Women with early-stage breast cancer may not benefit from chemo

Grant Boone
June 5, 2018

On Sunday, within hours of the trial results being presented at American Society of Clinical Oncology (ASCO) 2018 meeting in Chicago, the 48-year-old emailed them to her doctor with this line: "This is good news for me". For these women, the use of both hormones and chemotherapy is recommended.

Chemotherapy won't be necessary for thousands of women after a breakthrough in breast cancer research. "Its findings will greatly expand the number of patients who can forgo chemotherapy without compromising their outcomes".

The success of this case has raised hopes that the therapy could also be used to treat advanced ovarian and prostate cancers.

Nell Barrie from Cancer Research UK, said: "It's exciting to see this cutting-edge science at work".

The treatment is not only expensive but physically demanding and several other patients in the clinical trial died during treatment, including several who succumbed to side effects.

The current study focused on those whose scores were in the middle range, from 11 to 25.

In a media release, Genomic Health, who makes the Oncotype DX Breast Recurrence Score test, said it provided funding for collection of follow-up information from the treating sites, but was not involved in the planning and execution of the study. 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. Women with low risk scores - those below 10 - don't need chemotherapy after surgery, and instead can be treated with hormone therapy, previous studies have found.

Women can have the tendency to turn towards chemo, even if the results have a relatively small benefit, Albain says.

Jacoub told Healthline it's the women with mid-range scores of between 11 and 25 that have provided oncologists with tough decisions.

Carey pointed to some "grey areas" at the boundaries of the recurrance scores that need futher investigation, and said patients would need to discuss these details with their doctors before any decisions on treatement are made.

Oncotype DX, the genetic test, costs about $4,000.

The patients in this group were randomly assigned to chemotherapy with supplemental hormone therapy or just hormone therapy alone.

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This was particularly true for women between the ages of 50 and 75. Women younger than 50 still saw some benefit from chemotherapy, especially with scores between 21-25.

For the youngest participants, chemotherapy was only slightly more effective for women with scores between 16 and 25.

The doctors treated the woman by injecting 80 billion of the carefully-selected immune cells into her body.

For the TAILORx study, scientists recruited over 10,000 women with the most common type of breast cancer, called oestrogen-receptor positive (ER+) HER2-negative breast cancer.

According to the study, more than 20,000 women in the United Kingdom are diagnosed with hormone-receptor positive, HER2-negative, node-negative breast cancer annually.

"It feels miraculous and I am beyond amazed that I have now been free of cancer for two years", she told the media.

This study supports sparing thousands of women from the sometimes nasty side effects of chemotherapy, but we must be crystal clear that it applies to a very specific (and significant) subset of women. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, "but it was over fairly quickly and I'm really glad I had it".

Among the potential long-term effects are heart disease, leukemia, and neuropathy.

"But the important point is that this is using a patient's own cells to attack their own cancer".

"With this test, you listen to the tumor's genes", he said. Perkins first got chemotherapy, followed by the infusion of immune cells.

Brawley noted that the reduction in chemotherapy might reduce revenues for some oncologists, but he doesn't think they'll care.

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