Study finds women with early breast cancer may avoid chemotherapy

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For many patients, it's a hard choice to decide whether to go through chemotherapy.

A groundbreaking new therapy, which helped eradicate cancer completely from a woman who was diagnosed with an advanced stage of breast cancer and told by doctors that she would only be able to live for four months, is exciting doctors like never before.

Countless breast cancer patients in the future will be spared millions of dollars of chemotherapy thanks in part to something that millions of Americans did that cost them just pennies: bought a postage stamp. It's called the Oncotype DX test.

That could affect up to 70,000 women a year in the United States of America and thousands more around the world, the study said.

Jennifer Mall, 47, of Downers Grove, Ill., was a patient of Albain's who agreed to participate in the study. The rates of invasive disease-free survival at 9 years were similar for both groups, at 83.3% for the endocrine-therapy group and 84.3% for the chemoendocrine therapy group.

John Heymach, a professor at the University of Texas MD Anderson Cancer Center who was not involved in the Merck-funded study, described it as a "true milestone" and "a real important advance for patients". "I had a tumour in my chest that I could feel shrinking", she said.

The test examines the activity of 21 genes of breast cancer tissue and assigns it a score between 0 and 100. But the intermediate patients with scores of 11 to 25, we have not known what's best for them.

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.




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

The TAILORx study, led by the Montefiore Medical Centre in NY, found women older than 50 with this form of breast cancer and a score of up to 25 did not need chemotherapy. Twenty-five percent of those patients won't qualify for chemotherapy because of age or medical problems.

The study, published June 3 in the New England Journal of Medicine, finds that most patients with an intermediate risk of cancer recurrence can skip chemotherapy treatment without affecting their chances of surviving the disease. The problem with these cells is that they're too few to help a patient on their own, so the team grew new copies of the cells in the lab, multiplying them dramatically over a period of few weeks, after which they were infused back into the patient.

"We are now at the cusp of a major revolution in finally realising the elusive goal of being able to target the plethora of mutations in cancer through immunotherapy", he said.

The study found that women over 50 scoring up to 25 did not need chemo, nor did women under 50 with a score up to 15. The trial is in its early stages - with a projected closing date for the study pencilled in for 2023, it could be a while before medics can assume the new method is safe.

"Chemotherapy has saved a tremendous amount of lives, and will continue to do so", Baselga says. Doctors know that most don't need it, but evidence is thin on who can forgo it. "The era of one-size-fits-all is basically coming to an end, which is great news".

In addition to having their tumors removed, the women in the study underwent a genetic test called Oncotype DX, manufactured by California-based Genomic Health.

"With this test, you listen to the tumor's genes", he said. Half of that group also got chemotherapy. He expects the study's results will change that practice. The clinical trial followed over 10,000 women with hormone-receptor-positive, HER2-negative breast cancer, that had developed tumors under 5 cm (2 inches) in diameter, and which hadn't yet spread to the lymph nodes. "It's a technique done in a laboratory", she said. Some women 50 or younger, however, did see benefits from chemo.

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