New study says women with early stage breast cancer can avoid chemotherapy

Participant Adine Usher met last month with study leader Dr. Joseph Sparano at the Montefiore and Albert Einstein College of Medicine in New York

It enrolled 10,273 United States women with HR+HER2-AN- breast cancer, which accounts for 23,000 of the 55,000 diagnoses in the UK each year.

A leading oncologist said the findings will lead to a "fundamental change" in how the disease is treated. Previous studies had made clear that women with low scores could skip chemotherapy and those with high scores should get it. Professor Alan Melcher, an immunotherapy expert at The Institute of Cancer Research, said this "exciting" study showed "a remarkable success in terms of translating our basic biological understanding of how the immune system responds to cancer into a real treatment of real benefit for this particular woman".

Dr Steven Rosenberg, who led the trial by the US National Cancer Institute, said. Following this "recalibration" of the genetic test, the researchers estimated that chemotherapy was not justified in 70% of cases of breast cancer.

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

It addresses the sensitive issue which is being regularly raised in healthcare today: when is chemotherapy really necessary and when it is not, the underlying question being if the majority of patients is receiving chemotherapy unnecessarily.

Countless breast cancer patients in the future will be spared millions of dollars of chemotherapy thanks in part to something that millions of Americans did that cost them just pennies: bought a postage stamp.

The findings, published Sunday in the New England Journal of Medicine, showed that 70 percent of women diagnosed with the common cancer that has not spread to the lymph nodes can forgo chemotherapy without risking their chance of recurrence or ability to be cured, said Loyola Medicine oncologist Dr. Kathy Albain, a co-author of the study and a member of the clinical trial's steering committee. "I eat healthy. What?'" said Robyn Tuttle, who is now cancer free. Oncotype DX has spurred the trend, and is likely to accelerate it.

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The women who participated were randomized into two trials: one received hormone therapy with chemotherapy; the other received hormone therapy alone.

The current study involved more than 10,000 women and focused on those whose scores were in the middle range, from 11 to 25. Rates for freedom from disease recurrence at a distant site were also similar, at 94.5% and 95% for the endocrine therapy and chemoendocrine therapy groups, respectively, as were rates for freedom from disease at a distant or local-regional site (92.2% and 92.9%, respectively) and for overall survival (93.9% vs 93.8%.).

He added that it was important that the federal government funded the study because the pharmaceutical industry has little interest in sponsoring trials that result in a reduction of treatment.

A high recurrence score, above 25, means chemo is advised to ward off a recurrence while a low score, below 10, means it is not. "Chemotherapy has saved a tremendous amount of lives, and will continue to do so", Dr. José Baselga said, via NPR.

"We know all women over 50 score 0-25 can safely take endocrine therapy without chemo therapy".

"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.

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