Clinical Trial Shows Some Breast-cancer Survivors Can Forgo Chemotherapy

SPRINGFIELD — Some breast-cancer survivors now may have the option to safely avoid the toxic side effects of chemotherapy.

“Precision medicine is an evolving field today. It can mean more customized treatment for groups of cancer patients whose tumors share certain genetic properties or the choice of less treatment based on statistical outcomes within a group with some shared similarities,” said Dr. Grace Makari-Judson, chair of the Baystate Health Breast Network.

She noted that forward-looking studies, like one presented recently at the annual meeting of the American Society of Clinical Oncology, can now evaluate risk for invasive breast-cancer recurrence among certain survivors and help clinicians and survivors decide on best treatment options.

During the society’s June meeting in Chicago, the results of a 10-year breast cancer study, in which Baystate Regional Cancer Program oncologists and patients were participants, were presented. The study demonstrated that a wider group of women with early-stage breast cancer may be able to forego chemotherapy based on the molecular profile of their tumors for early-stage invasive breast-cancer recurrence post-surgery.

The study, “Trial Assigning Individualized Options for Treatment,” is practice-changing for many women newly diagnosed with stage I and stage II estrogen-receptor-positive, Her2-protein-negative breast cancer that has not spread to the lymph nodes, even if molecular testing of their tumor sample shows intermediate risk for recurrence.

Women with estrogen-receptor-positive breast cancer are uniformly recommended hormonal treatment after surgery for node-negative breast cancer. This often means using an oral medication that blocks the effect of estrogen in breast tissue, as this type of breast cancer can use the hormone to grow.

Previous studies in the trial had shown those with low-risk scores had done well with hormonal treatment alone. Those at high risk need chemotherapy — medicines designed to kill cancer cells — as well as hormonal treatment.

“However, questions remained as to the ideal treatment for women with tumors in the intermediate risk group,” Makari-Judson said.