A cancer diagnosis is never good news, but for two of the most common cancers, it should now be a little less terrifying with the announcement that chemotherapy is unnecessary in many cases of breast cancer and certain lung cancers.
Results from the prospective study, called Trial Assigning Individualized Options for Treatment (TAILORx), showed that for women whose tumors are hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary node-negative, and generate intermediate scores on the 21-gene Oncotype DX recurrence-score assay, hormone therapy was just as effective at preventing disease recurrence as hormone therapy plus chemotherapy.
Simon Vincent, director of research at Breast Cancer Now, added: "This is a remarkable and extremely promising result, but we need to see this effect repeated in other patients before giving hope of a new immunotherapy for incurable metastatic breast cancer".
In a comment also published by Nature Medicine, expert Laszlo Radvanyi from Canada's Ontario Institute for Cancer Research said the woman's response to the treatment was "unprecedented" for such advanced breast cancer. The results from the test are converted into a score which predicts the risk of the cancer returning.
"Now, the vast majority of patients can potentially receive benefits from immunotherapy instead", he added.
Of the 9,717 women, 6,711, or 67 percent, had test scores indicating an intermediate risk of recurrence - their score was 11 to 25.
About 17 percent of women had high-risk scores and were advised to have chemo. What the researchers wanted to know was whether chemotherapy was beneficial or necessary to women with scores in the middle range, as there is more uncertainty in this group.
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The type of hormone therapy administered was dependent upon whether women were premenopausal or postmenopausal-91% of postmenopausal women received an aromatase inhibitor-based regimen, whereas premenopausal women were most commonly prescribed either an endocrine therapy regimen comprising either tamoxifen alone or tamoxifen followed by an aromatase inhibitor (78%). Suppression of ovarian function was used in 13% of premenopausal women. After surgery, one group got endocrine therapy only, while the other was treated with endocrine therapy plus chemotherapy. "It looks at all 21 of those answers and gives that cancer a recurrent score between 0 and 100".
"Every day, women with certain types of breast cancer face the bad dilemma of whether or not to have the treatment, without hard facts about the benefit for them".
Hormone therapy was given for 5 years on average, and women were followed up to 9 years.
Nine-year survival rates were 93.9% without chemotherapy and 93.8% with chemotherapy, the study found. They say the data "provide evidence that that adjuvant chemotherapy was not beneficial in these patients". Exploratory analyses did suggest that the addition of chemotherapy was associated with some benefit for women 50 years of age or younger who had a recurrence score of 16 to 25, but not for those whose score 15 or lower. For women aged under 50 those at the higher end of the mid-range may still need chemotherapy.
In a landmark first case, Judy Perkins was diagnosed with breast cancer and given only three months to live.
"I think I fall right in line with the study and the results that came out from it", Reese said. As welcome as the lack of spread is, it leaves patients and their doctors with a conundrum: Should they undergo chemotherapy, with the often horrendous side-effects that involves, or is surgery and hormone therapy sufficient? "These kinds of tools allow us to make tailored medicine a reality, allowing us to offer the right therapy for the right patient at the right time".