Many can skip breast cancer chemo

Grant Boone
June 6, 2018

"Until now, we've been able to recommend treatment for women with these cancers at high and low risk of recurrence, but women at intermediate risk have been uncertain about the appropriate strategy to take", study co-author Jeffrey Abrams, associate director of the National Cancer Institute's Cancer Therapy Evaluation Program, which supported the trial, said in the statement. After years of follow-up, the data showed that most patients who did not get chemotherapy fared as well as those who did.

"To have your health professional tell you don't need chemo, there's one side glad you don't have to have it and the other wondering are we really taking care of my breast cancer", said Garner.

Oncotype DX is becoming more standard.

It is estimated that 3,000 to 5,000 women in the United Kingdom are likely to avoid chemotherapy every year following the trial.

To treat the patient in this trial, Dr Rosenberg and his colleagues sequenced genetic material from one of her tumours to identify mutations that were specific to her case. Patients with scores between 11 and 25, though, represent an uncertainty.

These women would instead be treated with radiation, surgery, and hormone therapy. This will impact about 70,000 patients a year. She hadn't felt any lumps or symptoms and had no family history of breast cancer before the diagnosis, she said. Twenty-five percent of those patients won't qualify for chemotherapy because of age or medical problems.

An experimental therapy that extracts and multiplies powerful immune-system cells from inside tumors eradicated a patient's breast cancer, a scientific first that could lead to new ways of treating malignancies that have resisted all other efforts. "We can de-escalate toxic treatments and do that with certainty". In 2009, she was diagnosed with bile-duct cancer that had spread to her liver.

The study is the largest ever done of breast cancer treatment.

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Chemotherapy did provide some benefit to women in the study who scored between 16 and 25, and were younger than 50 and premenopausal.

"Chemotherapy has saved a tremendous amount of lives, and will continue to do so", Baselga says.

"We have been waiting for these results for years", said Allison Kurian, an oncologist at Stanford University who wasn't involved in the trial. "The era of one- size-fits-all is basically coming to an end, which is great news". There is no published evidence for Keytruda having any effect on HR-positive breast cancer, and the researchers say the short course of the drug is unlikely to have been able to confer such a protracted benefit on its own.

Thousands of women have been tested over the years using Oncotype DX to help determine the true effectiveness of chemo. Now only about 60 percent of USA patients who could potentially benefit from it are taking the gene test, he says. The researchers are "trying to find ways" to achieve more consistent outcomes, Goff said.

After tumor removal, genetic testing is commonly used to predict which type of chemotherapy would give the most benefit. Perkins said she "cornered her with a beer" and said she wanted to enroll.

Scientists previously found that women with a low risk of their cancer returning can receive hormone therapy alone. They could potentially encourage patients to incorrectly avoid or stop treatment-with potentially tragic consequences.

The challenge so far in cancer immunotherapy is it tends to work spectacularly for some patients, but the majority do not benefit.

Sara Kiley Watson is NPR's Science Desk intern.

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