Breast Cancer study days some patients may not need chemo


Around half of women taking aromatase inhibitors, a common drug for postmenopausal women with hormone receptor positive breast cancer, experience joint pain. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test. "There are a number of men and women who say, 'I really don't care what you say, I am never likely to do chemo, '" and won't have the gene evaluation, she explained.

A gene test called "Oncotype DX" has been guiding doctors for years on whether women need chemo if early stage, estrogen-fueled breast cancer that hasn't spread. The trial enrolled 10,273 women with this type of breast cancer at 1,182 sites in the United States, Australia, Canada, Ireland, New Zealand, and Peru. It was the women in the intermediate stages of 11-25 who oncologists often had differing views when prescribing standards of care. In addition, women 50 and younger who scored between zero and 15 could be spared chemotherapy.

About 17 percent of women had high-risk scores and were advised to have chemo. Furthermore, 83.3% of those from the endocrine-only group were cancer free, while 84.3% of those from the combined therapy were cancer free. None of these differences were considered statistically significant.

The hormone treatment is usually taken for between five to 10 years after surgery. This confirms similar findings from earlier studies. The study confirmed that using a 21-gene analyzation to assess cancer recurrence risk can successfully indicate whether or not a woman needs to undergo invasive and unnecessary chemotherapy treatment.

Over the years, the Cancer Institute has used its $59.8 million in proceeds for studies trying to improve early detection and to determine which cancers are most risky and need heaviest treatment and which are less so.

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The new results are on the 67 percent of women at intermediate risk.

"We also know that the chemotherapy doesn't add much at all to these low-risk women - their outcomes are good", said Moore.

There is one caveat to the new findings. However, it is unclear if this benefit is due to the effect of chemotherapy or to endocrine suppression caused by chemotherapy-induced menopause. The test allows clinicians to assign a patient a recurrence score from 0 to 100. "The trial was created to address this question and provides a very definitive answer", said Dr. Sparano. In the old days we'd just have a bucket: 'breast cancer, ' 'prostate cancer, ' 'lung cancer.' Now we can look at the subtypes of cancer by looking at the genes and give the right treatment to the right patient at the right time.

TAILORx was one of the first large-scale trials to examine a methodology for personalizing cancer treatment. These come from small, early stage studies through to large randomised clinical trials.

The study was funded by the National Cancer Institute, some foundations and proceeds from the USA breast cancer postage stamp. The stamp funding provided more than $5 million to the trial. The extra 6 cents went for research - 70 percent to the Cancer Institute and 30 percent to the Department of Defense.

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