Can biomarker genetic testing save chemotherapy for breast cancer?

Is chemotherapy for breast cancer always useful?

In previous practice in the treatment of breast cancer followed by the surgical removal of a breast tumor chemotherapy to kill any remaining cancer cells. However, according to the German Cancer Society, cancer therapy has changed fundamentally due to the new possibility to genetically analyze tumors. While all patients received the same treatment in the past, today more and more of the individual patients are focused on their specific tumor properties. More and more doctors are using new gene therapy to save women from the stressful treatment.

The biomarker tests analyze the concentration of certain proteins or different genes whose properties are supposed to provide information about the course of the disease. The result should help the doctor to assess which woman needs adjuvant chemotherapy and which does not, depending on how aggressively the tumor is classified. For example, the test examines whether certain mutations exist in which specific drugs are particularly effective.

Although there is much interest in biomarker testing at Brustkresbs, some experts doubt the reliability of the current stage of development. (Image: WavebreakMediaMicro / fotolia.com)

Biomarker tests for breast cancer are controversial

According to the German Cancer Society, prognosis tests for breast cancer patients are well-known through media and advertising materials. But behind the strong presence is not least also of commercial interest. For the tests to be included in the standard repertoire of a treatment, they would have to be able to prove their benefit even more scientifically. The German Cancer Society has issued a new guideline recommending genetic testing for cancer in selected situations. If breast cancer is detected at an early stage and there is no clear recommendation for or against post-operative chemotherapy, a biomarker test can help with decision-making. After all, this is the case with around 20,000 patients every year.

IQWiG experts warn against the reliability of the test

The experts of the Institute for Quality and Efficiency in Health Care (IQWiG) in Cologne emphasize that the genetic test for cancer according to the current state of research does not bring any clear knowledge whether chemotherapy should be used or not. The five-year follow-up period for cancer is too short, as breast cancer relapses and metastases often do not occur until after ten to fifteen years. Recently, an IQWiG author team criticized the American Society of Clinical Oncology (ASCO). ASCO published a study that concluded that the biomarker Test MammaPrint could facilitate the decision on the treatment to be used in a given patient population. The IQWiG authors contradict the results in a letter to the editor. Although the study provided valuable information on the biomarker tests, the finding of the ASCO authors was wrong.

Who pays for the costly biomarker tests?

According to the German Cancer Society, health insurance funds are not obliged to bear the costs of prognostic tests for breast cancer. The inclusion of such a test would be the task of the Joint Federal Committee. However, individual health insurances would already cover the costs in the context of studies. Ultimately, every breast cancer patient must decide for herself whether to use chemotherapy or trust (and pay) for a biomarker test. (Fp)