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Breast cancer gene test could spare some women chemo

05 June 2018
Breast cancer gene test could spare some women chemo

Lead author Dr Joseph Sparano, of Montefiore Medical Centre in NY, said: "Any women with early stage breast cancer 75 or younger should have the test and discuss the results of TAILORx with her doctor".

Tens of thousands of women each year in North America alone fall into the categories where chemotherapy is unnecessary, accounting for 70 percent of those with the most common forms of breast cancer.

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.

"The 9-year rate of distant recurrence in women with a recurrence score of 11 to 25 in our trial was approximately 5%, irrespective of chemotherapy use", the authors write.

These gene tests are only applicable to patients with early-stage invasive breast cancer, Loyola's Albain says. This test, called Oncotype Dx, gives a score between 0 and 100.

"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, the associate director of the National Cancer Institute's Cancer Therapy Evaluation Program, stated in a press release. So they don't have to receive chemotherapy.

The woman was 49 when she signed up for the clinical trial after several attempts at a cure through conventional treatments had failed, said the study published in the scientific journal Nature Medicine. Around half of these patients would historically receive chemotherapy after having surgery to remove their tumour, to prevent recurrence of the disease.

As part of the TAILORx study, women were given a 21-gene test from Genomic Health called Oncotype DX.

It found that Merck pharmaceutical's drug Keytruda (pembrolizumab) - which famously helped former USA president Jimmy Carter stave off advanced melanoma that had spread to his brain - helped lung cancer patients live 4 to 8 months longer than chemo.

Currently, women who get a low score on the test are told they do not need chemo, those with a high score are told they definitely do. That means more than 85,000 women a year can safely forgo chemotherapy.

Of those, 6,711 scored in the intermediate range of 11-25, and were randomly assigned hormone therapy alone or hormone therapy plus chemotherapy.

The new findings offer reassurance to patients like 61-year-old Debra Reese of Houston, whose score of 10 led her doctor to recommend against chemotherapy.

He added: "This is an extraordinary day for breast cancer doctors and for women who have breast cancer".

Still, he acknowledged that most patients with this form of advanced cancer will die within months, and "we need to do a lot more work". In both groups 89% of women had survived the disease.

The 21-gene test has been used since 2003.

One of the big questions facing women diagnosed with early-stage breast cancer is whether to be treated with chemotherapy to reduce their risks that the cancer will return.

The test is performed on a sample of the tumour when it is removed during surgery.

"Oncologists have been getting much smarter about dialing back treatment so that it doesn't do more harm than good", said Steven Katz, a University of MI researcher who examines medical decision-making.

Those women should carefully discuss their options with their oncologist, said Brawley, because they would likely be candidates for the more aggressive, dual therapies.