Monday, 20 August, 2018

Chemo 'unnecessary' for thousands with breast cancer

Phyllis Laccetti a participant in the TailorX breast cancer study at her home in Ossining NY Phyllis Laccetti a participant in the TailorX breast cancer study at her home in Ossining NY
Steve Townsend | 07 June, 2018, 01:02

The prospective TAILORx study was created to help to discover whether chemotherapy is beneficial for women with a mid-range recurrence score of 11 to 25, as well as to prospectively confirm that a low recurrence score of 0-10 is associated with a low rate of distant recurrence if patients receive endocrine therapy without adjuvant chemotherapy. "I was planning on dying", she added, "After the treatment dissolved most of my tumours, I was able to go for a 40-mile hike".

The results were presented at the annual cancer conference (ASCO) held in Chicago.

"The study is going to provide women a piece of information to help them make a very hard decision", said the survivor now celebrating 10-years being cancer-free.

The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.

Oncotype DX is not available in India but samples are sent overseas for the test.

A trial of more than 10,000 women - including 690 Irish women - with the most common form of early breast cancer found the treatment was unnecessary for many after surgery.

Based on all this, Sparano's team concluded that chemotherapy is now unwarranted in women over 50 with this type of breast cancer who have an Oncotype score under 26. "Our uncertainty is over", she says. Among younger women with scores 16 to 25, outcomes were slightly better in the chemotherapy group, the study reported.

Past experiments revealed that one group of people particular results of the genetic test would benefit from a combination of endocrine therapy and chemotherapy.

After years of waiting, doctors and patients finally got the answer.

"We can spare thousands and thousands of women from getting toxic treatment that really wouldn't benefit them", said Dr Ingrid A Mayer, from Vanderbilt University Medical Center, an author of the study.

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The findings, from the largest breast cancer treatment trial ever conducted, showed that most patients who have an intermediate risk of a cancer recurrence - a group that numbers 65,000 women a year in the United States - can avoid chemotherapy and its often debilitating side effects. Now they can have confidence in those decisions, experts said. "This has very important public health implications".

"I, as an oncologist on Monday in clinic, will offer less chemotherapy that will not be of benefit to patients and that is very reassuring to know that when I am offering patients chemotherapy they are likely to benefit from it".

Women with breast cancer are at risk of having their disease spread to the lymph nodes, and from there elsewhere in the body.

This decline likely came about thanks to earlier research into gene testing, showing that chemo wasn't helpful for low-risk patients and of marginal benefits for others, says Baselga.

The study, dubbed TAILORx, was also published in the New England Journal of Medicine. "Chemotherapy has saved a tremendous amount of lives, and will continue to do so", Dr. José Baselga said, via NPR. For these women, the use of both hormones and chemotherapy is recommended. "The era of one-size-fits-all is basically coming to an end, which is great news".

"Not only have we shown that such treatment has a beneficial effect on disease control, but it also improves breast-cancer related survival", Philip Poortmans, head of the department of radiation oncology at the Institut Curie in Paris, said in a press release.

"They were able to give the patient's own immune system a major boost". Now only about 60 percent of USA patients who could potentially benefit from it are taking the gene test, he says.

Albain is excited to share the study results with her clients in her practice.

Irish oncologists have been giving progressively less chemotherapy to low risk women as evidence emerged in recent years.

This was particularly true for women between the ages of 50 and 75. But there was a big group of patients in between for whom it wasn't clear which treatment would work best. "And going forward we're going to do things differently'".

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