Published: Tue, June 05, 2018
Medicine | By Brett Sutton

Immunotherapy cures late-stage breast cancer in world first

Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major global study that is expected to quickly change medical treatment.

A decade-long study revealed that women who take a cancer recurrence gene test and yield results of low or intermediate risk of cancer recurrence - which effects more than 85,000 women a year - can forego chemotherapy altogether, according to CNN.

"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", Dr. Joseph A. Sparano, the study's lead author and associate director for clinical research at the Albert Einstein Cancer Center, said in a statement to CNN.

For women 50 or younger, chemotherapy is unwarranted for those with an Oncotype score under 16 - about 40 percent of breast cancers in this age group, the researchers said.

Breast cancer is the most common form of cancer among women in the world, and hormone-receptor-positive, HER2-negative, node-negative cancer constitutes about half of the 1.7 million cases diagnosed yearly worldwide.

Past research has shown that women with scores between 0 and 10 could skip chemotherapy, while those with scores over 25 benefited from adding chemotherapy to their hormonal treatment plan.

The Oncotype DX test costs $4,600 and is typically reimbursed by insurance, according to Dr. Steven Shak, chief medical officer of Genomic Health, the maker of Oncotype DX.

"But because this new approach to immunotherapy is dependent on mutations, not on cancer type, it is in a sense a blueprint we can use for the treatment of many types of cancer".

This researchers split the middle-scoring group into two randomized subgroups: one treated exclusively with estrogen-blocking hormone therapy, and one with chemo combined with hormone therapy.

In addition, a recent study says chemo does not improve survival, that most women can be safely treated with just surgery and hormone blockers.

"If confirmed in a larger study, it promises to further extend the reach of this T-cell therapy to a broader spectrum of cancers", he said. Women younger than 50 still saw some benefit from chemotherapy, especially with scores between 21-25.

A widely used gene test for breast cancer tumours was able to identify women who could forego chemotherapy in favour of endocrine therapy, the study found. The cells go on to attack all the tumours and shrink them in size finally curing the 49 year old woman.

The researchers hope the findings "greatly expand the number of patients who can forgo chemotherapy without compromising their outcomes".

The current study focused on those whose scores were in the middle range, from 11 to 25.

The latest results should mean more women can avoid chemotherapy, and its associated side effects, without compromising the effectiveness of their treatment.

It's been nine years and almost all women tested in both groups are still alive. These women should discuss chemotherapy with their doctors, the researchers said. More studies are needed to look at those groups of women, they said. Your odds of being cured are terrific, and you don't need chemotherapy because you don't need it.

It is estimated that 3,000 to 5,000 women in the United Kingdom are likely to avoid chemotherapy every year following the trial.

"Oncologists have been getting much smarter about dialing back treatment so that it doesn't do more harm than good", said Steven Katz, a University of MI researcher who examines medical decision-making. Now only about 60 percent of USA patients who could potentially benefit from it are taking the gene test, he says. Those in another group benefited exclusively from endocrine therapy, which blocks estrogen from reaching the tumors that would use it to grow.

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