Breast cancer study set to free women from chemotherapy

[Lawpy]

From the Financial Times:

"Trials find no benefit from grueling treatment for most patients diagnosed in early stages of disease"

Related article from ASCO Post: 2018 ASCO: TAILORx: Most Women With Early-Stage Breast Cancer Can Forgo Chemotherapy When Guided by a Diagnostic Test - The ASCO Post

The federally funded, phase III TAILORx clinical trial showed that most women with hormone receptor (HR)–positive, HER2-negative, axillary node–negative early-stage breast cancer and a mid-range score on a 21-tumor gene expression assay (Oncotype DX® Breast Recurrence Score) do not need chemotherapy after surgery. The study found no improvement in disease-free survival when chemotherapy was added to hormone therapy in this group, which accounts for about two-thirds of women who participated in the trial. The findings will have an immediate impact on clinical practice, sparing thousands of women the side effects of chemotherapy.

“Half of all breast cancers are HR-positive, HER2-negative, and axillary node–negative. Our study shows that chemotherapy may be avoided in about 70% of these women when its use is guided by the test, thus limiting chemotherapy to the 30% who we can predict will benefit from it,” said lead study author Joseph A. Sparano, MD, Associate Director for Clinical Research at the Albert Einstein Cancer Center and Montefiore Health System, and Vice-Chair of the ECOG-ACRIN Cancer Research Group. “Before TAILORx, there was uncertainty about the best treatment for women with a mid-range score of 11–25 on the Oncotype DX Breast Recurrence Score test. The trial was designed to address this question and provides a very definitive answer,” said Dr. Sparano. “Any woman with early-stage breast cancer 75 years or younger should have the test and discuss the results of TAILORx with her doctor to guide her decision regarding chemotherapy after surgery to prevent recurrence.”

The ASCO Post article says that chemotherapy may be spared in:

• All women older than 50 years with hormone receptor–positive, HER2-negative, node-negative breast cancer and a Recurrence Score of 0 to 25 (about 85% of women with breast cancer in this age group)
• All women 50 years or younger with hormone receptor–positive, HER2-negative, node-negative breast cancer and a Recurrence Score of 0 to 15 (about 40% of women with breast cancer in this age group).

What are your thoughts?

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[FindMeOnTheLinks]

The Oncotype Dx was originally validated back in the mid 2000's and has been used in clinical practice for some time, but only for a certain subset of breast cancer albeit the most common. From my understanding, this study essentially filled in the gap about what to do with the mid-range score - previously low scores meant no chemo, high scores meant chemo, but in between was still a bit iffy. The magnitude of these tests is reflected in the fact that the Oncotype Dx and Mammparint score have even made their way into the new AJCC staging guidelines -- a low oncotype Dx score in HR+, Her2-, LN- disease puts you into T1a-b regardless of tumor size.

these genomic indices will play a huge role in the future of oncology. there are many oncologic disease settings where traditional clinico-pathologic factors are unable to predict outcomes and guide treatment, but genomics are bridging the gap. it's only a matter of time and money.

 

[evilbooyaa]

Means less patients will have to undergo chemotherapy with node negative breast cancer. Felt that it was over-used for something that inherently has a 90%+ 10-year survival rate.