Not All Breast Cancer Patients Need Chemo, Study Confirms

The largest study ever conducted on breast cancer treatment called Trial Assigning IndividuaLized Options for Treatment (TAILORx) confirms that many patients in the early stage of the disease can safely skip chemotherapy after surgery.

Doctors reporting from this milestone medical research used genetic testing to gauge the risk of each participant in the clinical trial, concluding that skipping chemotherapy did not hurt their chances of beating the illness. The results are expected to spare up to 70,000 patients every year in the US and many more elsewhere the expense and ordeal of these drugs.

What The TAILORx Trial Is All About

The impact of the study is tremendous. For many years, chemotherapy has been used after surgery to get rid of any cancer cells that may be left behind to decrease the risk of the cancer coming back. And it doesn’t go without more expense and possible side effects, the most common being fatigue and hair loss. After the TAILORx trial, Dr. Joseph Sparano of Montefiore Medical Center in New York says that most women may not have to undergo further treatment beyond hormone therapy and surgery.

The National Cancer Institute, proceeds from the U.S. breast cancer postage stamp, and several foundations funded the landmark study. The trial used a pathology exam called OncotypeDx (Genomics Health), which calculates the risk of reoccurrence.

Over 10,000 women with the most common form of breast cancer participated in the study. All of them had tumors not involving lymph nodes, Her2 negative disease, and hormone receptor (HR) positive (+). Their tumors were screened using Oncotype testing.

For 8 years, doctors observed their condition and made regular follow-ups. They found that patients with intermediate or low Oncotype results, having chemo in addition to hormone-blocking endocrine medication does not lower the likelihood of cancer’s reoccurrence nor does it affect survival. Results were published by the New England Journal Medicine and discussed at an American Society of Clinical Oncology conference in Chicago.

Moving Away From Chemo

Many breast cancer patients are susceptible to overtreatment. The TAILORx findings are all the talk in the field since it was first reported because of its potential to reduce the overtreatment of breast cancer. The results will prevent patients from unnecessary exposure to chemotherapy – in a large fraction of cases.

Cancer treatment has been moving away from chemotherapy – older medicines with harsh side effects – in favor of hormone blockers, gene-targeting solutions, and immune-system boosters. Today, oncologists resort to using chemo only for lower doses or shorter periods than it once was. Another research discussed at the conference found that the drug Keytruda, Merck’s immunotherapy drug, worked better than chemo as an initial treatment for most people with the most prevalent type of lung cancer, and with far fewer side effects.

The TAILORx study focused on cases where chemo’s value ever more is in doubt: women with early-stage disease that are hormone-positive (meaning progesterone or estrogen fuels its growth), where the disease has not spread to lymph nodes, and is not the type that the drug Herceptin targets.

Surgery is the main treatment option, followed by years of taking a hormone-blocking drug. Still, these women were urged to undergo chemotherapy to help kill any remaining cancer cells. Doctors know that most don’t need to, but there used to be little evidence on who can go without it.

Participants of the study were through a test called Oncotype DX, where they were given a biopsy. Researchers used the samples to measure the activity of genes involved in cell growth and their response to hormone therapy to estimate the risk that a cancer will recur.

Findings Of The Study

Based on earlier results from the study, about 16 percent of patients had low-risk scores that they were advised to skip chemo. Meanwhile, 17 percent with high-risk scores still had to undergo further treatment.

The new findings are about the 67 percent of women at intermediate risk. All had hormone therapy and surgery, and half also got chemo. Nine years later, 94 percent of both pools were still healthy, and around 84 percent survived without any signs of cancer, so adding chemo posed no difference. Chemo did help certain women age 50 or below. For those who were given the procedure, a slightly fewer cases of cancer beyond the breast occurred, depending on their risk scores on the gene test.

Figuring Out Who Needs Chemo

Gene testing is set to guide all women like those in the study whether chemotherapy will be beneficial for them. The Oncotype DX testing costs about $4,000 in the US, which many insurers and Medicare cover. There are also similar tests like the MammaPrint that they can also consider. According to Dr. Harold Burstein, member of the Dana-Farber Cancer Institute in Boston, testing solved a huge problem of figuring out who requires chemo.

It has been ingrained in every patient that chemo is necessary if they want to survive breast cancer. However, recent studies prove there’s a sliding scale of benefit and sometimes none. Another breast specialist, Dr. Lisa Carey of the University of North Carolina, said she would be comfortable to advise against chemo if the patient’s situation is similar to the ones in the study who did not benefit from the treatment.

Still, some people do not want to risk it when it comes to cancer treatment. Dr. Jennifer Litton at MD Anderson Cancer Center in Houston said that a risk to one person is not the same thing to another. There are people who want to undergo chemo even for the smallest chance of benefit, while others vow to not get chemo and won’t even have the gene test.

Some people still view chemotherapy as extra insurance. It may come with unpleasant side effects, but they believe it’s worth taking the procedure. Meanwhile, those who firmly trust in the TAILORx research may choose to skip the therapy if their results show that it’s safe to do so. Overall, these recent discoveries aim to reduce overtreatment and toxicity. It will also help doctors in cancer care to provide more options for each patient.

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