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Many Breast Cancer Patients Can Skip Chemo, New Study Finds
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Many Breast Cancer Patients Can Skip Chemo, New Study Finds

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CHICAGO — June 4, 2018

Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, according to two studies released at the annual meeting of the American Society of Clinical Oncology in Chicago.

The first study, described as the most comprehensive breast cancer test to date, found that most women with a common type of breast cancer could avoid chemotherapy after surgery, depending on their score on a genetic test.

Until now, women faced great uncertainty about whether to add chemotherapy to hormone therapy after a breast cancer diagnosis of hormone receptor positive and HER2 negative, when they are at an early stage before it spreads to the lymph nodes.

With the results of this study, "we can safely avoid chemotherapy in about 70% of patients diagnosed with the most common form of breast cancer," said co-author Kathy Albain, an oncologist at Loyola Medicine.

“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 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 cancer will recur.

The study was funded by the National Cancer Institute, some foundations, and proceeds from the US breast cancer postage stamp. The results were discussed yesterday 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 drug makers or for the company that makes the gene test.

The studies reveal:

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.

The second study refers to the most common lung cancer in the world, known as non-small cell lung cancer.

The trial, which involved more than 1,200 people, found Merck's medication Keytruda (pembrolizumab) helped patients with lung cancer live four to eight months longer than when receiving chemotherapy.

These findings "do not resemble anything we've seen in the past for non-small cell lung cancer," said the study's lead author, Gilberto Lopes, an oncologist at the University of Miami Health Center.

Even so, he acknowledged that most patients with this type of advanced cancer would die within months, and there is "much more work" to be done.

The lung cancer is the deadliest cancer in the world, costing 1.7 million lives per year.

"We are leaving an era in which the only option for patients with non-small cell lung cancer was to start chemotherapy," said John Heymach, a professor at the MD Anderson Cancer Center at the University of Texas, who was not involved in the study.

"Now, the vast majority of patients can instead receive benefits from immunotherapy," he added.

Author: USA Really