When Less is More in Breast Cancer Treatment
The trial results from a decade-long breast cancer treatment study funded by the National Cancer Institute show most patients with an intermediate risk of cancer recurrence can avoid chemotherapy without risking their chances of beating the disease. After giving a test to over 10,000 patients known as Oncotype DX—a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy—researchers determined that patients with smaller-sized tumors that had not invaded nearby lymph nodes did just as well without chemotherapy as those who got the treatment.
“The Oncotype DX test is a tool that we use every day in the clinic in order to make decisions about whether or not to give chemotherapy in a woman with a lymph node negative breast cancer that is hormone receptor positive, Her-2 negative,” said Meredith Faggen, MD, medical director of medical oncology at Dana-Farber/Brigham and Women’s Cancer Center in clinical affiliation with South Shore Hospital. “These trial results show that chemotherapy is no better than endocrine therapy in patients in the dreaded "gray area" of treatment decision, taking away the uncertainty for so many women.”
For years oncologists everywhere have been concerned that in some instances, women with early-stage cancers are possibly being over treated. Unfortunately, because these patients have fallen in the gray zone of diagnosis, where deciding whether or not to undergo chemotherapy becomes a difficult decision to face.
Dr. Faggen acknowledges that it is not only a difficult decision for patients to make but also a difficult conversation to have with patients.
“You give them the numbers and your best estimate of how much (or little) you feel that chemotherapy would reduce their risk of recurrence, but this long-term data really helps back up these decisions,” she said.
“Having the ability to spare patients unnecessary treatment which is quite toxic and knowing that it will not affect outcomes, will certainly let us all sleep better at night.”
While we realize these results are extremely encouraging, chemotherapy still has its valuable place in treating patients and has saved a tremendous amount of lives. The study does show that in the younger patient demographic, less than age 50, we still need to be careful about completely omitting chemotherapy, especially with recurrence scores on the higher end of the Oncotype DX test. It is also important to note that patients with Her-2 neu positive or triple negative cancers are not affected by these data. These women will receive treatment, usually chemotherapy-based on their particular type of breast cancer.