Hormonocian breast cancers represent around 80 % of cases. Their development is stimulated by female hormones, and hormone therapy constitutes the cornerstone of their treatment. Chemotherapy is sometimes added to reduce the risk of recurrence, but its usefulness in elderly patients remained uncertain … to Aster 70s.
An unprecedented essay that upsets preconceived ideas
The ASTER 70S study followed more than 2,000 women aged 70 and over, suffering from hormone -dependent breast cancer, operated and at high clinical recurrence risks. The participants first benefited from a genomic test to assess this risk on a molecular scale. Those with high genomic risk have been divided into two groups: hormone therapy alone or hormone therapy associated with adjuvant chemotherapy.
After a 7.8 -year -old median follow -up, the results indicate that adding chemotherapy does not significantly improve overall survival. At four years old, the survival rate was 90.5 % for the group having received chemotherapy, compared to 89.3 % for the one without chemotherapy. At eight years, these rates were 72.7 % and 68.3 % respectively. Eight years is not statistically significant. Fatigue, pain, digestive problems and a decrease in autonomy.
After a median follow -up of 5.5 years, the results are clear. According to Professor Etienne Brain, medical oncologist at the Institut Curie, “For the first time, a phase III study shows that the addition of chemotherapy does not provide a statistically significant benefit of overall survival, even in patients at high genomic risk. These results confirm that therapeutic decisions must take into account not only tumor biology, but also age, fragility and expectations of patients. They encourage to revise the way in which standards established in younger subjects are then applied to older subjects without high level of evidence or with little-safe “.
Too limited to older women in clinical trials
This observation highlights a recurring problem: the elderly are under-represented in clinical research. Consequence: therapeutic decisions are often modeled on data from younger patients.
Professor Jean-Yves Blay, president of Unicancer, pleads for more inclusion of elderly patients in clinical trials to produce recommendations that are specific to them: “This collective work will make it possible to reduce unnecessary treatments and to improve the quality of life of elderly patients, based on robust data and representative of real life “.
Aster 70s, by its magnitude and its methodology, thus becomes a global reference to better adapt the protocols to the realities of this age group.
Towards a finer and less aggressive medicine
The lessons of this study open the door to more personalized therapeutic strategies, where we treat less but better.
This therapeutic de -escalation has animated research in oncology for several years. Thanks to the genomic test, oncologists may better target young patients really likely to benefit from chemotherapy, and save others from unnecessary treatments. But according to this study, the benefit of chemotherapy in the elderly is marginal, including for patients called “high genomic risk”, that is to say with a high risk of recurrence of cancer. Today, we do not know how to identify those in whom chemotherapy would be beneficial.
Professor Steven Le Gouill, Managing Director of the Curie Institute, recalls: “This study perfectly illustrates the commitment of the Curie Institute to promote a personalized oncology. These works devoted to the oldest patients, often excluded from major studies, are at the heart of the priorities of the Ihu Institute of Women’s Cancers, carried by the Curie Institute and fully mobilized around access to innovation, the quality of life of patients and the implementation of very specific routes, especially for elderly women “.
This approach, which consists in adjusting the intensity of treatments to each profile, could become a standard, thus reducing toxicity and preserving the quality of life without compromising efficiency.
A turning point for care after 70 years
Aster 70S is not only a scientific success: it is a message of hope and prudence. He confirms that in many cases, less aggressive treatment may be enough, even in the face of cancer considered at high risk. The therapeutic decision must therefore result from an open dialogue with patients in order to know whether or not they want to engage in chemotherapy.