Many women with common breast cancer can safely skip chemo, study says
- Eloise Marshall
Whether or not to have the treatment is a awful dilemma for many women with certain types of breast cancer as they often don't have clear-cut answers on the benefits.
Experts believe the case, discussed at the American Society of Clinical Oncology meeting in Chicago, marks the start of a breakthrough for thousands of women who now have no hope.
The majority of women in the study of more than 10,000 - who had an early stage form of the common type of breast cancer that affects tens of thousands of women - showed no extra benefit from chemotherapy treatments added to standard treatment alone.
There were 1.7 million new breast cancer cases in 2012, according to the World Cancer Research Fund International, making it the most common form of cancer in women globally. 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. If patients with higher scores receive chemotherapy, this risk of recurrence will be significantly reduced, enabling more patients to be cured. Among younger women with scores 16 to 25, outcomes were slightly better in the chemotherapy group.
"But 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". There was no benefit in terms of overall survival, disease-free survival, or cancer spread beyond the breast.
Researchers used it to estimate the risk that a cancer will come back based on 21 genes linked with breast cancer recurrence.
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Of the 9,717 women, 6,711, or 67 percent, had test scores indicating an intermediate risk of recurrence - their score was 11 to 25. In addition, women 50 and younger who scored between zero and 15 could be spared chemotherapy and its toxic side effects.
"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.
And while celebrating this genuine advance, we should remember just how far we have to go in finding effective therapies for metastatic breast cancer, and other breast cancer subtypes for which treatment options are still limited.
However, the results of the TAILORx trial show only 30 per cent of women with this particular form of early-stage breast cancer benefit from the treatment.
Women with early-stage breast cancer tend to have high survival rates, but their case worsens drastically if the cancer returns to other parts of the body. Kymriah, for young patients with a type of blood and bone marrow cancer, was initially costed at almost half a million U.S. dollars per treatment.
That could affect up to 70,000 women a year in the US and thousands more around the world, the study said.
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While the new study fills in a crucial gap of medical knowledge, what remains confusing is what took so long to get the point where we can measure twice and cut once, so to speak.
Previously in clinical trials, checkpoint inhibitors have proved ineffective against most breast cancers.
Immunotherapy drugs such as Keytruda are already widely used for other cancers, such as melanoma and increasingly lung cancer.
Along with hair loss, nausea and vomiting, chemo can leave a woman with a depressed immune system, said Dr. Jennifer Litton, an oncologist and an associate professor at the University of Texas MD Anderson Cancer Center. She enrolled in the TailorX trial and was relieved to be randomly assigned to the group that did not get chemotherapy. Those who score 26 or higher on the scale do benefit and now receive chemotherapy.
A chemo-free treatment isn't for every patient.
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