Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

Thought provoking

https://www.medscape.com/viewarticle...=1685006&faf=1

Abstract Medscape
Monday, July 16, 2018

"CHICAGO — Adjuvant chemotherapy is not necessary for a large proportion of women with early-stage breast cancer, according to new findings that experts agree are "practice changing."

The results come from a federally funded study, the Trial Assigning IndividuaLized Options for TReatment (TAILORx), which involved more than 10,000 patients and tested the 21-tumor gene expression assay (Oncotype Dx, Genomic Health).

"This is the largest adjuvant breast cancer trial ever performed," said lead study author Joseph A. Sparano, MD, associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Health System in New York City and vice-chair of the ECOG-ACRIN Cancer Research Group.

"What we were really trying to do with this trial was 'thread the needle,'" he said.

"In terms of the big picture and the impact on care, application of this test in clinical practice in this population will spare an estimated 70% [of patients] and limit chemotherapy to the 30% who may benefit from it," he added.

The results showed that about 70% of patients with hormone receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative, axillary node–negative early-stage breast cancer, who received a midrange (intermediate) score on the Oncotype Dx test, could be spared chemotherapy. The trial found no difference in the disease-free survival whether these women were treated with endocrine therapy alone or with the combination of endocrine therapy with chemotherapy."

. . . More in relation to specific groups follows . . .

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

This report is for her2 negative....not those with her 2 postive.

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

If you're HER2 positive, you should get chemo. Believe me, first time around they said they took it out and I didn't need chemo, nearly 5 years later, it was back and had spread. Not worth the risk. I wanted Herceptin then but back then it was only given to metastatic patients.

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

I’m with Sarah on this one. I was diagnosed with stage 1a and had radiation as well as anti-estrogens for 10 years. Herceptin was out of the question for early stage. 12 years later...

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

I understand you feel that way, but scientifically.... how do you explain all the women who have used chemo and still get reoccurrence?

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

Chemo kills a percentage of cells. Say 99.9%. There are still many cancer cells left and the survivors are resistant to the chemo that killed 99.9% of their "siblings." In time these survivors grow and multiply enough to form new mets. This new cancer is resistant to previous chemos.

The key may be copper reduction. Once you kill 99.9% of the original cancer, if you reduce the serum copper to 20% of normal, you have enough copper in your body to live but not enough copper for the surviving cancer cells to grow to more than about one million cells which is very small and insignificant. Once the cancer reaches this one million cell limit the cancer has to produce its own blood vessels to grow further and copper is an important cofactor for blood vessel formation known as angiogenesis.

Look up the work of Dr. Linda Vahdut and her use of Ammonium Tetrathiomolybdate copper chelation as a treatment for the aggressive triple negative breast cancer. The pioneer in the use of copper reduction as a treatment for cancer is Dr. George Brewer. He did his work in 1999 and published his results in 2000, 18 years ago. Yet so little is known about it. It should be on the news. I think these discoveries are far more important than what the media broadcasts today.

I mention Dr Vahdut and copper reduction for triple negative breast cancer. It is not just breast cancer. At present cancer cells of all types need copper for angiogenesis. There are 2 of courses.

1. Even tough you could treat breast, pancreatic, esophageal, colon, and other cancers (melanoma, even lymphomas and leukemias ) with copper reduction therapy, obviously the results in the differing cancers would differ, some being effectively treated, others not.

2. Of course in time a cancer may mutate to the point where copper is no longer needed for angiogenesis.

At the present time it is.We have to deal with now

Paul

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

Crystald, to respond to your question. If we knew the answer as why some patients respond to herception and some do not we would be seeing more cures. Each person and body is unique. chemistry and DNA etc. But we do know this, Herceptin has proven to save those with Her2 positive breast cancer. Not 100% cure. We are not there, unfortunately.

I will say this again and again to all, when I met with Dr. Salmon he said (and this was over 10 years ago. Anyone with Her2 positive breast cancer should have Her2.
There are those who do not want to have the chemo portion of the cocktail.
But, what we have now is Herceptin with chemo.

We just do not have all the answers to the puzzle. We do know what we know thus far. Herceptin is advisable for HER2 positive.

