Breast cancer is the second most common type of cancer in the United States. Half of the cases involve tumors that contain receptors for the hormones estrogen and/or progesterone (hormone receptor (HR)-positive), have very little of a growth-related protein called HER2 on the surface (HER2-negative), and have not moved to the lymph nodes (axillary lymph node-negative).
Many women with this type of breast cancer are advised to receive chemotherapy in addition to radiation and hormonal therapy. Treatment recommendations are based on their risk for a breast cancer recurrence. There are several commercially available tests to predict breast cancer recurrence. The Oncotype DX test (Genomic Health, Inc.) assesses 21 genes to assign a risk score for cancer recurrence on a scale of 0–100. Based on earlier evidence, women with a score in the low-risk range (0–10) can receive hormone therapy only. Those with a score in the high-risk range (26 and above) should be treated with hormone therapy and chemotherapy. For women with an intermediate level of risk for recurrence (11–25), however, the best course of action hasn’t been clear.
To investigate treatment options for women with intermediate risk levels, a clinical trial called TAILORx was designed to follow more than 10,000 women worldwide who had early-stage, HR-positive, HER2-negative, axillary lymph node-negative breast cancer. The study was supported in part by NIH’s National Cancer Institute (NCI).
When the women were enrolled, from April 2006 to October 2010, their tumors were analyzed using the Oncotype DX test. Those in the low-risk range received hormone therapy only. Those in the high-risk range were treated with hormone therapy and chemotherapy. Women in the intermediate range were randomly assigned to receive hormone therapy with chemotherapy or hormone therapy alone. Results were published online in the New England Journal of Medicine on June 3, 2018.
The rates of women who survived, or didn’t develop a recurrence or a second primary cancer, were very similar in both groups in the intermediate risk category. Five years after treatment, the rate of invasive disease-free survival was 92.8% for hormone therapy alone and 93.1% for those who also had chemotherapy. At nine years, the rate was 83.3% for those with hormone therapy alone and 84.3% for the group that had both therapies.
Some premenopausal women and those younger than 50 years old at the higher end of the intermediate-risk range (16–25) showed a small benefit from chemotherapy. However, it’s unclear why. Women in this group should consider chemotherapy with their doctor.
“The new results from TAILORx give clinicians high-quality data to inform personalized treatment recommendations for women,” says lead researcher Dr. Joseph A. Sparano of the Albert Einstein Cancer Center and Montefiore Health System. “These data confirm that using a 21-gene expression test to assess the risk of cancer recurrence can spare women unnecessary treatment if the test indicates that chemotherapy is not likely to provide benefit.”
The Southern Maryland Chronicle is a local, small business entrusted to provide factual, unbiased reporting to the Southern Maryland Community. While we look to local businesses for advertising, we hope to keep that cost as low as possible in order to attract even the smallest of local businesses and help them get out to the public. We must also be able to pay employees(part-time and full-time), along with equipment, and website related things. We never want to make the Chronicle a “pay-wall” style news site.
To that end, we are looking to the community to offer donations. Whether it’s a one-time donation or you set up a reoccurring monthly donation. It is all appreciated. All donations at this time will be going to furthering the Chronicle through hiring individuals that have the same goals of providing fair, and unbiased news to the community. For now, donations will be going to a business PayPal account I have set-up for the Southern Maryland Chronicle, KDC Designs. All business transactions currently occur within this PayPal account. If you have any questions regarding this you can email me at email@example.com
Thank you for all of your support and I hope to continue bringing Southern Maryland the best news possible for a very long time. — David M. Higgins II