New study says women with early stage breast cancer can avoid chemotherapy

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

"With the results of this groundbreaking study, we can now safely avoid chemotherapy in about 70 per cent of patients who are diagnosed with the most common form of breast cancer".

The study, published Sunday in the New England Journal of Medicine, finds that patients who fall in the intermediate risk zone do as well with hormone therapy alone as with chemo plus hormone therapy after surgery.

'These findings, showing no benefit from receiving chemotherapy plus hormone therapy for most patients in this intermediate-risk group, will go a long way to support oncologists and patients in decisions about the best course of treatment, ' Dr. Jeffrey Abrams, associate director of the National Cancer Institute's Cancer Therapy Evaluation Program, said in a statement.

"[The findings] are both important and significant, and also practice-changing", says, Dr. José Baselga, a medical oncologist and physician in chief at Memorial Sloan Kettering Cancer Center in NY, who was not involved with this research.

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.

How does the study fit into the debate over "de-escalating" treatment of early-stage breast cancer? Oncotype DX has spurred the trend, and is likely to accelerate it.

"Breast cancer treatments have advanced so much that treatments can nearly be tailored for patients and this is extremely welcome news as chemotherapy is a particularly invasive treatment". These womenrandomly divided into two groups: One group received only hormone therapy after surgery, and the other group received both hormone therapy and chemotherapy.

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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. Many women think "if I don't get chemotherapy I'm going to die, and if I get chemo I'm going to be cured", but the results show there's a sliding scale of benefit and sometimes none, he said.

The researchers who conducted the trial, which was the biggest breast-cancer treatment trial ever, used a gene test called Oncotype DX to gauge recurrence risk. "I've been anxious for a long time about unnecessary treatment for cancer, and unnecessary side effects from chemotherapy".

But, researchers say some women 50 and younger in high-risk groups might still need chemo.

"Its findings will greatly expand the number of patients who can forgo chemotherapy without compromising their outcomes". Of the 10,273 women tested, 6,711 (69%) had a score of 11-25.

"For countless women and their doctors, the days of uncertainty are over". The 49-year-old patient with advanced breast cancer was given three months to live before enrolling into the trial. They benefit just as much from chemotherapy, which many don't tolerate well and can have long-term consequences, as they do from hormone treatments, which have many fewer side effects. This left a lot of women, an estimated 65,000 in the US each year, in a gray zone, unsure if they would benefit from chemo.

There are typically more than 55,000 new cases of breast cancer diagnosed in the United Kingdom each year, while around 11,500 people die from the disease. The 21-gene test is already in use, but its applicability for those with mid-range scores has been unclear.

Dr Ring said the publication of the trial results was "timely", adding: "I would be very, very keen that the TAILORx results are incorporated into that evaluation". Those in another group benefited exclusively from endocrine therapy, which blocks estrogen from reaching the tumors that would use it to grow.

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