Personalised medicine and the decision to withhold chemotherapy in early breast cancer with intermediate risk of recurrence – a systematic review and meta-analysis.
| Autor: | Wallerstedt, Susanna M., Nilsson Ek, Astrid, Olofsson Bagge, Roger, Kovács, Anikó, Strandell, Annika, Linderholm, Barbro |
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| Předmět: |
BREAST tumor treatment
CANCER chemotherapy CANCER relapse CONFIDENCE intervals DECISION making MEDICAL databases INFORMATION storage & retrieval systems MEDICAL information storage & retrieval systems PSYCHOLOGY information storage & retrieval systems MEDLINE META-analysis ONLINE information services SYSTEMATIC reviews INDIVIDUALIZED medicine DESCRIPTIVE statistics DISEASE risk factors |
| Zdroj: | European Journal of Clinical Pharmacology; Sep2020, Vol. 76 Issue 9, p1199-1211, 13p, 2 Diagrams, 1 Chart, 1 Graph |
| Abstrakt: | Purpose: To assess the evidence for decision making, at the health care and the patient levels, regarding the use of gene expression assays to inform chemotherapy decisions in breast cancer patients with intermediate clinical risk of recurrence. Methods: Systematic literature searches were performed (January 2002–April 2020) in Medline, Embase, PubMed, Cochrane Library, PsycINFO and HTA databases. Inclusion criteria: patients (P) were individuals with post-surgical breast cancer at intermediate clinical risk of recurrence; intervention (I)/comparison (C) was (i) use of, versus no use of, a gene expression assay and (ii) withholding versus providing chemotherapy; outcomes (O) were overall survival (OS), health-related quality of life (HRQL), and recurrence. Randomised controlled trials (RCTs) and non-RCTs were included. Random-effects meta-analyses were performed where possible. Results: Three inconclusive non-RCTs, respectively, compared OS and recurrence with and without a gene expression assay. No studies investigated HRQL. Regarding the comparison withholding versus providing chemotherapy based on a gene expression assay, one RCT and four non-RCTs evaluated OS. In the RCT, 93.9% (I) versus 93.8% (C) were alive at 9 years. Three RCTs and seven non-RCTs evaluated recurrence. Three RCTs could be pooled regarding distant recurrence; 4.29% versus 3.88% had such an event (risk ratio: 1.12 (95% confidence interval: 0.90 to 1.39). Conclusion: Regarding the use of gene expression assays in breast cancer, evidence on patient effects, informing patient-level chemotherapy decision making, is available. However, evidence for prioritisation at the overall health care level, i.e. use of, versus no use of, such assays, is largely lacking. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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