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

Study finds women with early breast cancer may avoid chemotherapy

Study finds women with early breast cancer may avoid chemotherapy

Women affected by the new findings are estrogen-sensitive, test negative for HER2 and have early stage tumors below five centimeters that have not spread to lymph nodes.

The researchers who conducted the trial, which was the biggest breast-cancer treatment trial ever, used a gene test called Oncotype DX to gauge recurrence risk.

"... Because this new approach to immunotherapy is dependent on mutations, not on cancer type, it is, in a sense, a blueprint we can use for the treatment of many types of cancer", said Dr. Steven Rosenberg, the chief of the surgery branch at the National Cancer Institute's Center for Cancer Research. After years of follow-up, the data showed that most patients who did not get chemotherapy fared as well as those who did.

Commenting on the results, Professor Bryan Hennessy, clinical lead, Cancer Trials Ireland, said: "This is a globally important breast cancer trial". "[The findings] are both important and significant, and also practice-changing", says, Dr. José Baselga, a medical oncologist and physician in chief at Memorial Sloan Kettering Cancer Center in NY, who was not involved with this research. She had a lumpectomy, followed by a mastectomy, and had a recurrence score of 12 or 13, which put her in the middle range.

Some women with early stage breast cancer may no longer need to have chemotherapy to increase their chance of survival.

For the youngest participants, chemotherapy was only slightly more effective for women with scores between 16 and 25. "In an effort to reduce that burden on patients, clinicians over time have been refining the way we use our treatments and this is a really good example of how the genetic revolution is helping to do that even more".

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"We have been waiting for these results for years", said Allison Kurian, an oncologist at Stanford University who wasn't involved in the trial.

"One of the challenges that we've had in breast cancer is we thought once size fit all, and everyone was getting too much treatment", Olopade said.

Currently, women who get a low score on the test are told they do not need chemo, those with a high score are told they definitely do.

Oncotype DX first hit the market in 2004.

A woman with advanced breast cancer which had spread around her body has been completely cleared of the disease by a groundbreaking therapy that harnessed the power of her immune system to fight the tumours. Women older than 50 with a midrange risk - defined in the study as a score of 11 to 25 on a tumor test - can skip chemo and just have endocrine therapy.

Yet the move away from chemotherapy has been hotly debated, with some doctors warning that chemo can save lives and that a "de-escalation" of treatment could be risky.

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While trying treatment after treatment, she became a breast cancer advocate and went to California for training by Project Lead, a program run by the National Breast Cancer Coalition. Patients should not make any changes to their treatment based off this study, and should always consult their doctors. 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 patient with advanced colon cancer whom Rosenberg's team treated in 2015 is Celine Ryan of MI.

Harold Burstein, a breast cancer specialist at Dana-Farber Cancer Institute, said that in some ways the debate over de-escalation misses a larger issue.

It found that Merck pharmaceutical's drug Keytruda (pembrolizumab) - which famously helped former USA president Jimmy Carter stave off advanced melanoma that had spread to his brain - helped lung cancer patients live 4 to 8 months longer than chemo.

While chemotherapy is being dropped for some cases, it's being increased for more aggressive cancers.

"Chemotherapy is no Shangri-La", Brawley said. "No more, no less".

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