A genetic test will help determine who can stop treatment
By analysing the activity of 50 genes present in blood cells, scientists have been able to distinguish, with a certain degree of accuracy and good predictive power, which patients are likely to remain in remission
Key points
The day may soon come when a blood test will reveal which patients can stop their cancer treatment without losing control of the disease. For many people with chronic myeloid leukaemia, this is no longer just a dream, but a possibility within reach. The challenge lies in identifying in advance who can stop treatment without risking a relapse. And French research published in the Journal of Clinical Oncology suggests a possible answer. By analysing the activity of 50 genes present in blood cells, the scientists were able to distinguish, with a certain degree of accuracy and good predictive power, between patients likely to remain in remission even after stopping their medication and those at greater risk of a relapse without the safety net of treatment.
Chronic myeloid leukaemia is a blood cancer whose prognosis has changed radically thanks to the introduction of tyrosine kinase inhibitors (TKIs). For many patients, particularly when the diagnosis is made at an early stage and the response to treatment is optimal, life expectancy is now similar to that of the general population. This is an extraordinary success, which is giving rise to a new challenge: is it really necessary to continue taking medication for the rest of one’s life?
The dream of lasting remission without the need for ongoing treatment
In recent years, several studies have shown that, in selected patients, it is possible to discontinue treatment whilst maintaining what is known as ‘treatment-free remission’. This is a condition in which the disease remains under control even without medication.
Unfortunately, however, this strategy does not work for everyone. Around half of the patients who stop treatment experience a molecular relapse of the disease and have to resume treatment. Most of these relapses can be detected early through regular check-ups, and resuming the medication usually allows the response to be regained. However, identifying a reliable system that can predict who can safely discontinue treatment would represent a significant step forward.
Transcriptome profiling could lead to a decisive test
French researchers led by Vincent Alcazer, of the Hospices Civils de Lyon, analysed gene expression in the blood cells of 96 patients taking part in the STIM2 multicentre study at the time of discontinuation of imatinib therapy. Using transcriptome analysis techniques and artificial intelligence algorithms, the researchers identified a combination of 50 genes associated with the likelihood of remaining in remission over the following two years. The genetic ‘signature’ was then validated in a second group of 70 patients who had attempted to discontinue imatinib or nilotinib (another TKI).
