Most Early-Stage Breast Cancers May No Longer Need Chemo

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If there’s one thing a newly diagnosed cancer patient needs, it’s some good news. Women with the most common form of early stage breast cancer now have that news.

The recently released ­TAILORx study found that 70 percent of women with low to intermediate risk of breast cancer don’t need chemotherapy if their tumors have the following characteristics:

  • Have not spread to lymph nodes
  • Growth is driven by hormones
  • Up to 5 cm in size
  • Do not overexpress HER2 protein

“TAILORx is a pivotal study that used genomic testing to predict outcome and identify patients who would benefit from chemotherapy and to safely omit chemotherapy for women meeting the appropriate criteria,” says Dr. Carmen Calfa, an oncologist at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System.

While the research is transformative, Dr. Calfa points out that, “The study does not apply to everyone with a diagnosis of breast cancer.”

A major discovery

The 10-year, federally funded study tracked more than 10,000 women in the U.S. and five other countries after surgery for early-stage breast cancer. It had previously determined that low-risk women could safely forego chemotherapy, though they still need surgery and endocrine therapy. The study’s most recent caveat showed that chemotherapy did not benefit most intermediate risk women, either.

For years, doctors knew some women probably didn’t need chemotherapy, but did not have the evidence to back up their theory. “The uncertainty gap has narrowed significantly and many women will now be spared unnecessary chemotherapy,” says Dr. Calfa.

Important exceptions

The TAILORx researchers advise women in all risk categories to get genetic testing from a qualified medical professional. They also stated that some patients would get some benefit from chemotherapy. “Women 50 and younger with recurrence scores between 16 and 25 may benefit from chemotherapy. I encourage these women to carefully discuss their individual risk-benefit aspects with their oncologist,” Dr. Calfa says.

“Progress is being made, but we are proceeding cautiously and still using chemotherapy for many types of breast cancer. I spend a lot of time explaining to patients the reasons I recommend or do not recommend chemotherapy. I emphasize the role of each treatment modality and interventions such as exercise, diet, weight management, and limiting alcohol use. I do my best to practice ‘evidence-based medicine’ tailored to each individual. Patients are very receptive to that.”

More hope on the horizon

Unfortunately, breast cancer can recur or present at a late stage in some patients. Several clinical trials are studying innovative ways to prolong survival or cure the disease. “Precision medicine – matching cancer patients with treatment, based on the cancer’s molecular profile – is amongst the most promising options in this age of personalized medicine. Sylvester Comprehensive Cancer Center is at the frontline of precision medicine. Our interdisciplinary Molecular Tumor Board is a resource for patients and physicians in South Florida and provides the platform for molecular testing and clinical trial participation,” says Dr. Calfa.

Nancy Moreland is a contributing writer for the UMiami Health News blog.  She has written for several major health care systems and the Centers for Disease Control and Prevention. Her writing also appears in the Chicago Tribune.