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Chemotherapy may provide no benefit for breast cancer in some cases

05 June 2018

The study, which has been closely followed by many oncologists worldwide who have been using earlier findings to guide their treatment of patients since the study began in 2006, was praised by cancer research advocates as progress made possible by cutting-edge advances in genomics.

A woman with terminal breast cancer has been cured completely.

According to first author Joseph Sparano of Montefiore Medical Center in NY, "any woman with early-stage breast cancer 75 or younger should have the test and discuss the results" with her doctor.

Before the study, many doctors operated under the assumption that a score of 0 to 10 meant a patient could skip chemo, while a score of 26 or higher meant chemo would most likely help.

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In addition the scientists deployed one of a range of new immunotherapy drugs called checkpoint inhibitors, created to overcome a cancer's ability to shield itself from the immune system. The results are sure to accelerate the decline in chemotherapy for the disease. Tuttle was diagnosed with breast cancer last August.

British experts said the study was "exciting" even though it involved just one patient. Once collected, the cells are armed with cancer-recognizing molecules so that when they are reintroduced into the patient's body they can home in on the tumors and kill them off.

Being able to avoid chemotherapy would be a blessing for thousands of women with breast cancer.

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The same decade-long study had previously confirmed that patients at low risk, as determined by a genomic test of their tumors, can skip chemotherapy.

For years doctors were unsure how to treat women who fell in the middle range of the scoring system. Following this "recalibration" of the genetic test, the researchers estimated that chemotherapy was not justified in 70% of cases of breast cancer. 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?

Now, it's much more common to tackle the disease with gene-targeting therapies, hormone blockers and immune system treatments.

The findings will lead to a "fundamental change" in the way the disease is treated, a leading oncologist said, with an estimated 3,000 to 5,000 United Kingdom women likely to avoid chemotherapy every year as a result. Indeed, a genetic test can be done at the time of the operation to predict the risk of recurrence.

"It feels miraculous, and I am beyond amazed that I have now been free of cancer for two years", Ms Perkins said. "I sort of viewed chemo as extra insurance", she said.

Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo. Those women were then randomized into two trials: one received hormone therapy with chemotherapy; the other received hormone therapy alone.

Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute, told the BBC: "We're talking about the most highly personalised treatment imaginable".

Still, he acknowledged that most patients with this form of advanced cancer will die within months, and "we need to do a lot more work".

Chemotherapy may provide no benefit for breast cancer in some cases