Decision of Adjuvant Systemic Treatment in HR+ HER2- Early Invasive Breast Cancer: Which Biomarkers Could Help?

Marie Alexandre; Aurélie Maran-Gonzalez; Marie Viala; Nelly Firmin; Véronique D'Hondt; Marian Gutowski; Céline Bourgier; William Jacot; Séverine Guiu

doi:10.2147/CMAR.S221676

Decision of Adjuvant Systemic Treatment in HR+ HER2- Early Invasive Breast Cancer: Which Biomarkers Could Help?

Cancer Manag Res. 2019 Dec 11:11:10353-10373. doi: 10.2147/CMAR.S221676. eCollection 2019.

Authors

Marie Alexandre¹, Aurélie Maran-Gonzalez², Marie Viala¹, Nelly Firmin¹, Véronique D'Hondt^{1

3

4}, Marian Gutowski⁵, Céline Bourgier^{3

6}, William Jacot^{1

3

4}, Séverine Guiu^{1

3

4}

Affiliations

¹ Department of Medical Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France.
² Department of Pathology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France.
³ INSERM U1194 - Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France.
⁴ University of Montpellier, Montpellier,France.
⁵ Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France.
⁶ Department of Radiation Oncology, Institut Régional du Cancer de Montpellier, Montpellier Cedex 5 34298, France.

Abstract

The decision to administer adjuvant chemotherapy in treatment of early invasive breast cancer (EBC) is often complex, particularly for hormone receptor-positive (HR+) diseases, and current guidelines often classify these patients in an intermediate-risk group. Several biomarkers are currently available in this indication, in order to obtain additional and more accurate prognostic information compared to classic clinicopathological characteristics and guide the indication of adjuvant chemotherapy, optimizing the efficacy/toxicity ratio. We conducted a systematic review to evaluate the clinical validity and clinical utility of five biomarkers (uPA/PAI-1, OncotypeDX^®, MammaPrint^®, PAM50, and EndoPredict^®) in HR+/HER2- EBC, whatever the nodal status. A total of 89 studies met the inclusion criteria. Even though data currently available confirm the clinical validity of these biomarkers, there is a lack of data regarding clinical utility for most of them. Prospective studies in well-defined populations are needed to integrate these biomarkers in a decision strategy.

Keywords: adjuvant chemotherapy; biomarkers; breast cancer.

Publication types

Review

Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.