Published: Tue, June 05, 2018
Medicine | By Melba Vasquez

Many women with breast cancer can safely skip chemo, study says

Many women with breast cancer can safely skip chemo, study says

Thousands of breast cancer patients may be safely spared the "agony of chemotherapy" thanks to new genetic testing.

Until now, women have faced considerable uncertainty about whether to add chemo to hormone therapy after a diagnosis with hormone-receptor positive, HER-2 negative breast cancer when found at an early stage, before it has spread to the lymph nodes.

One of the big questions facing women diagnosed with early-stage breast cancer is whether to be treated with chemotherapy to reduce their risks that the cancer will return. In fact, about 70 percent of women with hormone-receptor-positive, HER2-negative, node-negative breast cancer wouldn't benefit from chemo-that's about 70,000 women annually in the United States.

This researchers split the middle-scoring group into two randomized subgroups: one treated exclusively with estrogen-blocking hormone therapy, and one with chemo combined with hormone therapy.

However, the results of the TAILORx trial show that only 30pc of women with this particular form of early-stage breast cancer benefit from the treatment. Determining such risk is critical in deciding treatment, because when breast cancer spreads to other parts of the body it's generally considered incurable.

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The TAILORx trial used the Oncotype DX test, now available on the NHS, which allows doctors to predict the likelihood of the breast cancer returning.

These results provide assurance that getting gene tested is a valuable first step for patients with this type of breast cancer.

A high recurrence score, above 25, means chemo is advised to ward off a recurrence, while a low score, below 10, means it is not. The test scores the tumor from 0 to 100, with a high score-26 or above-indicating that chemotherapy will improve therapeutic efficacy, and a low score-10 or under-suggesting a very low likelihood of distant recurrence at 10 years, which is unlikely to be affected by adjuvant chemotherapy. Doctors know that most don't need it, but evidence is thin on who can forgo it.

Texting also played a role in helping patients feel like they were in control of their treatment, particularly during the first month.

Dr Simon Vincent, director of research at the charity Breast Cancer Now, warned more patients will have to be treated to assess how effective the therapy is.

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Although chemo does help extend life in many cancers, saving patients from the extra treatment could lessen the overall burden of the breast cancer.

"Side effects, such as hair loss, severe pain and infertility, can be utterly devastating and linger long after they walk out the hospital doors". Most women in this situation don't need treatment beyond surgery and hormone therapy, he said.

After enrolling for new trial in 2015, doctors in the USA adopted an experimental approach combining two different forms of immunotherapy after conventional hormone treatments and chemotherapy failed. Oncotype DX and other genomic tests have spurred a trend sure to accelerate following Sunday's report. "I've been anxious for a long time about unnecessary treatment for cancer, and unnecessary side effects from chemotherapy".

This resulted in a "highly personalized" anti-cancer therapy that yielded "complete tumor regression", the researchers wrote. "You're never going to see these kinds of trials from drug companies, because what is being tested might result in less use of their products", Brawley said.

Dr. Albain, the Huizenga Family Endowed Chair in Oncology Research at Loyola University Chicago Stritch School of Medicine, has conducted research with the 21-gene test and also used it in her practice for years.

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