A new study comparing the efficacy of maintenance treatment with a targeted therapy matched to genomic alteration clearly demonstrate that genomic profiling can lead to the selection of effective therapies in patients with metastatic breast cancer; data were recently published on Nature.
Thanks to the advent of next-generation sequencing, DNA analyses have shown that the genomic drivers of cancer can differ between patients. This observation led to the development of cancer precision medicine, in which a comprehensive genomic profile is generated in each patient and a targeted therapy is given accordingly, but questions remain on how to use the results obtained from genomic profiling in daily practice, for treatment decision. Thus, the prospective randomized SAFIR02-BREAST trial compared targeted therapies matched to genomic alterations with maintenance chemotherapy in patients with HER2-non-overexpressing metastatic breast cancer. Results showed that targeted therapies matched to genomics improved progression-free survival when genomic alterations are classified as level I/II according to the ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT); no improvement was observed in the targeted therapies arm for patients presenting with ESCAT alteration beyond level I/II. Authors also noted that patients with germline BRCA1/2 mutations derived high benefit from olaparib. «The SAFIR02-BREAST trial suggests that the use of genomics improves the outcome of patients who present with a match drug/alteration ESCAT I/II», researchers say. «Reporting the results of genomics in the context of a framework of target actionability should therefore be considered as a standard of care. The results of the trial should be interpreted with caution, because a large part of the benefit observed with matched targeted therapies was derived from patients presenting with BRCA1/2 alteration and the small sample size does not allow exploration of the actionability of new genomic alterations», authors conclude.
