A test that scans the activity of 70 genes in breast cancer tissue can help identify patients with invasive lobular carcinoma (ILC) who have a high risk of the cancer recurring or progressing after surgery, new research by Dana-Farber Cancer Institute investigators shows. The findings, based on an international clinical trial involving nearly 500 women with ILC, will be presented at the 12th European Breast Cancer Conference (EBBC) today.
由美國達納-法伯癌症研究所調查研究員們進行的新研究證實，一項掃描乳腺癌組織中70個基因活性的測試，能有助於確認罹患浸潤性小葉癌(ILC)病人，在手術後，誰具有高癌腫復發或進展的風險。此些以一項涉及近500名罹患ILC女性之國際臨床試驗為基礎的研究發現，將在今天(2020年10月1日)的第十二屆歐洲乳腺癌會議(EBBC)上被提出。
Although the vast majority of patients who undergo surgery for ILC respond well to hormone therapy and do not require further treatment, some patients face an increased risk of the cancer recurring and might benefit from follow-up treatment with chemotherapy, radiation therapy, or targeted therapies. In the new study, researchers found that the 70-gene test, known as MammaPrint, identified some of these high-risk patients in a phase III clinical trial.
雖然接受ILC手術的絕大多數病患，對賀爾蒙療法反應良好，無需進一步治療。不過有些病患面對升高的癌腫復發風險，而可能從使用化學療法、放射療法或標靶療法等，後續治療獲益。在該項新研究中，研究人員們發現，上述被通稱為MammaPrint(針對早期乳腺癌病人的預後(指根據病人當前狀況，來推估未來經過治療後可能的結果)及預測性診斷測試，可評估腫瘤轉遺到身體其他部位的風險)的70個基因測試，在一項第三期臨床試驗中，確認了其中一些高風險的病人。
ILC accounts for about 10% of cases of invasive breast cancer. Determining which patients are likely to benefit from treatment after surgery and hormonal therapy has been a challenge.
ILC大約佔10％浸潤性乳腺癌病例。確認哪些病人，在手術及賀爾蒙療法後，可能從治療獲益是一項挑戰。
“The decision about whether or not to treat patients diagnosed with invasive lobular carcinoma with chemotherapy is difficult,” says Dana-Farber’s Otto Metzger, MD, who will be presenting the research at the EBBC.
在歐洲乳腺癌會議上，將提出該項研究的達納-法伯癌症研究所醫學博士，Otto Metzger宣稱：「有關是否使用化學療法來治療，被診斷罹患浸潤性小葉癌病人的決定是困難的。
Results from earlier research that I carried out with Professor Christos Sotiriou at the Institut Jules Bordet, in Belgium, indicated that 10 to 15% of ILC cases were classified as high-risk at a genomic level. These had worse survival outcomes when compared to those classified as low-risk.”
來自他較早與比利時朱爾斯博爾戴特研究所，Christos Sotiriou教授進行的研究結果顯示，在基因體水平上，有10到15％的ILC病例，被歸類為高風險。當與那些被歸類為低風險者比較時，高風險者具有較差的存活結果。」
The new study drew on data from the MINDACT study, a phase III trial comparing genetic testing and traditional clinical tests in their ability to determine which women with breast cancer that has spread to no more than three lymph nodes are likely to benefit from chemotherapy after surgery. Of the 5,313 participants evaluated in the trial, 487 had ILC, including 255 classic cases of the disease and 232 variants, and 4,826 had invasive ductal carcinoma (IDC).
該項新研究動用了來自，在淋巴結陰性疾病中，微陣列可避免化學治療(MINDACT：Microarray In Node negative Disease may Avoid ChemoTherapy)的研究數據。MINDACT是一項比較遺傳測試與傳統臨床測試，在其確認哪些罹患乳腺癌，已經擴散到不多於三個淋巴結的女性，在手術後可能從化療獲益之能耐的第三階段試驗。在該項試驗中，經評估的5313名參與者，487名罹患ILC，包括255例典型的該種疾病，及232例變異的該種疾病，4826名罹患浸潤性導管癌(IDC)。
The 70-gene signature test classified 16.2% of the patients with ILC, and 39.1% of those with IDC, as being at high genomic risk for cancer recurrence.
該項70個基因的特徵測試分類了，16.2%此些罹患ILC的病人。結果那些病人39.1%罹患IDC，被認為冒用癌腫復發的高基因體風險。
The researchers found that estimates for the proportion of patients surviving without the disease recurring (disease-free survival, DFS) or without the disease spreading to other parts of the body (distant metastases-free survival, DMFS) at five years were similar for both ILCs and IDCs that had been classified as high-risk by the 70-gene signature test. DFS was 87.1% for IDC and 84.6% for ILC. DMFS was 92.3% for IDC and 89.4% for ILC.
此些研究人員發現，就已經被上述70個基因之特徵測試，歸類為高風險的ILCs及IDCs而言，沒有疾病復發(無疾病的存活，DFS)，或沒有疾病擴散到身體其他部位(無遠處轉移的存活，DMFS)之存活病人的比例估計，在五年內是相似的。IDC的DFS是87.1%，而ILC是84.6%。IDC的DMFS是92.3%，而ILC是89.4%。
Estimates for IDCs and ILCs that the 70-gene signature test classified as low risk were also similar. DFS was 92.5% for IDC and 92% for ILC. DMFS was 96.5% for IDC and 96.6% for ILC.
該項70個基因之特徵測試歸類為低風險之IDCs及ILCs的估計，也相似。IDC的DFS是92.5%，而ILC是92.5%。IDC的DMFS是96.5%，而ILC是96.6%。
Says Metzger, “We found that DMFS and DFS estimates were similar for ILC and IDC classified as either low or high-risk by the 70-gene signature test. This suggests that the test has prognostic value for ILC. The incorporation of biological features defined by the 70-gene signature test in the treatment decisions for patients diagnosed with ILC should facilitate a complex decision-making process, that includes the extent of disease, other health conditions and patients’ preferences.”
Metzger宣稱：「他們發現，就被70個基因之特徵測試歸類為低或高風險的ILC及IDC而言，DMFS及DFS 的估計是相似的。這暗示，該項測試對ILC具有預後的價值。在被診斷罹患ILC病人的治療決定上，結合經70個基因之特徵測試定義的生物特徵，將有助於包括疾病程度、其他健康狀況及病人之優先選擇等，複雜的決定過程。」
In a statement before the conference, the principal investigator of the MINDACT trial, Fatima Cardoso, MD, director of the Breast Unit of the Champalimaud Clinical Centre, in Lisbon, Portugal, said, “Here we report for the first time the utility of the 70-gene signature test in a large group of patients with ILC in the MINDACT randomised phase III clinical trial. These results are important for clinicians to help them choose a precise treatment approach tailored to the individual patient.”
在會議前的一項聲明中，MINDACT試驗的首席調查研究員，葡萄牙里斯本，尚帕里莫德臨床中心乳腺科主任，Fatima Cardoso醫學博士宣稱：「在此，他們首度提出，在MINDACT隨機化的第三階段臨床試驗中，70個基因的特徵測試，在一大群罹患ILC病人中的效用報告。就協助臨床醫生們針對個別病人選擇量身訂作的精確治療法而言，此些研究結果是重要的。」
原文網址：https://www.dana-farber.org/newsroom/news-releases/2020/genetic-test-identifies-patients-with-invasive-lobular-breast-cancer-at-high-risk-of-disease-recurrence/
翻譯：許東榮
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