MINDACT

Many patients with node-negative or 1-to-3 node positive early breast cancer can be spared chemotherapy,
and it appears this is especially true for postmenopausal women.

Breast cancer patient with pink scarf

The MINDACT trial sponsored and run by the European Organisation for Research and Treatment of Cancer closely with BIG – involving 112 hospitals in 9 countries from 7 BIG collaborative groups – represents a large academic effort towards de-escalating therapies. This pioneering study was designed to evaluate the utility of adding the 70-gene test (MammaPrint®) to the standard clinicopathological criteria used to identify those patients with early-stage breast cancer who could be safely spared adjuvant chemotherapy without this significantly affecting their risk of disease recurrence.

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Between 2007 and 2011 the trial enrolled 6,693 women with node-negative or 1-to-3 node positive early breast cancer. The first results of MINDACT were published in 2016 in the New England Journal of Medicine, and at the time they showed that up to 46% of patients who would have received chemotherapy in the past could be spared this treatment and its side effects in the future.

The updated results of MINDACT, presented at the ASCO Annual Meeting in 2020 with a median follow-up of 8.7 years and published in March 2021 in the Lancet Oncology, supported the 2016 findings and confirm that many women can be spared chemotherapy. In other words, the evidence remains strong that MammaPrint® adds very helpful information to the usual tests to help make decisions about whether chemotherapy and its side effects can be avoided by many women with breast cancer.

The test was shown to be particularly useful in decision-making for postmenopausal women, for whom chemotherapy added no benefit when MammaPrint® indicated low risk of the breast cancer coming back, even if the usual tests indicated high risk.  In younger women, chemotherapy may still add benefit, but this requires careful discussion between doctor and patient.

One of the main challenges in treating breast cancer today has become to accurately distinguish between patients who need post-surgery treatment and those who do not. This, together with the identification of the best type of therapy for each individual patient and the development of drugs targeting specific characteristics of tumour cells, is a goal of treatment tailoring or personalised medicine.

It is BIG’s mission to find ways of ensuring patients receive the treatments most appropriate for them. MINDACT can be considered one of the very first clinical trials to investigate how drug therapy may be more effectively – and safely – tailored to individual breast cancer patient’s needs.

MINDACT demanded tremendous collaborative efforts and demonstrates how our joining efforts have a direct impact on patients’ lives. Today, it is a successful example of how, by working together across borders and disciplines, we can develop better treatments – and eliminate those that are not needed – while increasing the likelihood of finding cures.

Help us save lives and move breast cancer research forward