Licking cancer: US postal stamp helped fund key breast study

Pearl Mccarthy
June 5, 2018

Lead author Dr Joseph Sparano, of Montefiore Medical Centre in NY, said: "Any women with early stage breast cancer 75 or younger should have the test and discuss the results of TAILORx with her doctor".

The first study, described as the largest breast cancer treatment trial to date, found that the majority of women with a common form of breast cancer may be able to skip chemotherapy and its toxic, and often debilitating, side effects after surgery depending on their score on a genetic test.

The work "provides a major "proof-of-principle" step forward, in showing how the power of the immune system can be harnessed to attack even the most difficult-to-treat cancers", he said.

Compared to 52 women who only received an American Cancer Society pamphlet on chemotherapy, the 48 women in the texting group reported an overall lower level of distress and a higher quality of life during their therapy.

"But because this new approach to immunotherapy is dependent on mutations, not on cancer type, it is in a sense a blueprint we can use for the treatment of many types of cancer".

"This is a really big deal", said Dr. Adam Brufsky, a coauthor on the new study and a professor of medicine at the University of Pittsburgh. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test. The trial also wanted to confirm that a low RS of 0 to 10 is associated with a low rate of distant recurrence when patients receive endocrine therapy alone. 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 cancer in question is driven by hormones, has not spread to the lymph nodes and does not contain a protein called HER2.

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.

There is no known cure for breast cancer patients whose disease has spread so widely.

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The same decade-long study had previously confirmed that patients at low risk, as determined by a genomic test of their tumors, can skip chemotherapy.

The test randomized women with intermediate risk, about 67 percent.

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. For women aged under 50 with scores of 16-25, there was some benefit in getting chemotherapy, but for those aged over 50 with scores under 25, or those aged under 50 and scores below 16, there was nothing to be gained from going through the draining process.

Dr. Otis Brawley, chief medical and scientific officer for the American Cancer Society said that he was "delighted" by the study and anxious about unnecessary cancer treatment and the side effects that come from chemotherapy.

The Oncotype DX genetic test has been available on the NHS since 2013, but the National Institute for Health and Care Excellence (Nice) is now updating its guidance on whether it should be recommended for use.

"What that test does is look at 21 different genes to see if each is turned on or off and then if it is over-expressed or not", Brawley said.

Tens of thousands of women each year in North America alone fall into the categories where chemotherapy is unnecessary, accounting for 70 percent of those with the most common forms of breast cancer.

Dr. Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: "Risk to one person is not the same thing as a risk to another".

Charity Breast Cancer Care said it was a "life-changing breakthrough".

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