Revolution in cancer treatment
AS MANY as 5,000 British breast cancer patients a year could be spared the agony of chemotherapy after one of the biggest breakthroughs in the past two decades.
A landmark study has found that a significant proportion of women with the disease need only a daily pill – such as tamoxifen – to stop their cancer returning after surgery.
The researchers believe these women can be easily identified via a simple genetic test that is already available on the NHS.
Most breast cancer sufferers currently undergo a sixmonth course of chemotherapy after having either a lumpectomy or mastectomy to remove their tumour.
The chemo is supposed to
ensure their cancer does not return but it can come with debilitating side effects.
However, the study says many of these women would do just as well if they simply took a daily hormone therapy pill instead.
It is based on research involving more than 10,000 women, led by Montefiore Medical Centre in New York, and presented at the largest cancer conference in the world.
Last night, Dr alistair Ring, a consultant medical oncologist at the Royal Marsden Hospital in London, described the study as the most significant breast cancer breakthrough in 20 years.
He said: ‘It is about avoiding a treatment that, for most people with cancer, is what
‘Life-changing breakthrough’
they all fear being suggested to have. Chemotherapy use will drop. as an oncologist, I will offer less chemotherapy that will not be of benefit to patients.
‘That is very reassuring to know that when I am offering patients chemotherapy, they are likely to benefit from it.’
In Britain, 23,000 women a year – around 2,300 of them in scotland – are diagnosed with hormone receptor-positive, HeR2negative, axillary node-negative early-stage breast cancer, the most common type.
This affects half of all breast cancer sufferers. These women, whose cancer has not yet spread to their lymph nodes, will first have surgery in the form of a lumpectomy or mastectomy to remove the cancer, and may receive radiotherapy.
Then comes hormone therapy pills such as tamoxifen, which block or slow down signals in the body which trigger the growth of cancer cells, and are typically taken for five years. Patients often also have four to six months of chemotherapy after surgery, to kill any remaining cancer cells.
This is vital for those with the highest risk of their breast cancer returning after surgery, but it comes with side effects such as hair loss, sickness and fatigue.
However, about 69 per cent of women fall into a lower risk group, known as ‘intermediate’. For these, the benefits of chemotherapy have always been less clear cut.
Traditionally, it has been up to doctors to decide if they should have the treatment. The results of this study, however, show these women do not need chemotherapy.
It found that after nine years of taking daily hormone therapy pills, the survival rate for these patients was 93.9 per cent, which is almost exactly the same as the 93.8 per cent rate if women had undergone chemotherapy, too. Figures for those whose cancer returned were also almost identical. Women in this intermediate group can be accurately identified with a genetic test, known as the oncotype DX test, which detects 21 genes in breast cancer tumours and grades their risk of the disease returning from zero to 100.
The Us study found chemotherapy is unnecessary for all intermediate women – those with scores from 11 to 25. This means 3,000 to 5,000 women in Britain – 300 to 500 in scotland – could be spared the treatment every year, according to experts.
The genetic test, which takes two weeks to return results, costs £2,580 but the NHs gets a reduced rate. It is available on the NHs in scotland but it is up to individual clinicians whether to use it.
a scottish Government spokesman said: ‘our cancer strategy is clear in the expectation that oncotype DX be introduced for all women with breast cancer who would clinically benefit from it. Its use is an individual clinical decision for each person, in discussion with their consultant or other relevant healthcare professional.’
Rachel Rawson, clinical nurse specialist at Breast Cancer Care, said: ‘This lifechanging breakthrough is wonderful news.’
Chemotherapy typically costs £4,500 per patient, so the findings could save the health service millions of pounds.
The results were presented at the american society of Clinical oncology conference in Chicago. Dr Joseph sparano, lead author of the research, said: ‘Chemotherapy may be avoided in about 70 per cent of these women when its use is guided by the test, limiting chemotherapy to the 30 per cent who we can predict will benefit from it.’