STREAMING NOW: Watch Now

Many women with common breast cancer can safely skip chemo, study says

About 70% of women diagnosed with the early stages of one of the most common forms of breast cancer might not need ch...

Posted: Jun 4, 2018 10:26 AM
Updated: Jun 4, 2018 10:26 AM

About 70% of women diagnosed with the early stages of one of the most common forms of breast cancer might not need chemotherapy as part of treatment, according to the results of a long-awaited study presented at the American Society of Clinical Oncology meeting in Chicago Sunday.

The study, published Sunday in the New England Journal of Medicine, analyzed how well a widely used genetic test assessed cancer risk, based on 21 genes linked with breast cancer recurrence.

70% of women with common form of breast cancer might need only hormone therapy

Genetic test can assess breast cancer to personalize treatment

"These data confirm that using a 21-gene expression test to assess the risk of cancer recurrence can spare women unnecessary treatment if the test indicates that chemotherapy is not likely to provide benefit," lead author Dr. Joseph A. Sparano, associate director for clinical research at the Albert Einstein Cancer Center, said in a statement. The study was sponsored by the National Cancer Institute and led by the ECOG-ACRIN Cancer Research Group.

"I'm delighted," said Dr. Otis Brawley, chief medical and scientific officer for the American Cancer Society, who was not part of the study. "I've been worried for a long time about unnecessary treatment for cancer, and unnecessary side effects from chemotherapy.

"Now with these genomic tests, we are finding that we have multiple types of breast cancer, perhaps several dozen," said Brawley, "and we are being able to tailor our therapies to the type of breast cancer every woman has."

Breast cancer is the most common cancer in women worldwide; the World Cancer Research Fund International reported 1.7 million new cases in 2012. About 50% of all women diagnosed worldwide have hormone-receptor positive, HER2-negative, node-negative cancer. Treatment options include estrogen-blocking drugs along with doses of chemotherapy to lower the risk of recurrence.

Women affected by the new findings are estrogen-sensitive, test negative for HER2 and have early stage tumors below five centimeters that have not spread to lymph nodes. They also have a score between 11 and 25 on the Oncotype DX Breast Recurrence Score test.

"What that test does is look at 21 different genes to see if each is turned on or off and then if it is over-expressed or not," Brawley said. "So we have two yes-no answers for each gene. It looks at all 21 of those answers and gives that cancer a recurrent score between 0 and 100."

Past research has shown that women with scores between 0 and 10 could skip chemotherapy, while those with scores over 25 benefited from adding chemotherapy to their hormonal treatment plan.

"Those are the cancers that have likely already metastasized and a small amount could be hiding in a woman's lung, liver or bones," said Brawley. "Therefore they should get the chemotherapy along with hormonal treatment."

But doctors have been unsure how to treat women with scores in the intermediate range of 11 and 25. Protectively, many of those women have received chemotherapy, which can have devastating side effects, including anemia, a weakened immune system, hair loss, diarrhea, fatigue and memory loss.

Other less common but more serious side effects of chemotherapy include bone loss and osteoporosis, heart and vision problems.

The phase III clinical trial, named "TAILORx," followed over 10,000 women diagnosed with breast cancer between 2006 and 2010. Of those women, 6,711 had test scores between 11 and 25, which placed them in the intermediate risk group. Those women were then randomized into two trials: one received hormone therapy with chemotherapy; the other received hormone therapy alone.

Researchers followed the women for an average of nine years. At the end of that time they found 83.3% of those on hormone therapy alone had not developed a recurrence or a second primary cancer. For the group that had both hormone and chemotherapy, the rate was 84.3%, a difference that was not statistically significant.

The overall survival rate was similar: 93.9% for those who received hormone therapy alone and 93.8% for those who received both therapies.

"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.

Thirty percent of the women in the trial did have evidence of cancer hiding in their bodies. For these women, the use of both hormones and chemotherapy is recommended.

