Many Women with Breast Cancer Don't Need Chemotherapy

Alicia Farmer
June 7, 2018

"It feels miraculous, and I am beyond amazed that I have now been free of cancer for two years", Ms Perkins said.

"All cancers have mutations, and that's what we're attacking with this immunotherapy", he said.

Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute, told the BBC: "We're talking about the most highly personalised treatment imaginable".

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.

About 17 percent of women had high-risk scores and were advised to have chemo.

The 21-gene recurrence-score Oncotype Dx assay is one of several commercially available gene expression assays that can offer prognostic insight in hormone-receptor-positive breast cancer. It looks for a genetic "signature" in a sample of the tumour and gives a score between 0 and 100, which can help to direct treatment decisions.

A leading oncologist said the findings will lead to a "fundamental change" in how the disease is treated.

The trial (NCT00002851), carried out by the European Organisation for the Research and Treatment of Cancer (EORTC), involved 4,004 women at 43 centers diagnosed with stage 1 through 3 breast cancer, who had undergone surgery to remove their breast tumor and nearby (axillary) lymph nodes.

"For countless women and their doctors, the days of uncertainty are over". This has the potential to spare thousands of women from the terrible side effects of chemotherapy, including nausea, hair loss, and heart and nerve damage.

About 85% of breast cancers occur in women who have no family history of breast cancer.

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"If confirmed in a larger study, it promises to further extend the reach of this T-cell therapy to a broader spectrum of cancers", he said.

Of those, 6,711 scored in the intermediate range of 11-25, and were randomly assigned hormone therapy alone or hormone therapy plus chemotherapy.

This researchers split the middle-scoring group into two randomized subgroups: one treated exclusively with estrogen-blocking hormone therapy, and one with chemo combined with hormone therapy.

Researchers followed the women for an average of nine years. Indeed, a genetic test can be done at the time of the operation to predict the risk of recurrence. Rates for freedom from disease recurrence at a distant site were also similar, at 94.5% and 95% for the endocrine therapy and chemoendocrine therapy groups, respectively, as were rates for freedom from disease at a distant or local-regional site (92.2% and 92.9%, respectively) and for overall survival (93.9% vs 93.8%.).

Hormone-receptor-positive, axillary node-negative disease -- the type of breast cancer studied here - accounts for half of all the breast cancer cases in the US, and chemotherapy historically has been part of most women's treatment regimen after surgery.

If doctors had recommended she skip chemo based on the gene test, "I would have accepted that", she said. "It's exactly the sort of study that we need to make decisions about these genomic tests".

For those who fall in between - which includes most women - there was no clear evidence on whether they need chemotherapy.

But there is a note of caution in interpreting the study's findings. "With your help, we can continue to support a better informed local community and a healthier democracy for another 30 years".

This was particularly true for women between the ages of 50 and 75.

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