Chemo 'unnecessary' for thousands with breast cancer

The study is thought to be the largest breast cancer treatment trial ever

Image The study is thought to be the largest breast cancer treatment trial ever

After growing billions of these immune cells in the lab, the researchers screened them to find which ones would most effectively find and destroy the woman's cancer cells by recognising their abnormal proteins.

This researchers split the middle-scoring group into two randomized subgroups: one treated exclusively with estrogen-blocking hormone therapy, and one with chemo combined with hormone therapy.

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. "We are de-escalating toxic therapy", study co-author Dr. Kathy Albain added.

'I'm delighted. I've been anxious for a long time about unnecessary treatment for cancer, and unnecessary side effects from chemotherapy, ' Dr. Otis Brawley, the chief medical and scientific officer for the American Cancer Society who was not part of the study, said.

This means in practice doctors can tell 70 percent of these patients they don't need to agonize over whether to get chemo, says study co-author Dr. Kathy Albain, a hematology and oncology professor at Loyola University Medical Center in IL. For those people, the side effects of chemotherapy could have been avoided, without making the treatment any less effective.

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As many as 65,000 women in the United States alone could be affected by the findings. "We are creating a new drug for every patient, targeting the unique mutations in that same patient's cancer". They used gene testing of the tumor to determine risks and treatment.

The team at the U.S. National Cancer Institute say that an immunotherapy treatment used on a woman suffering from advanced stage breast cancer with barely months to live, has helped her keep cancer away for two years. The findings indicate that chemotherapy may be considered for the remaining 30% of women. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.

CAR-T only works in blood cancers, Rosenberg said.

Patients with these kind of tumors typically undergo surgery followed by treatment with drugs that target rapidly dividing cells (chemotherapy) and drugs that block the production or action of the hormone estrogen (endocrine therapy, such as the drug Tamoxifen). That doctors and researchers need to constantly re-evaluate the assumptions on which medical decisions are based, especially for something as important and time-sensitive as cancer treatments. Others want chemo for even the smallest chance of benefit. Another, more sinister, aspect to these headlines is the potential to fuel myths and conspiracy theories about the effectiveness of chemotherapy.

If doctors adopt the study's findings, a lot of women could be affected.

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According to the TAILORx researchers, 260,000 women who are diagnosed with breast cancer each year around the world fall into the medium-risk category that wouldn't benefit from chemotherapy.

About 41,000 women and 465 men died from the disease that year.

The study published on Sunday, on which early-stage breast cancer patients can forgo chemo, is by far the most impactful so far. "It also helps identify those women with this disease who really do benefit from the chemotherapy they receive", Prof Keane commented.

"Chemotherapy is not without its own risks", said Jacoub.

"With this test, you listen to the tumor's genes", he said.

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After enrolling for new trial in 2015, doctors in the USA adopted an experimental approach combining two different forms of immunotherapy after conventional hormone treatments and chemotherapy failed. She remains free of cancer today, Rosenberg said - the first successful targeting of a deadly mutation called KRAS, which is implicated not only in some colon cancers but in pancreatic and lung cancers.

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