Millions of breast cancer patients could avoid chemotherapy with new genome test
Millions of breast cancer patients could be spared chemotherapy thanks to a revolutionary new genomic test, a clinical trial has shown.
Breast cancer, the most common type of cancer in women in the UK, is usually treated by surgically removing the tumors before tackling a resurgence with chemotherapy.
However, although effective in fighting some forms of cancer, chemotherapy can also bring a host of unwanted side effects, such as hair loss, nausea, insomnia, fatigue, even infertility and cognitive impairment.
Doctors are also concerned that many people with the most common, hormone-sensitive type of breast cancer see little or no benefit from chemotherapy but still experience significant and sometimes dangerous side effects of chemotherapy.
A groundbreaking new genomic test can reliably tell women who will and will not benefit from chemotherapy, a study from University College London (UCL) has shown.
The Optima study observed more than 4,400 men and women ages 40 and older who had surgery for hormone-sensitive breast cancer. All participants were considered to be at high risk of future recurrence and were often prescribed chemotherapy.
All of the participants underwent a genomic test called Prosigna, which measures the activity of genes involved in breast cancer growth.
Those with high scores (above 60) were given chemotherapy and hormone therapy, while those with low scores (60 and below) were given only hormone therapy.
Results in the low-score group that did not receive chemotherapy showed that the results were very similar whether chemotherapy was given or not. Five years after treatment, 94.8 percent of those who received chemotherapy in addition to hormone therapy were alive and free of breast cancer recurrence; Of those who received hormone therapy alone, 93.6 percent were alive and did not relapse.
The results show that people aged 40 and over with hormone-sensitive breast cancer and a low Prosigna score can safely avoid chemotherapy, doctors said.
Karen Bonham, 64, from Cardiff, attended the hearing after she was diagnosed with breast cancer in June 2017.
Ms Bonham was just days away from starting treatment and had “already cut my hair short” when she was told she was part of the group that did not need chemotherapy.
“How can I describe the first feeling? Is it tremendous relief? It’s like Christmas? It’s definitely a mix of both,” he said.
Karen continued to receive radiotherapy and hormone therapy instead of chemotherapy. Almost nine years after her diagnosis, Karen says she no longer finds herself diagnosed with cancer and has returned to normal family life. He added that taking part in the Optima trial “helped me make decisions that enabled me to receive targeted, appropriate treatment more quickly, enabling me to achieve positive health outcomes.”
Researchers said they were confident the trial showed health officials could “safely reduce” the use of chemotherapy for women with breast cancer worldwide.
But they said more research was needed to understand whether the test could provide the same benefits for men and those under 40.
Iain MacPherson, co-principal investigator and professor of breast oncology at the University of Glasgow, said: “Optima provides robust, practice-changing evidence that we can safely reduce the use of chemotherapy for many patients with hormone-sensitive breast cancer.
“These findings represent a major step forward in delivering more personalized, precision care by ensuring that treatment decisions are made based on what will truly improve outcomes for patients while avoiding unnecessary toxicity. The potential impact for both patients and healthcare is enormous.”
