illil Fraser, chief of oncology. in the Civilis de Lyon hostel.

Until then, the choice was based on statistical studies that, according to clinical features, predicted a risk of death at 5, 10, or 15 years and indicated the benefit of chemotherapy or hormone therapy. "It's a good approach to a prognostic and predictive issue, but it's a population approach: for a given patient, we don't know the exact prognosis or effectiveness of chemotherapy in this particular case," says Ills Fraser.

"Individualizing Risk Assessment"

"Molecular signatures have established a genomic approach that allows for individualized risk assessment of the patient and the nature of her tumor," continues the oncologist who specifies the advantages and limits of the various signatures available today: "One is moderately prognostic but very predictable. the benefits of chemotherapy, others are very good prognostic signatures without being predictable, and others, with more limited use, very well predict the benefits of chemotherapy. continuing hormone therapy. "

But, Gail Freire insists, these molecular signatures should not be interpreted "literally": "It is necessary to refine predictions based on histopathological data."

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