Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient’s risk.
The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the US, and many more elsewhere, the ordeal and expense of these drugs.
“The impact is tremendous,” said the study leader, 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.
Photo: AP
The study was funded by the National Cancer Institute, some foundations and proceeds from the US breast cancer postage stamp. Results were discussed Sunday 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 drugmakers or for the company that makes the gene test.
MOVING AWAY FROM CHEMO
Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of gene-targeting therapies, hormone blockers and immune system treatments. 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 breast cancer study focused on cases where chemo’s value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.
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.
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 a cancer will recur.
WHAT THE STUDY FOUND
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.
WILL PEOPLE TRUST THE RESULTS?
All women like those in the study should get gene testing to guide their care, said Richard Schilsky, chief medical officer of the oncology society. Oncotype DX costs around US$4,000, which Medicare and many insurers cover. Similar tests including one called MdusammaPrint also are widely used.
Testing solved a big problem of figuring out who needs chemo, said Harold Burstein of the Dana-Farber Cancer Institute in Boston. Many women think “if I don’t get chemotherapy I’m going to die, and if I get chemo I’m going to be cured,” but the results show there’s a sliding scale of benefit and sometimes none, he said.
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.
Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: “Risk to one person is not the same thing as risk to another. There are some people who say, ‘I don’t care what you say, I’m never going to do chemo,’” and won’t even have the gene test, she said. Others want chemo for even the smallest chance of benefit.
Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo.
“I was a little relieved. I sort of viewed chemo as extra insurance,” she said. The treatments “weren’t pleasant,” she concedes. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, “but it was over fairly quickly and I’m really glad I had it.”
If doctors had recommended she skip chemo based on the gene test, “I would have accepted that,” she said. “I’m a firm believer in medical research.”
In late October of 1873 the government of Japan decided against sending a military expedition to Korea to force that nation to open trade relations. Across the government supporters of the expedition resigned immediately. The spectacle of revolt by disaffected samurai began to loom over Japanese politics. In January of 1874 disaffected samurai attacked a senior minister in Tokyo. A month later, a group of pro-Korea expedition and anti-foreign elements from Saga prefecture in Kyushu revolted, driven in part by high food prices stemming from poor harvests. Their leader, according to Edward Drea’s classic Japan’s Imperial Army, was a samurai
The following three paragraphs are just some of what the local Chinese-language press is reporting on breathlessly and following every twist and turn with the eagerness of a soap opera fan. For many English-language readers, it probably comes across as incomprehensibly opaque, so bear with me briefly dear reader: To the surprise of many, former pop singer and Democratic Progressive Party (DPP) ex-lawmaker Yu Tien (余天) of the Taiwan Normal Country Promotion Association (TNCPA) at the last minute dropped out of the running for committee chair of the DPP’s New Taipei City chapter, paving the way for DPP legislator Su
It’s hard to know where to begin with Mark Tovell’s Taiwan: Roads Above the Clouds. Having published a travelogue myself, as well as having contributed to several guidebooks, at first glance Tovell’s book appears to inhabit a middle ground — the kind of hard-to-sell nowheresville publishers detest. Leaf through the pages and you’ll find them suffuse with the purple prose best associated with travel literature: “When the sun is low on a warm, clear morning, and with the heat already rising, we stand at the riverside bike path leading south from Sanxia’s old cobble streets.” Hardly the stuff of your
Located down a sideroad in old Wanhua District (萬華區), Waley Art (水谷藝術) has an established reputation for curating some of the more provocative indie art exhibitions in Taipei. And this month is no exception. Beyond the innocuous facade of a shophouse, the full three stories of the gallery space (including the basement) have been taken over by photographs, installation videos and abstract images courtesy of two creatives who hail from the opposite ends of the earth, Taiwan’s Hsu Yi-ting (許懿婷) and Germany’s Benjamin Janzen. “In 2019, I had an art residency in Europe,” Hsu says. “I met Benjamin in the lobby