Thousands of breast cancer patients each year could be spared
chemotherapy or get gentler versions of it without harming their odds
of beating the disease, new research suggests.
One study found that certain women did better - were less likely to
die or have a relapse - if given a less harsh drug than Adriamycin, a
mainstay of treatment for decades.
Another study found that a gene test can help predict whether some
women need chemo at all - even among those whose cancer has spread to
their lymph nodes, which typically brings full treatment now.
The findings are sure to speed the growing trend away from chemo for
many breast cancer patients and targeting it to a smaller group of
women who truly need it, doctors said at the San Antonio
Breast Cancer Symposium, where the studies were reported.
New test will change practice
"We are backing off on chemotherapy and using chemotherapy more
selectively" in certain women, said Dr Eric Winer of the Dana-Farber
Cancer Institute in Boston.
The gene test in particular "will start changing practice nearly
immediately," said D. Peter Ravdin of the University of Texas M.D.
Anderson Cancer Centre in Houston. "The results are compelling that
this test helps select patients who will most benefit from
Breast cancer is the most common major cancer in American women.
More than 178,000 new cases are expected this year. Most are helped to
grow by oestrogen, and hormone-blocking medicines like tamoxifen are
used to treat those.
Chemo no effect on some
Here is where Oncotype DX, a test that measures the activity of 21
genes and gives a score to predict a woman's risk of recurrence, comes
in. Doctors have used it for several years to guide treatment for
certain women with early breast cancers, especially those that have not
The new study, led by Dr Kathy Albain of Loyola University in
Chicago, looked at whether it accurately predicted chemo's benefit in
367 women whose hormone-driven cancer had spread to lymph nodes.
A decade after these women were treated, those who had low scores on
the gene test were found to have had no benefit from chemo. Conversely,
chemo did a lot of good for those with high scores.
Because 40 percent of the women scored low, it means that as many as
18,000 women each year might safely skip chemo.
Test is expensive
Dr Kelly Marcom, a Duke University cancer expert said the test would give valuable information to guide treatment for more patients in the future. He has used it on about 50 women in the last year.
"I've had it cut both ways" - ruling chemo in and out, Marcom said.
The test is expensive - $3,400 (about R23 000) - though many US insurers
are paying for it because it can avoid even more costly chemo.
These new studies should lead to less use of chemo, but there has
been "intense" resistance from doctors, who fear giving up on a treatment
that might help some patients, said Barbara Brenner, head of the
advocacy group Breast Cancer Action.
"It's very hard to turn a ship like this," she said. "Adding things
never takes much, but removing things takes a mountain of data from the
medical community." – (Sapa/AP)
Chemo side effects underestimated