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Adjuvant chemotherapy

Various chemotherapy options can be chosen depending on the biological phenotype of the tumour, the evaluated risk of recurrence and the patient’s comorbidities. Currently there is no certain evidence concerning the superiority of one approach over another and there are no predictive markers to determine the response to a particular type of chemotherapy. 

In the case of triple-negative breast carcinoma (negative hormone receptors and HER-2) and of HER-2 positive carcinoma, the benefit of chemotherapy is in no doubt. However, in patients with hormone-sensitive carcinoma, the indication is less certain. These patients will receive hormone therapy and the benefit provided by chemotherapy will be less evident. It is also necessary to assess the risk of recurrence based on certain factors (tumour growth, grade, lymph node involvement, …). If the risk is high, chemotherapy will be proposed to the patient before hormone therapy. 

Oncotype DX and MammaPrint are two «tools» that could make a decisive contribution to the treatment of cancers with an intermediate risk of recurrence. The technique is based on gene sequencing on the tumour material. Unfortunately, these investigations are expensive and, for the time being, their cost is not covered by all health insurance schemes.