Many breast cancer patients can skip chemo, study finds

Posted: Updated:

By MARILYNN MARCHIONE
AP Chief Medical Writer

CHICAGO (AP) - Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient's risk.

The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs.

"The impact is tremendous," said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don't need treatment beyond surgery and hormone therapy, he said.

The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.

MOVING AWAY FROM CHEMO

Cancer care has been evolving away from chemotherapy - older drugs with harsh side effects - in favor of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it's sometimes for shorter periods or lower doses than it once was.

For example, another study at the conference found that Merck's immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects.

The breast cancer study focused on cases where chemo's value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.

The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill any stray cancer cells. Doctors know that most don't need it, but evidence is thin on who can forgo it.

The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.

WHAT THE STUDY FOUND

About 17 percent of women had high-risk scores and were advised to have chemo. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.

The new results are on the 67 percent of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo.

After nine years, 94 percent of both groups were still alive, and about 84 percent were alive without signs of cancer, so adding chemo made no difference.

Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.

WILL PEOPLE TRUST THE RESULTS?

All women like those in the study should get gene testing to guide their care, said Dr. Richard Schilsky, chief medical officer of the oncology society. Oncotype DX costs around $4,000, which Medicare and many insurers cover. Similar tests including one called MammaPrint also are widely used.

Testing solved a big problem of figuring out who needs chemo, said Dr. Harold Burstein of the Dana-Farber Cancer Institute in Boston. Many women think "if I don't get chemotherapy I'm going to die, and if I get chemo I'm going to be cured," but the results show there's a sliding scale of benefit and sometimes none, he said.

Dr. Lisa Carey, a breast specialist at the University of North Carolina's Lineberger Comprehensive Cancer Center, said she would be very comfortable advising patients to skip chemo if they were like those in the study who did not benefit from it.

Dr. Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: "Risk to one person is not the same thing as risk to another. There are some people who say, 'I don't care what you say, I'm never going to do chemo,'" and won't even have the gene test, she said. Others want chemo for even the smallest chance of benefit.

Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo.

"I was a little relieved. I sort of viewed chemo as extra insurance," she said. The treatments "weren't pleasant," she concedes. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, "but it was over fairly quickly and I'm really glad I had it."

If doctors had recommended she skip chemo based on the gene test, "I would have accepted that," she said. "I'm a firm believer in medical research."

___

Marilynn Marchione can be followed at MMarchioneAP .

The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.

(Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

6/3/2018 4:20:57 PM (GMT -4:00)

  • Top StoriesMore>>

  • Altuve's HR in 9th sends Astros to World Series over Yankees

    Altuve's HR in 9th sends Astros to World Series over Yankees

    Sunday, October 20 2019 12:33 AM EDT2019-10-20 04:33:41 GMT
    Sunday, October 20 2019 5:03 AM EDT2019-10-20 09:03:06 GMT
    (AP Photo/Matt Slocum). Houston Astros' Jose Altuve hits a double against the New York Yankees during the first inning in Game 6 of baseball's American League Championship Series Saturday, Oct. 19, 2019, in Houston.(AP Photo/Matt Slocum). Houston Astros' Jose Altuve hits a double against the New York Yankees during the first inning in Game 6 of baseball's American League Championship Series Saturday, Oct. 19, 2019, in Houston.
    (AP Photo/Matt Slocum). Houston Astros' Jose Altuve hits a double against the New York Yankees during the first inning in Game 6 of baseball's American League Championship Series Saturday, Oct. 19, 2019, in Houston.(AP Photo/Matt Slocum). Houston Astros' Jose Altuve hits a double against the New York Yankees during the first inning in Game 6 of baseball's American League Championship Series Saturday, Oct. 19, 2019, in Houston.
    Jose Altuve hit a game-ending homer off Aroldis Chapman with two outs in the ninth inning and the Houston Astros outlasted the New York Yankees 6-4 to advance to the World Series for the second time in three years.
    Jose Altuve hit a game-ending homer off Aroldis Chapman with two outs in the ninth inning and the Houston Astros outlasted the New York Yankees 6-4 to advance to the World Series for the second time in three years.
  • Teen charged with rape after disturbing video was shared on Snapchat

    Teen charged with rape after disturbing video was shared on Snapchat

    Saturday, October 19 2019 4:02 PM EDT2019-10-19 20:02:56 GMT
    State police investigate 'disturbing' Snapchat video made by studentState police investigate 'disturbing' Snapchat video made by student
    State police investigate 'disturbing' Snapchat video made by studentState police investigate 'disturbing' Snapchat video made by student
    A teen is facing charges after police say video of a rape was sent to several Brewster High School students on Snapchat.
    A teen is facing charges after police say video of a rape was sent to several Brewster High School students on Snapchat.
  • School Spirit Showdown: Vote on the Top 12 schools

    School Spirit Showdown: Vote on the Top 12 schools

    It's a battle for bragging rights! News 12 is looking for the schools with the most school spirit! Is it yours?

    It's a battle for bragging rights! News 12 is looking for the schools with the most school spirit! Is it yours?

  • SlideshowsGalleriesMore>>

  • Your Oct. 16 storm photos

    Your Oct. 16 storm photos

    Storm photos Oct. 17Storm photos Oct. 17
    Storm photos Oct. 17Storm photos Oct. 17
    Heavy right and high winds swept through the tri-state area due to a large coast storm on the night of Oct. 16. Here are your photos from the storm.
    Heavy right and high winds swept through the tri-state area due to a large coast storm on the night of Oct. 16. Here are your photos from the storm.
  • Yankees in the 2019 Playoffs

    Yankees in the 2019 Playoffs

    New York Yankees pitcher CC Sabathia throws against the Houston Astros during the 10th inning in Game 2 of baseball's American League Championship Series Sunday, Oct. 13, 2019, in Houston.New York Yankees pitcher CC Sabathia throws against the Houston Astros during the 10th inning in Game 2 of baseball's American League Championship Series Sunday, Oct. 13, 2019, in Houston.
    New York Yankees pitcher CC Sabathia throws against the Houston Astros during the 10th inning in Game 2 of baseball's American League Championship Series Sunday, Oct. 13, 2019, in Houston.New York Yankees pitcher CC Sabathia throws against the Houston Astros during the 10th inning in Game 2 of baseball's American League Championship Series Sunday, Oct. 13, 2019, in Houston.
    Photos on the field of the New York Yankees in the 2019 American League Division Series vs. the Minnesota Twins.
    Photos on the field of the New York Yankees in the 2019 American League Division Series vs. the Minnesota Twins.
  • Guide: Entertainment Venues in the Tri-State Area

    Guide: Entertainment Venues in the Tri-State Area

    Looking for a place to listen to some music or see a local play? Here is a list of concert venues in the Tri-state area.
    Looking for a place to listen to some music or see a local play? Here is a list of concert venues in the Tri-state area.
sorry to interrupt
your first 20 are free
Access to News 12 is free for Optimum, Comcast®, Spectrum Networks® and Service ElectricSM customers.
Please enjoy 20 complimentary views of articles, photos, and videos during the next 30 days.
you have reached your 20 view limit
Access to News 12 is free for Optimum, Comcast®, Spectrum Networks® and Service ElectricSM customers.
Please login or create an account to continue enjoying News12.
Our sign-up page is undergoing maintenance and is not currently available. However, you will be given direct access to news12.com while we complete our upgrade.
When we are back up and running you will be prompted at that time to complete your sign in. Until then, enjoy the local news, weather, traffic and more that's "as local as local news gets."