Tuesday, 20 November, 2018

Breast Cancer: Some Patients May Not Need Chemo-But Beware Misleading Headlines

Participant Adine Usher met last month with study leader Dr. Joseph Sparano at the Montefiore and Albert Einstein College of Medicine in New York Breast Cancer: Some Patients May Not Need Chemo-But Beware Misleading Headlines
Melissa Porter | 05 June, 2018, 23:08

In addition, a recent study says chemo does not improve survival, that most women can be safely treated with just surgery and hormone blockers.

In the US, the most recent data shows around 135,000 new cases yearly of the specific breast cancer studied, says Dr. Joseph Sparano, an oncologist at Montefiore Medical Center, a professor of medicine at the Albert Einstein College of Medicine and the lead author of the study.

So the biggest unanswered questions involved women in the intermediate-risk category: Did chemo reduce their chance of recurrence?

"Its findings will greatly expand the number of patients who can forgo chemotherapy without compromising their outcomes".

A new study published Sunday in the New England Journal of Medicine may drastically change how medical professionals approach treating women diagnosed with breast cancer.

The Oncotype DX test costs $4,600 and is typically reimbursed by insurance, according to Dr. Steven Shak, chief medical officer of Genomic Health, the maker of Oncotype DX.

"All cancers have mutations, and that's what we're attacking with this immunotherapy", he said.

"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.

What did the study show? Almost 7,000 patients' scores fell into the middle range, between 11 and 25.

Figueredo explained the 9 year-long study like this: Researchers took more than 10,000 women with the most common type of breast cancer that's node-negative estrogen sensitive cancer. The researchers isolate rare T-cells that each patient produces in response to unique mutations that fuel the development of their cancer. Those who score 26 or higher on the scale do benefit and now receive chemotherapy.

The patients in this group were randomly assigned to chemotherapy with supplemental hormone therapy or just hormone therapy alone.

After nine years, 94 percent of the women in both groups were still alive.

A new study presented yesterday (June 3) at an American Society of Clinical Oncology meeting in Chicago, Illinois, suggests that about half of the women who are diagnosed with a subset of early-stage breast cancer may not need chemotherapy as part of their post-surgery treatment.

"Our study shows that chemotherapy may be avoided in about 70 percent of these women when its use is guided by the test, thus limiting chemotherapy to the 30 percent who we can predict will benefit from it", said lead researcher Dr Joseph A. Sparano, associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Health System in NY. This left a lot of women, an estimated 65,000 in the USA each year, in a gray zone, unsure if they would benefit from chemo. The side effects are often harsh and debilitating. Clearly communicating research findings are important for helping patients make informed decisions about treatment and modifying risk.

Where did these results come from?

Other experts agreed that while these initial results would need to be confirmed in larger clinical trials, they hold promise for a variety of particularly stubborn forms of cancer.

This resulted in a "highly personalised" anti-cancer therapy that yielded "complete tumour regression", the researchers wrote.

The trial focused on HR positive, HER2-negative, node-negative breast cancer, which is the most common type of early stage breast cancer.