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06 June 2018, 05:41 | Melissa Porter
Image The study is thought to be the largest breast cancer treatment trial ever
More than two years on, she is cancer-free and says she has "gone back to normal everyday life", even enjoying strenuous hiking and kayaking trips. Or was it sufficient for them to be treated only with endocrine therapy, which blocks the cancer-spurring properties of hormones?
Out of the 10,000 women enrolled in the TAILORxstudy, around 6,700 fell in the medium-risk range.
However, there is still uncertainty about the benefit of chemotherapy for most patients who have a midrange score, they specified.
Her case, detailed in the journal Nature Medicine, involves a new treatment which harnesses the body's own immune system to destroy cancerous cells. Oncotype DX costs around $4,000, which Medicare and many insurers cover. It looks for a genetic "signature" in a sample of the tumour and gives a score between 0 and 100, which can help to direct treatment decisions. "But we need to be precise on when to use it and who to recommend it to".
How does the study fit into the debate over "de-escalating" treatment of early-stage breast cancer?
What did the study show?
Doctors allow patients with scores of 10 or below to forgo chemotherapy and take estrogen-blocking drugs alone, because their likelihood of developing recurrent cancer is so low.
But the best treatment for those with a score in the middle has been unclear.
Although this work does indicate that thousands of women can be spared this hard treatment, it doesn't mean skipping chemo is the right choice for all early-stage breast cancer patients. The patient's cancer could not have spread to the lymph nodes. It was the women in the intermediate stages of 11-25 who oncologists often had differing views when prescribing standards of care.
Now we do. This very large, very important study is telling us that people with those intermediate scores have a very good prognosis and that prognosis is not improved by chemotherapy. After nine years, 94 percent of both groups were still alive - and about 84 percent were alive without signs of cancer, indicating that the chemo made no difference.
Sunday's results came from a federally sponsored trial called TailorX, which was created to help doctors more precisely tailor treatments for early-stage breast cancer.
The results are expected to spare as many as 70,000 women from the expensive procedure that comes with harsh side effects.
WHEN THIS Delhi-based businesswoman was recently diagnosed with early stage breast cancer, her world came crashing down. "Practically speaking, this means that thousands of women will be able to avoid chemotherapy, with all of its side effects, while still achieving excellent long-term outcomes", said ASCO expert Dr Harold Burstein.
'We have been waiting for these results for years.
There has always been suspicion that chemotherapy is overused in treating some forms of cancer-now doctors and patients can make more informed decisions about which cancer treatments they choose and which will be effective. Doctors do say chemotherapy is still effective and necessary in treating certain patients.
This resulted in a "highly personalised" anti-cancer therapy that yielded "complete tumour regression", the researchers wrote.
Ahmed Elkhanany, MD, a Roswell Park clinical fellow, is lead author and Kazuaki Takabe, MD, PhD, FACS, Alfiero Foundation Endowed Chair in Breast Oncology, is senior author of the study, "Racial disparity in breast cancer immune microenvironment" (abstract 1081), to be presented in a poster session on Saturday, June 2, from 8 a.m.to 11:30 a.m. CDT in McCormick Place, Poster Hall A.
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A high recurrence score, above 25, means chemo is advised to ward off a recurrence, while a low score, below 10, means it is not. Breast Cancer Now also called for Nice to reflect the findings in its guidance. "We want to give the right amount", he said.
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