Breast Cancer Genetic Test May Help Women Forgo Chemotherapy
07 June, 2018, 06:13 | Author: Nina Hammond
A leading oncologist said the findings will lead to a "fundamental change" in how the disease is treated.
The 49-year-old woman had been selected for the novel therapy after chemotherapy failed to stop a tumor in her right breast from growing. There is no published evidence for Keytruda having any effect on HR-positive breast cancer, and the researchers say the short course of the drug is unlikely to have been able to confer such a protracted benefit on its own.
Lead investigator Steven Rosenberg said: "Because this new approach to immunotherapy is dependent on mutations, not on cancer type, it is in a sense a blueprint we can use for the treatment of many types of cancer". Following this "recalibration" of the genetic test, the researchers estimated that chemotherapy was not justified in 70% of cases of breast cancer. Among women younger than 50, outcomes were similar when gene test scores were 15 or lower.
Patients with a recurrence score of up to 10 out of 100 have been shown not to benefit from chemotherapy and only hormone treatment is required. "With all the side effects that chemotherapy has, if there's any way it can be avoided, if it's not necessary, you don't want to give it, you don't want to take it", Yost said. Most women who fit this criteria need only surgery and hormone therapy, he said.
The company now provides tests to more than 900,000 patients in more than 90 countries, Shak said. Their study showed, for example, that chemotherapy use in patients whose cancer had not spread to the lymph nodes declined from 26.6 percent in 2013 to 14.1 percent in 2015. Oncotype DX has spurred the trend, and is likely to accelerate it.
Doctors in the U.S. combined two different forms of immunotherapy after conventional hormone treatments and chemotherapy failed. "Most women in this situation don't need treatment beyond surgery and hormone therapy", he said, and "the rest of them are receiving chemotherapy unnecessarily". Longer-term effects of chemotherapy include infertility and heart failure.
"This study gives us information on a very specific group of women with a very specific type of cancer", she said, "but it doesn't tell us chemotherapy is not effective in some cases".
"I don't get optimistic about a lot of things, but I've been very optimistic about this", said Otis Brawley, chief medical officer of the American Cancer Society.
Overall survival was also higher in the group given this radiation treatment (73.2%) compared to control patients (70.8%).
Findings of the past have indicated that women who met these criteria and scored below ten on the index test could safely skip chemotherapy without raising their rate of recurrence, however, those above 25 would nearly always be advised to use chemotherapy as a necessary treatment to lower risk of recurrence.
This is the largest study ever done on breast cancer treatment.
About 17 percent of the women tested had high-risk scores and were advised to have chemotherapy.
"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.
Jennifer Litton, an associate professor and oncologist at MD Anderson Cancer Center in Houston, told USA Today that the results will help patients and their doctors make more informed decisions.
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