Most Breast Cancer Patients Can Forgo Chemotherapy, Study Finds
Coal City resident Therese Dearth, 59, was committed to chemotherapy even if it decreased the odds of her breast cancer from recurring by as little as 2 percent.
“You bet I’ll do chemo if that’s going to prevent me from having a recurrence when I’m 80 (years old),” Dearth said. “It’ll be easier to do it now.”
But thanks to a new study, Dearth and thousands of others with the most common type of early breast cancer can safely forgo chemotherapy.
“With the results of this groundbreaking study, we now can safely avoid chemotherapy in about 70 percent of patients who are diagnosed with the most common form of breast cancer,” said Dr. Kathy Albain, a co-author of the study and Huizenga Family Endowed Chair in Oncology Research at Loyola University Chicago Stritch School of Medicine. “For countless women and their doctors, the days of uncertainty are over.”
Dearth, who was diagnosed with stage one invasive ductal breast cancer in April, was elated she didn’t have to undergo chemotherapy. “It was the most wonderful news,” Dearth said, adding she had “psyched” herself up for the treatment. “I was ready to do it because I have an aunt who is 82 and she is now going through chemotherapy. ... I kept looking at her, and thought if I can go through this now and have no chance of recurrence when I’m 82 or 83, I’ll do it.”
The study, published in the New England Journal of Medicine, enrolled 10,273 women who had the most common type of breast cancer (hormone-receptor positive, HER-2 negative) that had not spread to lymph nodes.
Participants’ tumors were examined with a 21-gene test to determine how active they were. Clinicians, including Albain, have been using this test for years. The tumor is assigned a “recurrence score” from 0 to 100; the higher the score, the greater the chance the cancer will recur in distant organs and decrease a patient’s chance of survival. Previous studies have shown that women with low scores (10 or lower) did not need chemotherapy, while women with higher scores (above 25) required chemotherapy and that it would significantly reduce the risk of recurrence.
But the majority of women with breast cancer fall in the intermediate range of 11-25. That’s just the group this study was designed for, said Albain, a member of the clinical trial’s steering committee.
Of the 10,273 women enrolled in the study, 69 percent had intermediate test scores. Patients were randomly assigned to receive both chemotherapy and hormonal therapy or only hormonal therapy. Researchers tracked disease-free survival, cancer recurrence and overall survival, among other factors, in both groups.
For women with intermediate scores, there was no significant difference between the two groups in terms of disease-free survival (83.3 percent in the hormonal therapy group and 84.3 percent in the chemotherapy and hormonal therapy group), disease recurrence at a distant site (94.5 percent and 95.0 percent), and overall survival (93.9 percent and 93.8 percent), according to the study.
“This study should have a huge impact on doctors and patients,” Albain said, adding the results mean 69,000 women per year can safely forgo chemotherapy. “It’s not just de-escalating toxic chemotherapy. But for the women who really need it, it gives them a peace of mind that they’re getting it for the right reason.”
The results also gave Dearth peace of mind. Had it not been for the study, she said she would have been “haunted” by the possibility that cancer could return if she didn’t do chemotherapy. “It would always be in the back of mind, is it going to come back? Now, I know it’s not going to and I don’t have to go through chemotherapy,” she said.
Note: This story was originally published June 12, 2018.