"Our study shows that chemotherapy may be avoided in about 70 percent of these women when its use is guided by the test, thus limiting chemotherapy to the 30 percent who we can predict will benefit from it", said lead researcher Dr Joseph A. Sparano, associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Health System in NY. The test, which has been on the market for several years, analyzes the activity of 21 genes to predict a woman's risk of recurrence over 10 years.
The study's lead author, Dr. Joseph Sparano, the associate director for clinical research at the Albert Einstein Cancer Center in NY, says patients with early stage breast cancer should consider this kind of testing.
"These results will inform clinical decision making, and in future, many women with certain types of early-stage breast cancer can avoid chemotherapy without impacting on the success of their treatment", he said. A key part - the initial $4.5 million of the cancer institute's $36 million contribution - came from the stamp, said Dinah Singer, who is involved in the institute's use of stamp proceeds.
The result: After an average follow-up of 7.5 years, the researchers saw no added benefit in this group to adding chemotherapy to the treatment mix.
And while celebrating this genuine advance, we should remember just how far we have to go in finding effective therapies for metastatic breast cancer, and other breast cancer subtypes for which treatment options are still limited.
What is less clear is whether chemotherapy will be of any benefit to the majority of patients who have a mid-range recurrence score. Those women were then randomized into two trials: one received hormone therapy with chemotherapy; the other received hormone therapy alone.
Doctors were unsure, however, whether women in the medium-risk range were benefiting from chemotherapy or just experiencing the side effects. The problem with these cells is that they're too few to help a patient on their own, so the team grew new copies of the cells in the lab, multiplying them dramatically over a period of few weeks, after which they were infused back into the patient. The gene test results are measured on a scale of 0-26. Apparently, those who are receiving the said treatment under current medical standards don't actually need it.
The most significant risk factors for breast cancer are gender (being a woman) and age (growing older).
But, researchers say some women 50 and younger in high-risk groups might still need chemo.
Findings of the past have indicated that women who met these criteria and scored below ten on the index test could safely skip chemotherapy without raising their rate of recurrence, however, those above 25 would nearly always be advised to use chemotherapy as a necessary treatment to lower risk of recurrence. "I had a tumour in my chest that I could feel shrinking", she said.
Until now, chemotherapy was highly recommended with a result greater than 25, and below 10 it was not.
While the new study fills in a crucial gap of medical knowledge, what remains confusing is what took so long to get the point where we can measure twice and cut once, so to speak. Similar tests including one called MammaPrint also are widely used. Another, more sinister, aspect to these headlines is the potential to fuel myths and conspiracy theories about the effectiveness of chemotherapy.
Previously in clinical trials, checkpoint inhibitors have proved ineffective against most breast cancers.
Applying radiation therapy to lymph nodes behind the breast bone and above the collar bone can improve outcomes for earlier-stage breast cancer patients, with limited side effects, Phase 3 long-term data show.