Who Can Safely Skip Chemo for Breast Cancer?

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Who can safely skip chemo for breast cancer?

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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 ­ 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? "

Breast cancer is only the opening salvo. Researchers are furiously

developing who-to-treat gene tests for colorectal cancer ­

particularly for early Stage 2 disease that doctors fear is being

under-treated ­ 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 " ­ greater than 30 ­ 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 ­ a recurrence score of less

than 18 ­ 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. "

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information is intended for educational purposes only, in order to

help you make informed health choices and may not have been touched

upon by your doctors. We are not doctors and we do not recommend any

particular treatments. We are sending this information to advise you

of the complete scientific overview that is currently available,

although we may not necessarily endorse it.

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