Duke-led study suggests less invasive way to treat early breast cancer скачать в хорошем качестве

Duke-led study suggests less invasive way to treat early breast cancer

The first study comparing surgery to active monitoring as treatment for ductal carcinoma in situ (DCIS) finds women who carefully monitor the precancerous cells are no more likely to develop breast cancer after two years than women who undergo surgery to remove them. The early results of the Comparing an Operation to Monitoring with or without Endocrine Therapy (COMET) study suggest women and their doctors may consider active monitoring as a safe, less-aggressive alternative for treating low-risk DCIS. Researchers have believed that many women diagnosed with DCIS do not benefit from treatment, but this has not been put to the test in a clinical trial. E. Shelley Hwang, M.D., of the Duke Cancer Institute, and who is vice-chair of research in Duke’s Department of Surgery, was a co-principal investigator on the study. Hwang and the research team – including co-principal investigator Ann Partridge, M.D., of Dana-Farber Cancer Institute - enrolled nearly 1,000 women ages 40 and up.   After biopsy and confirmation of DCIS, study participants were randomized into two treatment groups: the current standard of care involving surgery and radiation, or the alternative of active monitoring. Most women in both groups also received endocrine therapy to block the estrogen hormone, which often fuels cancer cells. At two years, the rate of invasive cancer in women in the surgery group was 5.9%, compared to 4.2% in women who did active monitoring. Hwang said the higher rate of invasive cancers found among the group receiving traditional treatment could be the result of “upstaging,” in which invasive cancer is identified in patients diagnosed with DCIS at the time of surgery. “We noted there were fewer cancers diagnosed in those patients who had active monitoring, and we feel that part of this was due to the hormone blocking treatment that many of them had,” Hwang said. “Although this was optional on the study, over 70% of women combined active monitoring with endocrine therapy, suggesting that this may be an important part of active monitoring in the future for women with DCIS." Both selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) have been shown to reduce the incidence of invasive cancer by approximately 50%, with plausible mechanisms being either prevention of DCIS progression or reversal of invasive cancer. “These early results are provocative and potentially exciting for patients, but we clearly need more long-term follow-up,” Hwang said. “If these results hold up over time, most patients who have this type of low-risk disease will have the option of avoiding invasive treatments. That would be a complete change in how we care for these patients and think about this disease.” In a separate analysis, Hwang and Partridge co-led an additional study measuring patient-reported outcomes from both groups involved in the COMET study. “The women in the study also told us in surveys how they felt over time,” said Partridge, interim chair of Medical Oncology at Dana-Farber Cancer Institute. “Fortunately, the overall health-related quality of life, anxiety, depression, worries, and symptom trajectories were comparable regardless of the treatment received during two years of follow-up.” In addition to Hwang, study authors from Duke include Thomas Lynch, Marc D. Ryser, Lars Grimm, Jeff Marks, and Yan Li. For a full list of authors, see the study manuscript. The COMET study received funding support from the Patient-Centered Outcomes Research Institute (PCS-1505-30497) and the Breast Cancer Research Foundation.