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Thousands of women with breast cancer may be spared chemotherapy

Targeted approach could mean 3,000 women in the UK need less aggressive treatment

Mark Gould

Monday, 04 June 2018

New research* could herald rapid changes in the treatment of women in the early stages of breast cancer with many spared the rigours of chemotherapy.

The charity Breast Cancer Care said the findings which apply to women with specific early stage breast cancer, could affect 3,000 UK women a year, were "wonderful news".

The study, led by the Albert Einstein Cancer Center in New York, analysed 10,273 women with breast cancer using a genetic test that is already widely available, including on the NHS. The test is performed on a sample of the tumour when it is removed during surgery. It works by looking at the activity levels of 21 genes, which are markers of how aggressive the cancer is.

The study is strictly about early stage breast cancers - specifically those that can still be treated with hormone therapy, have not spread to the lymph nodes and do not have the HER2 mutation, which makes them grow more quickly.

Currently, women who get a low score on the test are told they do not need chemotherapy, those with a high score are told they definitely do.

But most women get an intermediate result meaning they are unclear as to what to do. The new analysis shows these women have the same survival rates with or without chemo.

The nine-year-survival-rate was 93.9% without chemotherapy and 93.8% with chemotherapy.

According to the authors, the findings suggest that chemotherapy may be spared in:

  • all women older than 50 years with hormone-receptor positive, HER2-negative, node-negative breast cancer and a Recurrence Score of 0 to 25 (about 85% of women with breast cancer in this age group)
  • all women 50 years or younger with hormone-receptor positive, HER2-negative, node-negative breast cancer and a Recurrence Score of 0 to 15 (about 40% of women with breast cancer in this age group).
Speaking yesterday Dr Alistair Ring, a consultant at the Royal Marsden Hospital in London, told the BBC: "Oncologists have been waiting for these results, it will affect practice on Monday morning. It's a fundamental change in the way we look after women with early breast cancer.”

Dr Ring estimates 3,000 women a year in the UK will no longer need chemotherapy because of this trial.

Rachel Rawson, from the charity Breast Cancer Care, said: "Every day, women with certain types of breast cancer face the terrible dilemma of whether or not to have the treatment, without hard facts about the benefit for them. This life-changing breakthrough is absolutely wonderful news as it could liberate thousands of women from the agony of chemotherapy."

*Sparano J A., Gray RJ, Wood W C., et al. TAILORx: Phase III trial of chemoendocrine therapy versus endocrine therapy alone in hormone receptor-positive, HER2-negative, node-negative breast cancer and an intermediate prognosis 21-gene recurrence score. Presented at the 2018 ASCO Annual Meeting, 3 June 2018.

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