May 22, 2019 by John Fernandez and Tanya Racoobian
Thousands of Breast Cancer Patients Can Skip Chemotherapy, New Research Finds
As many as 60,000 women a year in the U.S. with certain types of early-stage breast cancer could benefit from treatments that are less invasive than chemotherapy to combat their disease, according to new research presented this week at the American Society of Clinical Oncology (ASCO) meeting in Chicago.
Chemotherapy is an established primary treatment associated with improving survival among women with several types of breast cancer tumors. Instead, patients diagnosed early with breast tumors that are smaller than five centimeters, and have not spread to lymph nodes, can benefit from taking a drug that helps prevent the body from making estrogen, according to the research, which was published in the New England Journal of Medicine (NEJM).
Tamoxifen and other medications that block hormones that can promote cancer are among the meds used in what’s called endocrine therapy. This treatment guideline applies to the most common type of breast cancer, known as hormone-positive, HER-2 negative. It represents about half of all breast cancer cases in the United States, according to National Cancer Institute statistics.
The study, named TAILORx (Trial Assigning Individualized Options for Treatment), followed approximately 10,000 women with breast cancer for nearly 10 years. Tumors removed from the women during breast cancer surgery were examined with a special type of gene testing that helps determine the rate of cancer recurrence.
“This study illustrates the use of a personalized test that will allow physicians to safely omit chemotherapy treatment to breast cancer patients who are at low risk of relapse as determined by the 21-gene recurrence score,” said Sara Garrido, M.D., medical oncologist at Miami Cancer Institute. “This is a very important development, and it could have wide application in our daily practice. Breast cancer, like other cancers, is a vastly complex and personalized disease, and diagnosis and treatment vary from person to person. We encourage patients to consult with their physician about the course of treatment that’s most suitable for them.”
Spearheaded by the National Cancer Institute (NCI) and conducted in cooperation with other federally-funded agencies in the U.S. and Canada, the clinical trial’s results mean many breast cancer patients can be spared the bothersome side effects of the chemotherapy, such as hair loss and nausea, as well as other potentially more serious risks like heart and nerve damage, the researchers note.
While the study is good news for many women, the researchers caution some younger breast cancer patients about that treatment that is best for them. Some women age 50 and younger may still benefit from chemotherapy even when their gene tests indicate otherwise, the study also found. Younger women diagnosed with more advanced and invasive breast cancers often have higher chances of recurrence, research has shown.
“Some young women with breast cancer are more likely than others to harbor genes that predispose them to future cancer diagnoses,” said Starr Mautner, M.D., a breast surgeon at Miami Cancer Institute. “With the results of advanced genetic testing and proper genetic counseling, these women can become better informed about their risk factors and opt for tailored treatment options that are best for them.”
When breast cancer is found early and in a localized state, the five-year survival rate is near 100 percent, according to the National Breast Cancer Foundation.
While early diagnosis remains a key to survival and reducing the risk of recurrence, many doctors encourage women to discuss with them the types of breast cancer tests and treatments available, such as mammograms.
“A patient’s age, ethnicity and personal and family history of cancer are important to include in the equation to determine how often a woman should have a screening mammogram,” said Jane Mendez, M.D., chief of breast surgery at Miami Cancer Institute.
Although breast cancer remains the most common type of cancer in women worldwide, the number of women in the U.S. who have died from the disease has declined 39 percent in the last two decades, according to the American Cancer Society. In addition to medical tests, lifestyle choices also play a vital role in lowering the risk of breast cancer. Regular exercise, a healthy diet, moderate Body Mass Index (BMI), minimal alcohol consumption and no smoking are among the most important, controllable risk factors that lead doctors’ recommendations.
“One of the most important things we can do when it comes to breast cancer is to know your own body and individual risk factors so you can be proactive,” Dr. Mendez said.