Published: Tue, June 05, 2018
Medical | By Marta Holmes

Breast cancer gene test could spare some women chemo

Breast cancer gene test could spare some women chemo

A doctor exams mammograms, as part of a regular cancer prevention medical check-up at a clinic in Nice, south eastern France.

The study used a gene test done on tumors to help decide whether a woman would benefit from chemo or if they could receive hormone therapy.

The woman was 49 when she signed up for the clinical trial after several attempts at a cure through conventional treatments had failed, said the study published in the scientific journal Nature Medicine.

Sunday's results came from a federally sponsored trial called TailorX, which was created to help doctors more precisely tailor treatments for early-stage breast cancer.

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Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major global study that is expected to quickly change medical treatment. Lastly, these cancer diagnoses must land between 11 and 25 on the Oncotype DX Breast Recurrence Score test. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study. She had a lumpectomy, followed by a mastectomy, and had a recurrence score of 12 or 13, which put her in the middle range. So, we used to say for that group of women, in terms of chemotherapy, "better safe than sorry".

Researchers studied their outcomes, including whether or not cancer recurred, and their overall survival. A score lower than 10 means the risk of distant recurrence is low, and the women will not benefit from chemotherapy. And for those with scores of 26 or above, 13 percent went on to develop metastatic cancer despite receiving both hormonal treatment and chemotherapy, the team said.

"The study should have a huge impact on doctors and patients", Dr. Kathy Albain, a hematologist/oncologist at Loyola Medicine in IL and a study co-author, said in a press release.

"We are de-escalating toxic therapy". The new study provides the highest level of proof that the assay is an accurate tool and thus reduces uncertainty for the intermediate group, said Dawn Hershman, a breast oncologist at NewYork-Presbyterian Columbia University Medical Center.

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Tom Misteli, Ph.D., from the US National Cancer Institute, said the results highlighted the power of immunotherapy. Six weeks after getting it, the amount of cancer in her body had shrunk by half.

Researchers were keen to stress that more trials on greater numbers of patients will need to be carried out before the therapy could come into wider use. The drug was approved in 2014 for melanoma and in 2015 for lung cancer.

This means in practice doctors can tell 70 percent of these patients they don't need to agonize over whether to get chemo, says study co-author Dr. Kathy Albain, a hematology and oncology professor at Loyola University Medical Center in IL. This difference was present in most breast cancer subtypes but most notable in triple-negative breast cancer, which is three times more likely to develop in African-Americans than whites.

"We have been using Oncotype DX for some years now among women in tumours that are less than 4 cm with no axillary lymph nodes, estrogen progesterone receptor positive and HER 2 new negative".

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Treatment is a personal decision and that's why it's important for patients to discuss their options with their doctor, Figueredo said. "Patients should not make any changes to their treatment based off this study, and should always consult their doctors".

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