Landmark Study Finds More Breast Cancer Patients Can Safely Forgo Chemotherapy

Patient whose breast cancer had spread to her liver has been free of the disease for two years after ‘exciting immunotherapy treatment

Doctors then drain the defective white blood cells and inject the patient with the new super clones.

Charity Breast Cancer Care said it was a "life-changing breakthrough".

Chemo and hormone therapy didn't work but this one-time treatment with more personalized immunotherapy did work for Perkins.

Around half of these patients would historically receive chemotherapy after having surgery to remove their tumour, to prevent recurrence of the disease.

The researchers performed a prospective trial between 2006 and 2010 involving 10,273 women with hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary node-negative breast cancer.

But Melcher points out that the therapy is complex and expensive and more importantly, requires doctors to find enough infiltrating immune cells in a patient's tumour to make the treatment effective.

The study was centred on a 21-gene test performed on tumours that has been available for breast cancer patients since the early 2000s.

The TAILORx trial used the Oncotype DX test, now available on the NHS, which allows doctors to predict the likelihood of the breast cancer returning.

A sample of the tumour is tested after surgery for 21 genetic markers, which indicate if it could grow and spread.

However, there is still uncertainty about the benefit of chemotherapy for most patients who have a midrange score, they specified. Those at high risk are advised to receive it but intermediate was a toss-up until this study. However the benefits were unclear for those who fall between which is the vast majority.

Lead author Dr Joseph Sparano, of Montefiore Medical Centre in NY, said: "Any women with early stage breast cancer 75 or younger should have the test and discuss the results of TAILORx with her doctor". One received just hormone therapy and the other received hormone therapy with chemotherapy. Nine-year rates were similar for iDFS (83.3% vs 84.3%), DRFI (94.5% vs 95.0%), RFI (92.2% vs 92.9%), and OS (93.9% vs 93.8%) for the RS 11 to 25 arm.

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Researchers underlined that breast cancer is the most common cancer in women in the United States and worldwide.

"I, as an oncologist on Monday in clinic, will offer less chemotherapy that will not be of benefit to patients and that is very reassuring to know that when I am offering patients chemotherapy they are likely to benefit from it".

Some fantastic news in the fight against breast cancer. For women aged under 50 with scores of 16-25, there was some benefit in getting chemotherapy, but for those aged over 50 with scores under 25, or those aged under 50 and scores below 16, there was nothing to be gained from going through the draining process.

"Side effects, such as hair loss, severe pain and infertility, can be utterly devastating and linger long after they walk out the hospital doors. Yet many endure it to try and avoid the cancer coming back".

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.

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

The genetic test, Oncotype Dx, gives a score between 0 and 100. "I sort of viewed chemo as extra insurance", she said.

"Because this is a huge study".

The news follows the publication of the trial of a test, routinely used in the NHS for women with a type of early-stage breast cancer, which works out the chances of breast cancer returning after treatment.

But doctors have been unsure how to treat women with scores in the intermediate range of 11 and 25.

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