Study: Many women with early stage breast cancer do not need chemo

New research is expected to redefine treatment decisions


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A new study is redefining treatment decisions decisions for many women with early-stage breast cancer.

Groundbreaking research showed no benefit from chemotherapy for 70 percent of women with the most common type of breast cancer. This was the main finding from the Trial Assigning Individualized Options for Treatment (Rx), or TAILORx trial, at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting.

This research, resulting from a 12-year study, showed that for women with a specific type of breast cancer, treatment with chemotherapy and hormone therapy after surgery is not more beneficial than treatment with hormone therapy alone.

The results will give clinicians high-quality data to inform personalized treatment recommendations for women, said the lead author of the study, Joseph Sparano, MD, Associate Director of Clinical Research, Montefiore Einstein Center for Cancer Care, Montefiore Health System.

"These data confirm that using a 21-gene expression test to assess the risk of cancer recurrence can spare women unnecessary treatment if the test indicates that chemotherapy is not likely to provide benefit," he said.

Survival rates similiarTAILORx started in 2006 to assess whether women who received hormone therapy alone had outcomes that were as good as those among women who received chemotherapy in addition to hormone therapy.

"Until now, we've been able to recommend treatment for women with these cancers at high and low risk of recurrence, but women at intermediate risk have been uncertain about the appropriate strategy to take," said Jeffrey Abrams, M.D., associate director of the National Cancer Institute's Cancer Therapy Evaluation Program. "These findings, showing no benefit from receiving chemotherapy plus hormone therapy for most patients in this intermediate-risk group, will go a long way to support oncologists and patients in decisions about the best course of treatment."

The researchers found that disease-free survival — the proportion of women who had not died or developed a recurrence or a second primary cancer — was very similar in both groups. Five years after treatment, the rate of invasive disease-free survival was 92.8 percent for those who had hormone therapy alone and 93.1 percent for those who also had chemotherapy. At nine years, the rate was 83.3 percent for those with hormone therapy alone and 84.3 percent for the group that had both therapies. None of these differences were considered statistically significant.

The rates of overall survival were also very similar in the two groups. At five years, the overall survival rate was 98.0 percent for those who received hormone therapy alone and 98.1 percent for those who received both therapies, and at nine years the respective overall survival rates were 93.9 percent and 93.8 percent.

The researchers also found that women with a score of 0–10 had very low recurrence rates with hormone therapy alone at nine years (3 percent). This confirms similar findings from earlier studies.

RecommendationsAccording to the authors, the new findings suggest that chemotherapy may be avoided in about 70 percent of women with HR-positive, HER2-negative, node-negative breast cancer who are:

Older than 50 and with a recurrence score of 11–25 (45 percent)

Any age with a recurrence score of 0–10 (16 percent)

50 years old or younger with a recurrence score of 11–15 (8 percent)

The findings suggest that chemotherapy may be considered for the remaining 30 percent of women with HR-positive, HER2-negative, node-negative breast cancer who are:

Any age with a recurrence score of 26–100 (17 percent)

50 years old or younger with a recurrence score of 16–25 (14 percent)

The new results demonstrate that chemotherapy is not beneficial for most women in the intermediate-risk group.

Source: The TAILORx trial finding most women with early breast cancer do not benefit from chemotherapy was originally published by the National Cancer Institute: https://bit.ly/2J8DowK.



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