Who can safely skip chemo for breast cancer?

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Who can safely skip chemo for breast cancer?

http://www.foxnews.com/story/0,2933,199257,00.html?sPage=fnc.health/cancer

Genetic test may help determine which patients can pass on harsh drugs

WASHINGTON - Lowry had a scary decision: Could she safely skip

chemotherapy after surgeons removed her breast cancer?

Tens of thousands of women undergo chemo for breast cancer every year when

they don’t really need it, but doctors don’t have an easy way to tell who

can

gamble on skipping the harsh drugs.

A simple gene test now promises to help women like Lowry make that

nerve-wracking choice & shy; and a major government study is enrolling more than

10,000

patients around the country to see just how well it does the job.

“Most of the patients are advised to have chemotherapy. Most of the patients

are going to do very well without it,†says Dr. Sheila Taube of the National

Cancer Institute. “So how can we spare the patients that don’t need it?â€

Breast cancer is only the opening salvo. Researchers are furiously developing

who-to-treat gene tests for colorectal cancer & shy; particularly for early

Stage 2 disease that doctors fear is being under-treated & shy; and other

malignancies, too.

Gene-tailored therapy

But if the new breast cancer study pans out, it will mark a big step toward

genetically tailored therapy that specialists expect will rapidly replace

today’

s simplistic guidelines for treating early-stage cancer.

More than 100,000 U.S. women a year are diagnosed with early breast cancer

that has a remarkably good prognosis: The tumors are small, haven’t spread,

and

are hormone-sensitive. The vast majority would survive with surgery, radiation

and hormone treatment. Yet guidelines today recommend chemotherapy as well

for most of those women to catch the few who need more aggressive help.

In other words, 100 women get chemo, and the risk of harsh, sometimes

life-threatening, side effects, to prevent two or three of them from relapsing.

The Oncotype DX test is supposed to help winnow out some of that

overtreatment. It checks a woman’s surgically removed tumor for 21 different

genes whose

interactions can predict the likelihood of a relapse. Those odds are calculated

on a scale from zero to 100.

Having a high “recurrence score†& shy; greater than 30 & shy; makes

chemotherapy a good bet: Adding chemo for those patients improves their chances

of

being cancer-free 10 years later from 61 percent to 88 percent, concluded a

manufacturer-funded study that tested tumors stored from hundreds of patients.

But giving chemo to a low-risk patient & shy; a recurrence score of less than

18 & shy; made no difference, researchers reported in the Journal of Clinical

Oncology.

The problem: Women with scores in the middle, between 18 and 30, were in a

grey zone; it’s unclear if they benefited from chemo or not.

The new study, funded by the National Cancer Institute, aims to settle how

the $3,000 gene test affects treatment decisions.

The main purpose: to determine how to treat the half of patients estimated to

fall into that grey zone, with intermediate risk of a relapse. Researchers

will randomly assign those women to either get chemotherapy or skip it, and see

who fares best. (To double-check the earlier findings, the study also will

track low-risk women who skip chemo and high-risk women who get it. )

Results can’t come soon enough, as women like Lowry already struggle to

decipher an intermediate score.

A veteran oncology nurse, Lowry knew she didn’t want to undergo the chemo

side effects she’d watched patients suffer. But the Kokomo, Ind., woman also

had

fought back uterine cancer a year earlier. Was she cancer-prone and thus chemo

would help?

Oncotype DX didn’t give a clear answer; Lowry’s score was 24, solidly in the

grey zone. Still, her doctor used the rating in pouring over previous

research to estimate that chemo would only slightly lower her odds of breast

cancer

returning, validating her decision to skip it.

“It gives us a number, it’s not just a doctor thinking,†Lowry said of the

test. “I think it will help a lot of women make up their minds.â€