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

As I live in the Netherlands, things are done differently here. I was borderline Her2 positive and Herceptin was only available for metastatic disease at the time. I had radiotherapy & 5 years of endocrine therapy. In 3 months it will be 15 years since my diagnosis. So no chemo, no recurrence so far.

There are no guarantees with this disease, but with every year that passes I'm more hopeful. According to Dutch statistics, in three years time I'll be just as likely to develop breast cancer as any other woman. I think it's a 1 in 8 chance. Not great, but a lot better than it used to be for the past 14 years.

Jacqueline

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

It's one of those things where if I didn't get chemo and it came back I would believe it was because I refused chemo - same for herceptin. Chemo is not fun but I'd rather get a drug and not have needed it than to have passed on it and find out (or if it came back wonder if) it would've made the difference in whether I had a recurrence or not. Kind of a better safe than sorry thing for me.

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

As the first person replying to this thread said, this study showed that for those early breast cancer patients without the HER2+ factor, and with Estrogen factor, those who only take the hormone-cancelling treatment do about as well as those who take that plus get chemo.
This is not about HER2+ people like all/most of us.
In answer to Chrystald and donocco, I understand that the answer to how and why breast cancers metastasize comes down to stem-cell-like tumor cells. Despite the amount of main-stream professional research going into this issue, few people seem to know about stem-cell-like tumor cells, which are very abundant in HER2+ tumors and much less so in luminal types. I believe this lack of information/interest is because almost all the research into breast cancer is done as trials of drugs, and is funded by drug companies whose interest is in establishing the best dosages to use for different treatment regimes. And because our oncological teams do not see it as relevant, which is ironic because the breast cancer we die of (if we die of it) will almost certainly be metastatic breast cancer. But they are mostly concerned with treating the biggest patient group, ie newly diagnosed individuals with early breast cancer. WHich I cynically think is because it is the biggest market for their drugs.

The research that has been done into stem-cell-like-tumor cells shows that these cells even seed themselves into bloodstream and lymph system, eg as they break out of the cell membrane of the duct they start in to become invasive ductal carcinomas. And they are easily spilt during any biopsy or surgery that breaks open the tumor. Once in the bloodstream, they change form and float around till they find a suitable niche to grow in, in tissue that is of the right sort (eg lung, liver, brain), and if they can establish a food source and not get devoured by the right sort of white blood cell, they develop into a metastatic tumor. This may have happened before we get our diagnosis and have surgery/herceptin/chemo/radiotherapy, or the seeding can happen anytime up to the total removal of the whole tumor. Some stem-cell-tumor cells may find a niche that doesn't support their growth. Some may begin growing before we finish herceptin/chemotherapy, and then get hit by our chemotherapy and wiped out. Some may get consumed by our immune system before they can do anything. Mets are only diagnosed once they are over about 1cm so we don't really know if they are there until they make it big enough and are located somehow. I don't think the individual tumor cells floating in the bloodstream are at risk from herceptin/chemo, only the ones that are still in the breast tissue or have found a niche to metastasise.

The closest our oncological providers get to talking to us about stem-cell-like tumor cells is to recommend we have radiotherapy "to mop up anything left behind" if we have a lumpectomy or are node-positive. And that if we survive NED for 5 years, we then have no more chance that any other person our age without breast cancer of getting it again, back or mets.

It surprised me to discover there was this whole area of high-quality professional research, discovering for example that various food chemicals like tumeric and green tea have substances that can affect stem-cell-like tumor cells. And that there is this complete scientific explanation as to why even if we have every last bit of breast tissue removed, and massive herceptin/chemotherapy and radiotherapy, we may still get metastatic cancer.

Re: Chemo Not Needed for Most Early Breast Cancer: TAILORx
 

Living despite being at some risk of maybe dying soon is about the only life anyone gets. I love Peggy Lee's sentiment:

I remember when I was a very little girl, our house caught on fire
I'll never forget the look on my father's face as he gathered me up
in his arms and raced through the burning building out to the pavement
I stood there shivering in my pajamas and watched the whole world go up in flames
And when it was all over I said to myself, is that all there is to a fire
Is that all there is, is that all there is
If that's all there is my friends, then let's keep dancing
Let's break out the booze and have a ball
If that's all there is...