Breast cancer patients to be spared chemotherapy

Adine Usher 78 meets with breast cancer study leader Dr. Joseph Sparano at the Montefiore and Albert Einstein College of Medicine in the Bronx borough of New York. Usher was one of about 10,000 participants in the study which shows women at low or inter

Adine Usher 78 meets with breast cancer study leader Dr. Joseph Sparano at the Montefiore and Albert Einstein College of Medicine in the Bronx borough of New York. Usher was one of about 10,000 participants in the study which shows women at low or inter

An experimental therapy that extracts and multiplies powerful immune-system cells from inside tumors eradicated a patient's breast cancer, a scientific first that could lead to new ways of treating malignancies that have resisted all other efforts.

Now, the choice is getting easier for some patients. "[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.

A 21-gene test called Oncotype DX, available since 2004, has helped guide some decisions on proper care after surgery. Oncotype DX has spurred the trend, and is likely to accelerate it.

Many women are also urged to undergo chemotherapy to help kill off any cancer cells that might have migrated from the tumour.

The new study, called TAILORx, is a large, randomized trial involving thousands of patients. Dr Alistair Ring, consultant medical oncologist at the Royal Marsden NHS Hospital in London, said: "I think this is a fundamental change in the way we treat women with early-stage breast cancer and will lead to a considerable number of women no longer needing to have chemotherapy". Among women younger than 50, outcomes were similar when gene test scores were 15 or lower.

"The study should have a huge impact on doctors and patients", said Dr Kathy Albain, one of the main co-authors. "Our uncertainty is over", she says.

Chemotherapy can be avoided for 70pc of women with the most common type of early stage breast cancer, the study found. At least 30-40 per cent patients, to whom we advice Oncotype DX, come in this score range.

This researchers split the middle-scoring group into two randomized subgroups: one treated exclusively with estrogen-blocking hormone therapy, and one with chemo combined with hormone therapy.

"The impact is tremendous", said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in NY.

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

"This is going to provide the highest level of evidence now for our test being indispensable in clinical practice", Shak said. "This has very important public health implications".

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The study was funded by the National Cancer Institute, some foundations and proceeds from the USA breast cancer postage stamp.

The breast cancer study focused on cases where chemo's value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.

"Chemotherapy has saved a tremendous amount of lives, and will continue to do so", Baselga says.

"It's a great news story". Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.

Breast cancer is the most common cancer to affect women across the globe. Oncotype DX costs around $4,000, which Medicare and many insurers cover. Now only about 60 percent of US patients who could potentially benefit from it are taking the gene test, he says.

Another added: "I was also diagnosed with breast cancer, had 5 lumps in left breast". She enrolled in the TailorX trial and was relieved to be randomly assigned to the group that did not get chemotherapy. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.

The study followed women with intermediate score between 11 to 25 who opted for endocrine (hormone) therapy and others who were treated with endocrine therapy as well as chemotherapy.

"We are now leaving an era where the only choice for non-small-cell lung cancer patients was to start with chemotherapy", he told reporters at the ASCO conference. "Now, we're not going to have to have that long discussion", she says.

It found that Merck pharmaceutical's drug Keytruda (pembrolizumab) - which famously helped former United States 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.

The study found that for participants with gene test scores between 11 and 25 - especially among women ages 50 to 75 - there was no significant difference between the chemotherapy and no chemotherapy groups.

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