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Chemotherapy not necessary in most breast cancer patients: Landmark study


Chemotherapy not necessary in most breast cancer patients: Landmark study

Chemotherapy is an integral part of Breast cancer treatment in addition to Hormone therapy after surgery. In a new study, U.S. researchers have found that as many as  70 percent of women with early-stage breast cancer and an intermediate risk of cancer recurrence can safely skip chemotherapy after their tumors have been removed. A 21-gene test Oncotype DX from Genomic Health performed on tumors shall enable most patients with the most common type of early breast cancer to safely forgo chemotherapy. The landmark study has been published in the New England Journal of Medicine.

Dr. Albain,  at Loyola University Chicago Stritch School of Medicine and colleagues have conducted research with the 21-gene test and which was presented at the American Society of Clinical Oncology (ASCO) meeting in Chicago, that studied how to treat women with early-stage breast cancer that responds to hormone therapy.

“With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70 percent of patients who are diagnosed with the most common form of breast cancer,” main co-authors of the study,Dr. Albain said. “For countless women and their doctors, the days of uncertainty are over.”

This is a major finding,” said Dr. Larry Norton, a breast cancer expert at Memorial Sloan Kettering Cancer Center in New York, who helped organize the government-funded study more than a decade ago.“It means that maybe 100,000 women in the United States alone do not require chemotherapy,” Norton said.

The study enrolled 10,273 women who had the most common type of breast cancer (hormone-receptor positive, HER-2 negative) that had not spread to lymph nodes. Researchers examined outcomes of the 69 percent of patients who had intermediate scores on the 21-gene test.

Patients were randomly assigned to receive chemotherapy followed by hormonal therapy or hormone therapy alone. Researchers examined the chemotherapy and non-chemotherapy groups for several outcomes, including being cancer free, having cancer recur locally or to distant sites in the body and overall survival.

The study found that all women over 50 with this type of breast cancer could skip chemotherapy, a group that represented 85 percent of the study’s population. In addition, women 50 and younger who scored between zero and 15 could be spared chemotherapy and its toxic side effects.

The findings implied that women were deemed to have a medium level risk of cancer coming back based on a 21-gene panel which predicts the likelihood of cancer recurrence within 10 years. Those who score low on the test – from zero to 10 – are already told to skip chemotherapy after their tumors are removed and they receive hormone therapy. Those who score high – 26 to 100 – receive both hormone therapy and chemotherapy.

However, chemotherapy did offer some benefit to women aged 50 and younger who had a cancer recurrence score of 16-25, researchers found.

Dr. Steven Shak, the chief scientific officer at Genomic Health, said about four in 10 women in the United States with early-stage breast cancers are not tested for recurrence risk. He expects the study’s results will change that practice.“This is going to provide the highest level of evidence now for our test being indispensable in clinical practice,” Shak said.

The findings of the study will greatly expand the number of patients who can forgo chemotherapy without compromising their outcomes.

For further reference log on to :

DOI: 10.1056/NEJMoa1804710


Source: Loyola University Health System

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  1. user
    RADHA KESARWANI June 11, 2018, 11:27 am

    what was the tumour size, of patients in which chemotherapy has not been given. Whether in patients in which tumour size is between 4-5 cm with node negative and low recurrence score, chemotherapy has been given or not.

  2. The cost of oncotype dx is more than the cost of chemo. It may be cheaper to give chemo than doing the test. Unless the cost comes down for the test, it is not practical in india

  3. user
    Dr D Balakrishnan June 7, 2018, 7:41 am

    The financial cost of chemo might be lower than that of the gene test. But, the morbidity of chemo must be kept in mind. What we must do is to – bring the cost of the tests down – this may be feasible, if we inarrow down the number of tested genes to a few of the really relevant ones.

  4. Many Doctors in India and Many hospitals will still continue what they do because of M which every one doesn\’t want to loose.

  5. Ye Sara Dhanda chaupat karwa denge.
    Indian study will prove double dose double duration chemotherapy 😢