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Chemotherapy can be avoided with common breast cancer

05 June 2018

For the TAILORx study, scientists recruited over 10,000 women with the most common type of breast cancer, called oestrogen-receptor positive (ER+) HER2-negative breast cancer.

Now, the choice is getting easier for some patients.

The study, earmarked as Trial Assigning Individualised Options for Treatment (Tailorx), was published in the New England Journal of Medicine. "[The findings] are both important and significant, and also practice-changing", says, Dr. José Baselga, a medical oncologist and physician in chief at Memorial Sloan Kettering Cancer Center in NY, who was not involved with this research.

"Breast cancer treatments have advanced so much that treatments can nearly be tailored for patients and this is extremely welcome news as chemotherapy is a particularly invasive treatment". Oncotype DX costs around $4,000, which Medicare and many insurers cover.

Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.

The latest results should mean more women can avoid chemotherapy, and its associated side effects, without compromising the effectiveness of their treatment.

John Heymach, a professor at the University of Texas MD Anderson Cancer Center who was not involved in the Merck-funded study, described it as a "true milestone" and "a real important advance for patients". "It also helps identify those women with this disease who really do benefit from the chemotherapy they receive", Prof Keane commented.

"Part of the excitement is because all cancers contain mutations, it's a technique that could potentially be applied to any tumor type", Rosenberg said.

The current study focused on those whose scores were in the middle range, from 11 to 25. Instead, these women will likely remain in remission after having their tumors removed, and then taking estrogen-blocking hormone-therapy drugs. The researchers tracked the patients' health outcomes over nine years.

A woman with advanced breast cancer which had spread around her body has been completely cleared of the disease by a groundbreaking therapy that harnessed the power of her immune system to fight the tumours. Twenty-five percent of those patients won't qualify for chemotherapy because of age or medical problems.

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"The impact is tremendous", study leader, Dr. Joseph Sparano of Montefiore Medical Center in NY, told the Associated Press. "We can de-escalate toxic treatments and do that with certainty".

ACT has been shown to be effective in treating tumours with a high level of mutations such as melanoma, but has been less successful when tested in cancers with a lesser mutation load, such as stomach, oesophageal, ovarian, and breast cancers.

The study found that women over 50 scoring up to 25 did not need chemo, nor did women under 50 with a score up to 15.

All the same, he says, the message of the new study isn't that chemotherapy is irrelevant.

Yet the move away from chemotherapy has been hotly debated, with some doctors warning that chemo can save lives and that a "de-escalation" of treatment could be unsafe. "The era of one- size-fits-all is basically coming to an end, which is great news". Now only about 60 percent of US patients who could potentially benefit from it are taking the gene test, he says. A new United States study, TAILORx, has shown that up to 70% of these women could avoid this painful treatment, which has multiple side effects.

This resulted in a "highly personalised" anti-cancer therapy that yielded "complete tumour regression", the researchers wrote.

Past experiments revealed that one group of people particular results of the genetic test would benefit from a combination of endocrine therapy and chemotherapy.

"My first clinic when I get back, she's on my schedule and it's going to be fun showing her this", she says.

"We have to develop a new drug for every patient", Rosenberg said.

Chemotherapy can be avoided with common breast cancer