Even small tumours can be aggressive, according to a study in patients with early stage breast cancer that will be presented at the ESMO 2017 Congress in Madrid.  Researchers found that nearly one in four small tumours were aggressive and patients benefited from chemotherapy. Aggressive tumours could be identified by a 70-gene signature.

“Our results challenge the assumption that all small tumours are less serious and do not need adjuvant chemotherapy,” said lead author Dr Konstantinos Tryfonidis, a researcher at the European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium.

The MINDACT study is managed and sponsored by the EORTC in collaboration with the Breast International Group (BIG) and included 6,693 women with early stage breast cancer (lymph node negative or 1-3 lymph node positive).  As previously reported, MINDACT showed that around 46% of patients who were at high clinical risk for recurrence, defined using Adjuvant! might not require chemotherapy. (3) These women had a low genomic risk for recurrence according to MammaPrint, a genomic signature that assists in predicting clinical outcomes in women with early stage breast cancer.


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The sub analysis presented at ESMO 2017 Congress included the 826 patients in MINDACT with a primary tumour size of less than 1 cm (pT1abpN0). Clinical and genomic risks were assessed and 196 patients (24%) were found to be at clinical low risk and genomic high risk. These patients were randomised to receive, or not receive, chemotherapy.

The researchers found that at five years, very few patients who received chemotherapy experienced disease relapses, showing high rates of distant metastases-free survival, disease-free survival and overall survival, which confirms that they derived benefit from chemotherapy.

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