Study Finds That Patients With Early-Stage Breast Cancer May Be Able To Avoid Chemotherapy In The Future

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A recent study by researchers at The University of Texas MD Anderson Cancer found that women with early-stage breast cancer, who had an intermediate risk recurrence score (RS) from a 21-gene expression assay had similar outcomes, whether or not they received chemotherapy.

However, the findings of the study still need to be validated in an ongoing international trial. If the results are verified, women with intermediate scores could be able to avoid chemotherapy as a treatment. The standard care for women with early-stage breast cancer has been very aggressive, assistant professor, Breast Medical Oncology, Carlos H. Barcenas, M.D. explained.

But in previous years, discoveries made across the breast cancer landscape have evolved in a way that less is now more, for women with early-stage disease. "Through years of research discoveries, it became clear that we were over-treating many women with breast cancer, especially those with early-stage disease. In addition to chemotherapy's obvious side effects, there were also long-term complications for these women as survivors," Barcenas said.

Among the discoveries was that a 21-gene-expression assay could predict the risk of recurrence among some women with early-stage breast cancer. Findings from the international clinical trial, TAILORx in 2015, suggest that it is possible for women with hormone receptor positive, HER2 and lymph node negative early stage disease with a low RS of 0-10 to have chemotherapy omitted altogether, according to Medical Express.

Although the findings of the study significantly changed the standard care for women with a low RS, there are still many unanswered questions with regards to the management of women with an intermediate RS, defined as 11-25 score. Barcenas said he often has the conversation to apply or not to apply chemotherapy is his clinic.

In the study, the researchers identified 1,424 Stage I and II breast cancer patients who were treated at the institution between 2005 and 2011. All the patients underwent the 21-gene expression assay. The women were also hormone receptor positive, HER2 and lymph node negative. The researchers stated that none of the identified MD Anderson patients participated in the TAILORx study.

The researchers utilized the same RS cutoff scores that were used in the TAILORx study and found that the RS distribution of the MD Anderson patients was: 21 percent (297) of the patients scored 0 - 10, 63 percent (894) scored 11-25 and 16 percent (233) scored more than 25. Among the participants, 1.7, 15 and 73.4 percent were given chemotherapy, respectively.

The researchers discovered that participants with an RS of 11-25 had an invasive disease-free survival (IDFS) rate at five years of 92.6 percent with a median follow-up of 58 months. This was regardless of whether patients received chemotherapy or not.

They also found that the estimated rates of IDFS and overall survival rate was 93 percent and 98 percent, respectively among the participants who did not receive chemotherapy. This was compared to those who receive chemotherapy, according to Science Daily.

However, due to a relatively short follow-up and the few number of outcome events, the researchers think the benefit of chemotherapy cannot be ruled out yet in this group of patients. They published their findings in the journal Cancer.

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