"We'll give women in this group about six months of chemotherapy," Brawley said.

But there is a note of caution in interpreting the study's findings. Data on premenopausal women and those younger than 50 who scored at the higher end of the intermediate-risk range,16 to 25, was analyzed separately. The results showed there might be a small benefit from chemotherapy.

"Tumors grow more aggressively in premenopausal women, not just women under 50," Brawley said.

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

If the woman's score is 16 or higher and she is premenopausal, "then we're going to want to give her the chemotherapy," said Brawley.

In a media release, Genomic Health, who makes the Oncotype DX Breast Recurrence Score test, said it provided funding for collection of follow-up information from the treating sites, but was not involved in the planning and execution of the study.

Mississippi Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 16041

Reported Deaths: 767
CountyConfirmedDeaths
Hinds103526
Lauderdale74568
Madison74525
Neshoba70742
Jones66331
Scott66112
Forrest59439
DeSoto5538
Leake44712
Rankin4468
Holmes43928
Copiah3154
Jackson30813
Attala30318
Yazoo2864
Newton2824
Leflore27334
Lincoln27029
Monroe26525
Harrison2637
Oktibbeha25314
Lamar2485
Lowndes2309
Wayne2242
Pearl River21131
Pike20411
Adams20015
Noxubee1916
Washington1917
Warren18110
Covington1732
Jasper1654
Lee1657
Bolivar16511
Clarke15419
Smith15311
Kemper14711
Lafayette1414
Chickasaw13714
Coahoma1274
Winston1211
Marion1179
Carroll11711
Clay1154
Claiborne1122
Lawrence1061
Simpson1020
Grenada993
Yalobusha966
Tate951
Hancock9112
Itawamba897
Wilkinson859
Union857
Sunflower853
Montgomery851
Panola843
Marshall813
Jefferson Davis803
Tippah7611
Webster683
Calhoun674
Amite641
Walthall610
Humphreys597
Tunica563
Prentiss563
Perry513
Choctaw482
Pontotoc433
Jefferson431
Tishomingo340
Quitman340
Stone310
Franklin292
Tallahatchie291
George261
Greene221
Alcorn181
Benton140
Sharkey70
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 18474

Reported Deaths: 651
CountyConfirmedDeaths
Mobile2283118
Jefferson1882103
Montgomery180243
Tuscaloosa81616
Marshall7059
Franklin5768
Lee55234
Shelby52220
Tallapoosa43166
Butler41618
Walker3782
Elmore3739
Chambers35826
Madison3444
Morgan2971
Baldwin2929
Unassigned2922
Dallas2823
Etowah26112
DeKalb2563
Lowndes25512
Autauga2395
Coffee2381
Sumter2267
Houston2235
Bullock2136
Pike2080
Colbert1872
Hale1789
Russell1770
Barbour1751
Marengo1746
Lauderdale1672
Calhoun1653
Choctaw15310
Wilcox1527
Cullman1501
Clarke1482
St. Clair1311
Randolph1287
Marion12411
Dale1230
Pickens1215
Talladega1175
Limestone1080
Chilton1041
Greene954
Winston910
Macon864
Jackson833
Henry812
Covington811
Crenshaw783
Bibb761
Escambia743
Washington726
Blount631
Lawrence510
Monroe442
Geneva430
Perry420
Conecuh411
Coosa401
Cherokee383
Clay282
Lamar260
Fayette160
Cleburne151
Tupelo
Clear
75° wxIcon
Hi: 87° Lo: 70°
Feels Like: 75°
Columbus
Clear
74° wxIcon
Hi: 87° Lo: 70°
Feels Like: 74°
Oxford
Clear
68° wxIcon
Hi: 88° Lo: 68°
Feels Like: 68°
Starkville
Clear
70° wxIcon
Hi: 86° Lo: 66°
Feels Like: 70°
WTVA Radar
WTVA Temperatures
WTVA Severe Weather