Automatic texting helps ease stress of chemotherapy in breast cancer patients
Jun 05 2018 by Kathy Alvarado
"Oncologists have been getting much smarter about dialing back treatment so that it doesn't do more harm than good", said Steven Katz, a University of MI researcher who examines medical decision-making.
Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major worldwide study that is expected to quickly change medical treatment.
The first patient to undergo the treatment, Judy Perkins, was diagnosed with incurable stage 4 breast cancer in 2013, ten years after undergoing a mastectomy for an earlier bout with the disease.
For women under 50 with a score of 0 to 15, chemo could be skipped.
The study was centred on a 21-gene test performed on tumours that has been available for breast cancer patients since the early 2000s.
The treatment, which succeeded after all other conventional treatments had failed, marks the first successful application of T-cell immunotherapy for late-stage breast cancer.
Of the 9,717 women, 6,711, or 67 percent, had test scores indicating an intermediate risk of recurrence - their score was 11 to 25.
The study is limited in some ways.
A recently published case study from an ongoing clinical trial has revealed an experimental immunotherapy treatment has cured a breast cancer patient.
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Thousands of breast cancer patients may be safely spared gruelling chemotherapy following a landmark study.
Albain said research is ongoing, as scientists are now exploring questions about what types of chemotherapy might be effective on various groups based on their genomics, and what will happen to the participants of the clinical trial as even more time passes. For women aged under 50 with scores of 16-25, there was some benefit in getting chemotherapy, but for those aged over 50 with scores under 25, or those aged under 50 and scores below 16, there was nothing to be gained from going through the draining process.
Out of the 100,000 or so patients who could take the gene test to help make a decision about chemotherapy, he says at least two-thirds fall into the middle range that can benefit from the study findings.
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.
A high recurrence score, above 25, means chemo is advised to ward off a recurrence, while a low score, below 10, means it is not.
Patients were randomly assigned to receive hormone therapy or chemotherapy, followed by hormone therapy.
The new approach - a modified version of a technique known as adoptive cell transfer (ACT) - is being developed by researchers at the National Cancer Institute in the USA, and involves sequencing the DNA and RNA of tumours to try to identify mutations that were unique to her specific cancer. Others want chemo for even the smallest chance of benefit.
Oncotype DX is becoming more standard. After that, a Phase 3 trial will need to broaden the volume of patients treated to verify any positive results, .
Harold Burstein, a breast cancer specialist at Dana-Farber Cancer Institute, said that in some ways the debate over de-escalation misses a larger issue. Their study showed, for example, that chemotherapy use in patients whose cancer had not spread to the lymph nodes declined from 26.6 percent in 2013 to 14.1 percent in 2015. "We want to give the right amount", he said.