Medicine

Many Breast Cancer Patients Don’t Need Chemo

Many Breast Cancer Patients Don’t Need Chemo

Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major worldwide study that is expected to quickly change medical treatment. Based on the pattern in which these genes are turned either on or off, the test produces a score between 0 and 100, which measures the woman's risk of developing breast cancer again in the future.

Those with recurrence scores of 16 and above got a "substantial" benefit from chemotherapy and should consider it, said lead author Joseph Sparano, associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Medical Center.

The hormone-blocking drug tamoxifen and related medicines, called endocrine therapy, have become an essential part of treatment for most women because they lower the risks of recurrence, new breast tumors and death from the disease.

According to Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, "Breast surgeons and oncologists have been using the 21-gene assay for years to guide treatment after surgical excision".

The new study was funded by the U.S. National Cancer Institute, the Breast Cancer Research Foundation, the Komen Foundation, and the U.S. Postal Service Breast Cancer Stamp.

The US team led by Dr Steven Rosenberg, from the National Cancer Institute in Bethesda, Maryland, identified immune system T-cells within the cancerous breast tissue that were able to recognise and target four mutant tumour proteins. "With your help, we can continue to support a better informed local community and a healthier democracy for another 30 years".

She said the breast cancer study and others like it show the importance of research groups like the CRCWM and how their work can have huge payoffs. The presence of hormone receptors in these tumours means that they respond to hormone therapy. Whether or not to have the treatment is a bad dilemma for many women with certain types of breast cancer as they often don't have clear-cut answers on the benefits.

However, these are the results from a single patient and much larger trials will be needed to confirm the findings. "It's exactly the sort of study that we need to make decisions about these genomic tests".

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The study found that all women over 50 with this type of breast cancer could skip chemotherapy, a group that represented 85 per cent of the study's population.

Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test. "I was planning on dying", she added, "After the treatment dissolved most of my tumours, I was able to go for a 40-mile hike".

She had undergone a mastectomy in 2003 after the cancer was first diagnosed.

The researchers performed a prospective trial between 2006 and 2010 involving 10,273 women with hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary node-negative breast cancer.

"Oncologists have been getting much smarter about dialing back treatment so that it doesn't do more harm than good", Steven Katz, a University of MI researcher who examines medical decision-making, told the Washington Post.

More than 1,200 people enrolled in the study, the largest clinical trial to date of pembrolizumab as a stand-alone therapy for lung cancer. Others want chemo for even the smallest chance of benefit.

The Oncotype DX genetic test has been available on the NHS since 2013, but the National Institute for Health and Care Excellence (Nice) is now updating its guidance on whether it should be recommended for use.

Applying radiation therapy to lymph nodes behind the breast bone and above the collar bone can improve outcomes for earlier-stage breast cancer patients, with limited side effects, Phase 3 long-term data show.


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