Health Care

Chemotherapy is not needed in 70% of cases of breast cancer

Chemotherapy is not needed in 70% of cases of breast cancer”

A woman with an aggressive form of breast cancer which defied chemotherapy and spread to other organs, was cured with an experimental treatment that triggered her immune system, researchers said Monday. Others want chemo for even the smallest chance of benefit.

Doctors who cared for the woman at the US National Cancer Institute in Maryland said Perkins's response had been "remarkable": the therapy wiped out cancer cells so effectively that she has now been free of the disease for two years.

Along with hair loss, nausea and vomiting, chemo can leave a woman with a depressed immune system, said Dr. Jennifer Litton, an oncologist and an associate professor at the University of Texas MD Anderson Cancer Center. They were scored using the Oncotype DX genetic test, which assesses how the cancer is likely to respond to treatment. The trial also wanted to confirm that a low RS of 0 to 10 is associated with a low rate of distant recurrence when patients receive endocrine therapy alone.

Trial Assigning IndividuaLized Options for Treatment (Rx), or TAILORx, successfully confirmed the benefit of endocrine therapy (ET) alone in patients with early-stage breast cancer who have an Oncotype DX Breast Recurrence Score (RS) of 11 to 25.

New research suggests that more breast cancer sufferers may be able to avoid grueling chemotherapy treatment.

The research, involving a genetic test is already available on the NHS and has revealed less than a third of women with the most common form of the disease benefit from the treatment.

The results of this work were published in the journal Nature Medicine. Women at high risk, or scores of 26 or higher, were advised to have chemo. Out of the 100,000 or so patients who could take the gene test to help make a decision about chemotherapy, he says at least two-thirds fall into the middle range that can benefit from the study findings.

However, among younger women with scores 16 to 25, outcomes were slightly better in the chemotherapy group, so in those cases doctors may urge patients to consider a chemo regimen.

Women aged 50 or younger were the notable exception. "The impact is tremendous", said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in NY.

Ms Perkins had ten cancer-free years after having her left breast removed. She enrolled in the TailorX trial and was relieved to be randomly assigned to the group that did not get chemotherapy. She also watched her brother and sister - who died of thyroid cancer and leukemia, respectively - suffer through chemotherapy treatments.

"It feels miraculous and I am beyond amazed", the 52-year-old said.

The trial results are the latest piece of the puzzle on how to treat early-stage breast cancer. Most patients with the disease have a high survival rate, but their prognoses worsen drastically if their cancer returns in other parts of the body.

Lung cancer is the leading cause of cancer death worldwide, taking 1.7 million lives per year.

Yet the move away from chemotherapy has been hotly debated, with some doctors warning that chemo can save lives and that a "de-escalation" of treatment could be risky.

James Doroshow, director of the division of cancer treatment and diagnosis at the National Cancer Institute, which was the primary sponsor of the study, predicted that the trial would lead to changes in treatment "for a large number of potential patients". He expects treatment guidelines to quickly change based on the study, which was conducted by a research group named ECOG-ACRIN.

U.S. Food and Drug Administration Commissioner Scott Gottlieb said he expects the agency will still decide in some cases whether terminally ill patients can receive unproven drugs, despite a new law meant to weaken the FDA's power over such cases.



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