Early breast cancer: new clinicogenomic classifier predicts who needs more radiotherapy

  • Sjöström M & al.
  • J Clin Oncol
  • 16 Oct 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • ARTIC, a new clinicogenomic classifier combining age with a 27-gene expression-based tumor assay, identifies patients who need higher intensity of radiotherapy (RT) after breast-conserving surgery (BCS) for early breast cancer (eBCa).

Why this matters

  • ARTIC is the first successful RT classifier for individualized tailoring of postoperative RT.
  • Patients with high ARTIC scores are more likely to benefit from more intensive RT, such as tumor-bed boost.

Study design

  • ARTIC was developed from 3 publicly available cohorts and validated on a randomized controlled trial (SweBCG91-RT; n=748) in which patients with node-negative eBCa (stage I-IIA) were randomly assigned to whole-breast RT or no RT after BCS.
  • Primary outcome: cumulative incidence of locoregional recurrence (LRR).
  • Funding: PFS Genomics; Swedish Breast Cancer Association; others.

Key results

  • Median follow-up, 15.0 years.
  • In patients treated with RT vs no RT, ARTIC was highly prognostic of LRR (HR, 3.4; 95% CI, 2.0-5.9; P<.001 and predictive of rt benefit>interaction=.005).
    • Low ARTIC scores had the greatest benefit from RT (HR, 0.33; P<.001 cumulative incidence of lrr with rt vs without a absolute reduction.>
    • High ARTIC scores had a lower benefit from RT (HR, 0.73; P=.23); 10-year cumulative incidence of LRR, 25% vs 32%, a 7% absolute reduction.

Limitations

  • Actual ARTIC scores not given.

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