More Women May be Able to Avoid Chemotherapy
A very important study was released last week in The New England Journal of Medicine. Researchers studied women with newly diagnosed early stage breast cancer who were in a gray area re the value of/need for chemotherapy in addition to hormonal/endocrine therapy. All of the women had ER positive disease. Their tumors were evaluated by the Mammaprint genomic test that examines the genetic structure of the specific cancer cell. In the United States, the Oncotype DX, a similar test, is used much more frequently while the Mammaprint is widely used in Europe. Of note, these tests cost several thousand dollars, and insurance coverage varies.
As an aside: I am puzzled by the uneven insurance coverage for these tests as they potentially save not only the patient, but also the insurance company, from the high costs of chemotherapy. One would think that the insurer would rather put out a few thousand for a test than cover many thousands for a course of chemotherapy.
Back to the study: Researchers suggest that these results could be important for between 35,000 and 45,000 women each year in the US--and more in Europe. The study design included women whose pathology reports and clinical presentation would indicate the need for chemotherapy in addition to hormonal therapy. Half of these women were given chemo, and the other half were not, moving instead directly to endocrine treatment (Tamoxifen or one of the AIs). After five years, among those who did not receive chemotherapy, 94.4 percent had no distant spread. Those who received chemo fared slightly better: 95.9 percent had no distant spread. Yes, there was a 1.5% difference between the groups, but that means for every 1.5 (?) woman who benefited from the chemo, 98 women were treated unnecessarily. Each of us likely has our own reaction to that fact.
The authors of the study are careful to say that more research needs to be done, that women need to be followed longer as ER positive breast cancers often recur later than ER negative ones. But the facts hold.
From The New York Times, here is the start and a link to read more:
Gene Tests Identify Breast Cancer Patients Who Can Skip
Chemotherapy, Study Says
By DENISE GRADY
A new study helps answer that question, based on a test of gene activity in tumors. It found that nearly half of women with early-stage breast cancer who would traditionally receive chemo can avoid it, with little risk of the cancer coming back or spreading in the next five years.
The so-called genomic test measures the activity of genes that control the growth and spread of cancer, and can identify women with a low risk of recurrence and therefore little to gain from chemo.
“More and more evidence is mounting that there is a substantial number of women with breast cancer who will not need chemotherapy to do well,” said Dr. Rachel A. Freedman, a breast cancer oncologist at the Dana-Farber Cancer Institute in Boston. She was not involved in the study.
The researchers estimated that their findings, published Wednesday in The New England Journal of Medicine, would apply to 35,000 to 40,000 women a year in the United States, and 60,000 to 70,000 in Europe. They are patients with early disease who because of tumor size, cancerous lymph nodes and other factors would normally be prescribed chemo.