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Many Women With Breast Cancer Can Avoid Chemotherapy, New Study Shows

Treatment for early-stage breast cancer could be hormone therapy alone.

ARTICLE FROM Reading Eagle Written by Matthew Nojiri

Dr. Marc Rovito remembers the early years of breast cancer treatment.

“I’m an old-timer,” said Rovito, medical director and medical oncologist at Penn State Health St. Joseph’s cancer center. “I’ve been doing this awhile. If you had a 1 centimeter (tumor) you always got chemo. Period. Those are women we don’t by and large treat with chemotherapy. There are a lot of women who are no longer exposed to chemotherapy that used to be.”

Last week, Rovito and other area cancer experts were reviewing the results of a study published in the New England Journal of Medicine. The research looked at thousands of early-stage breast cancer patients and confirmed what had been a years-long belief among many doctors.

The big takeaway: Many patients with early-stage breast cancer can avoid chemotherapy since they do just as well with hormone therapy alone.

The study, known as TAILORx, was published June 3, but the region’s cancer specialists have been awaiting the results for years.

Area oncologists talked about their desire to treat patients with the best evidence-based therapies, while considering the burden those treatments place on patients.

For many years, that has meant taking a closer look at when to use chemotherapy and when other treatments may work just as well.

“This is a continuation of what’s been happening over the last 15 years,” said Dr. Nick Leasure, co-chair of the Multi-disciplinary Breast Clinic at Reading Hospital McGlinn Cancer Institute. “We’re curing more and more patients with less and less treatment. I think that’s going to continue.”

About the study

The study looked at women with early-stage tumors that were sensitive to estrogen, had tested negative for the protein HER2 and had not spread to the lymph nodes.

The lead researcher told The New York Times the study results could affect as many as 60,000 women a year in the U.S.

For the last 10 years or so, oncologists have looked to a gene test to help get a sense of the chance of recurrence.

The Oncotype DX test looks at the genetic makeup of early-stage breast cancer tumors. Doctors have known patients with lower scores on the test require less treatment, while patients who score higher need more aggressive therapies, Rovito said.

The study looks at 6,711 patients who fall in the middle with a score between 11 and 25. In one group, patients received chemotherapy and the estrogen-blocking hormone drugs, such as tamoxifen. In the other, the patients only received the hormone therapy.

After nine years, the two treatment groups had nearly identical survival rates, with 93.9 percent of patients surviving in the hormone therapy group as compared to 93.8 percent in the group that received both hormone drugs and chemotherapy.

Rovito and Leasure said the study provided good news, confirming the overall trend in breast cancer care for this subset of patients.

“It validated that we were doing the right things by not overtreating,” Leasure said.

The study has one caveat that women under 50 who score in the intermediate zone still get some benefit from chemotherapy, Rovito said.

“If you’re young, we tend to treat you more aggressively because you tend to have a more aggressive tumor,” he said.

Side effects

In general, patients do well on chemotherapy, but that doesn’t mean it should always be the first option, Leasure and Rovito said.

The treatment has well-known side effects from hair loss to fatigue, and there’s always a chance of permanent injuries to the heart and nerves in the body.

“Most people do really well and we’re really good at managing the side effects,” Leasure said. “But you don’t want to expose them unnecessarily to treatment.”

The anti-estrogen hormonal treatment also has its own side effects, such as hot flashes and symptoms of menopause.

“For most patients, that’s preferable to the side effects of chemotherapy,” Rovito said.

Rovito said the study could lead to changes in the national guidelines that direct breast cancer care, and that’s a good thing.

“Treatment is better than it used to be, but it’s still not easy to go through,” Rovito said of chemotherapy. “It’s an every-other-week reminder you have a serious illness.”

Benefits and risks

The chemo question is important beyond the painful side effects, said Kathy Kolb, executive director of Breast Cancer Support Services of Berks County.

There’s a significant cost that comes with the treatment, said Kolb, who was diagnosed twice with breast cancer.

Kolb said she was excited about the idea of patients avoiding the physical and financial toll from chemotherapy.

“A common question that I get is someone telling me, ‘My Oncotype score is in the middle and I don’t know what to do,’ ” Kolb said. “I’m delighted about this study, that it might offer women some guidance.”

She said all breast cancer patients deserve treatment that is based on evidence and research.

“If this research is showing there’s no benefit to chemotherapy for an entire group of survivors, then they shouldn’t be getting it,” she said. “This is something good, and I think it’s really concrete. Hopefully, it takes a gray area out.”