Almost 70 percent with common breast cancer could skip chemo, study says

The study is thought to be the largest breast cancer treatment trial ever

The majority of women in the study of more than 10,000 - who had an early stage form of the common type of breast cancer that affects tens of thousands of women - showed no extra benefit from chemotherapy treatments added to standard treatment alone.

A new study presented Sunday at the annual meeting of the American Society of Clinical Oncology provides much-needed clarity: Most of these women can safely skip chemo. "[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.

Cancer researchers are increasingly exploring whether they can eliminate or scale back treatments to spare patients from tough side effects-and costs-without jeopardizing survival.

All of the women in the study, called the Trial Assigning Individualized Options for Treatment (Rx), or TAILORx, had their breast tumors analyzed with a molecular test.

According to the Centers for Disease Control and Prevention (CDC), about 236,000 women and 2,100 men were diagnosed with breast cancer in 2014, the most recent year for which figures are available.

The success, reported in the journal Nature Medicine, is all the more remarkable because breast cancers, like prostate and ovarian cancer, have relatively few mutations, which makes them harder for the immune system to spot amid the body's healthy tissues.

Charity Breast Cancer Care said it was a "life-changing breakthrough". "So we have two yes-no answers for each gene". It looks for a genetic "signature" in a sample of the tumour and gives a score between 0 and 100, which can help to direct treatment decisions.

The patient with advanced colon cancer whom Rosenberg's team treated in 2015 is Celine Ryan of MI. Perkins first got chemotherapy, followed by the infusion of immune cells.

But prior to the new trial, "there was uncertainty about the best treatment for women with a mid-range score of 11-25", Sparano explained.

In recent years, many doctors have reduced their use of chemo, which can cause nausea, fatigue and, in rare cases, more serious complications such as leukemia and heart failure.

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However, the results of the TAILORx trial show only 30 per cent of women with this particular form of early-stage breast cancer benefit from the treatment.

In this study, nearly 7,000 women had scores between 11 and 25.

Scientists previously found that women with a low risk of their cancer returning can receive hormone therapy alone.

"This is another significant step towards personalised breast cancer treatment and we hope these practice-changing findings will help refine our use of chemotherapy on the NHS".

After nine years, the study found that the two treatment groups had similar survival rates and freedom from disease recurrence.

Oncotype DX first hit the market in 2004.

Thirty percent of the women in the trial did have evidence of cancer hiding in their bodies.

These women would instead be treated with radiation, surgery, and hormone therapy.

But there is a note of caution in interpreting the study's findings. Women 50 or younger can avoid chemo if their scores are lower than 16, said lead author Joseph Sparano, associate director for clinical research at the Albert Einstein Cancer Center in NY. Others want chemo for even the smallest chance of benefit.

"Tumors grow more aggressively in premenopausal women, not just women under 50", Brawley said. Now only about 60 percent of USA patients who could potentially benefit from it are taking the gene test, he says. Those with recurrence scores of 16 and above got a "substantial" benefit from chemotherapy and should consider it, said lead author Joseph Sparano, associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Medical Center.

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