Breast Cancer Update, Issue 2, 2016 (Video Program) - Video 12Use of genomic assays to refine treatment decision-making
1:55 minutes.
TRANSCRIPTION:
DR LOVE: But just to finish out on the BCI, the Breast Cancer Index, a lot of these genomic assays almost kind of — I don't know. It’s almost like a religious, “Do you believe in it?” For people like myself, the statistics sometimes are a little bit intimidating. But when you look at the data, and maybe you can talk about the data that you’ve seen. I mean, it’s one thing to say, “Okay. Here’s a risk of 3%,” or, “15%,” but how were the data derived? And how valid do you think these estimates are? And what do we know about benefit? I mean, yes, maybe there’s a risk of 8%, but is that going to change with hormonal therapy? DR GOETZ: Yes. So this is obviously a really great point. And I think one of the things that I like to first start out with when I’m seeing a patient is, we would like a more accurate estimate of what that risk is in years 5 through 14. And so I think a number of these tests may be helpful, giving a more accurate estimate especially for the node-negative patients, which, as you know, most of those patients are doing quite well. Where I think it’s much more difficult, Neil, is this issue of benefit or predictive. Is the test predictive of benefit? And I think that’s where right now I’m still a bit skeptical. And that is obviously because we have very few data sets out there, that is, of extended adjuvant therapy versus no therapy, where we can confidently say that these tests are predictive of benefit. So I think where clinicians can find these tests potentially helpful is simply from a prognostic standpoint. Is the risk so low that continuing on with therapy really — that if the relative benefit is the same but the absolute benefit is so small, then one can fairly confidently tell our patients that, based on such a low risk, that they could feel confident in foregoing additional therapy? |