Early-stage breast cancer patients may not require chemo, says new study
There’s good news for cancer patients. A new study done by Montefiore Medical Center in New York says that most women with early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease.
The landmark study is the largest ever done of breast cancer treatment and used genetic testing to gauge each patient’s risk. The results are expected to spare patients the ordeal and expense of the chemo drugs. “The impact is tremendous. Most women in this situation don’t need treatment beyond surgery and hormone therapy,” said the study leader Dr Joseph Sparano of Montefiore Medical Center in New York.
The study was funded by the National Cancer Institute, some foundations and proceeds from the US breast cancer postage stamp. Results were discussed at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine.
Moving away from chemo
Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favour of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it’s sometimes for shorter periods or lower doses than it once was.
For example, another study at the conference found that Merck’s immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects. The breast cancer study focused on cases where chemo’s value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fuelled by estrogen or progesterone) and is not the type that the drug Herceptin targets.
The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill stray cancer cells. Doctors know that most don’t need it, but evidence is thin on who can forego it.
What the study found
About 17% of women had high-risk scores and were advised to have chemo, while 16% women with low-risk scores skipped chemo, based on earlier results from this study. The new results are on the 67% of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo. After nine years, 94% of both groups were still alive, and about 84% were alive without signs of cancer, so adding chemo made no difference.
Some of the women aged 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.
Women should get gene testing to guide their care, said Dr Richard Schilsky, chief medical officer of the oncology society. Testing solved a big problem of figuring out who needs chemo, said Dr Harold Burstein of the Dana-Farber Cancer Institute in Boston. “Many women think ‘If I don’t get chemotherapy, I’m going to die, and if I get chemo, I’m going to be cured’, but the results show there’s a sliding scale of benefit and sometimes none,” he said.
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