A few breast cancer patients may avoid chemotherapy

As the test predicted, after five years, 99 percent of women who avoided chemo had no recurrence of cancer.

Study leader, Dr. Joseph Sparano of Montefiore Medical Center commented, “You can’t do better than that”. He claims Oncotype DX “lets us focus our chemotherapy more on the higher risk patients who do benefit”.

The data, published in the New England Journal of Medicine, found that the babies – aged 18 months and then three years when they were tested – had developed normally when compared to children whose mothers had not had cancer.

More than half of the mothers-to-be had breast cancer, and 16 percent had blood cancers.

Children born to mothers diagnosed with cancer during their pregnancy did not experience impairments to cognitive, cardiac or general development in early childhood regardless of maternal treatment receipt, according to research presented at European Society of Medical Oncology’s European Cancer Congress.

The study did not include men, who represent just one percent of all breast cancer patients.

Hayes and his colleagues are now testing to see which of these patients benefit from chemotherapy. Although the lymph nodes were not involved, the tumors had other features that indicated chemotherapy should be given, followed by tamoxifen or other endocrine therapy pills. However, these studies involved fewer patients than the current study, which enrolled 10,253 women with a certain kind of breast cancer known as hormone-receptor positive, HER2 negative cancer. For now, however, this assay is the most rigorously tested option and provides proof of the principle that we can develop reproducible predictive tests to select patients who should not receive chemotherapy. Continued follow-up still will be needed to determine whether any women in this larger group, with tumors in the intermediate-score range, can safely forgo chemotherapy. Every two weeks, she’s at UT Health Northeast going through chemotherapy treatments for her breast cancer.

By looking at the activity of 21 genes in the cancer tumor, the genetic test was able to accurately decipher whether women with early-stage breast cancer can take hormone-blocking drugs for treatment and forgo the chemotherapy that would often be prescribed along with it. Chemotherapy often has unpleasant side effects.

“Much easier on patients and that’s what we want”, he said. Also, they are urged to have chemo which kills any stray cancer cells if spread beyond the breast.

Currently, the test – called Oncotype DC – costs a little bit over $4,000 and is covered by most insurers. Others besides Oncotype DX also are on the market, and Hudis said he hopes the new study will encourage more, to compete on price and accuracy. The study found that after the gene test, doctors change their recommendations in 31.5 percent of cases, while 27 percent of patients changed their treatment decisions.