Early stage BC chemo prevention of recurrence "are only one in 20 to one in 100" ? !!

[R.B.]

Thought Provoking.

More info needed!!!

RB


http://www.wnbc.com/news/9407297/detail.html

ABSTRACT


"The words "breast cancer" are enough to scare most women. Not only must they face the fear of death, but the prospect of chemotherapy is also daunting.

Breast cancer patient Victorine Lambert said she knows chemotherapy kept her alive, but acknowledged that the treatment is very difficult.

"I've just basically been on and off the chemo," she said. "Sometimes it's been alright. Sometimes (I) have bad days."

Lambert's cancer was advanced enough that she clearly needed chemotherapy.

But when a breast tumor is found at an early stage, the chances that chemotherapy will actually help prevent a recurrence are only one in 20 to one in 100.

Since there's no way to tell which individual patient will benefit from chemotherapy, Dr. Joseph Sparano said some women get it when they don't need it.

"It certainly means that most women that we're treating who have early-stage estrogen-receptive-positive breast cancer, are being overtreated with chemotherapy," said Sparano. "Not intentionally, but in order to provide a level of safety to prevent a relapse, because we really can't predict who is clearly benefiting from the treatment."

But a new genetic test called Oncotype DX is changing that. The test analyzes a pattern of a set of 21 genes that, taken together, give doctors a numerical indication of the likelihood of breast cancer recurring.

The test also helps predict which chemo drugs are most likely to be effective against a particular tumor. In other words, it can lead to personalized cancer therapy.

"One size definitely doesn't fit all as it relates to cancer therapy," said Sparano.

A woman who scores high on the Oncotype DX test would almost certainly benefit from chemotherapy, while those who score very low would not.

However, nearly half of hormone-positive breast cancer patients fall into a gray area in the middle. So Sparano is part of a trial where patients will be randomly assigned to get either chemotherapy and hormone blockers, or blockers alone.

"This is part of an effort to try and individualize the therapy based on the characteristics of the tumor, rather than the characteristics of many tumors in a large population," said Sparano.

This multicenter national trial needs to recruit about 10,000 breast cancer patients, about 4,500 of whom will fall into that gray zone between clearly needing and clearly not needing chemotherapy.

Researchers at Montefiore Medical Center are looking for volunteers. For more information about participating, call (718) 405-8522."

[Becky]

Please take this at face value as it emphasizes hormone positive bc. At ASCO, many of the posters and presentations focused on who chemo helps the most in an adjuvant setting. Chemo may not help women with early breast cancer that are only highly ER/PR positive. Even if there are 3 or less nodes involved. However, regardless of ER/PR status, if you are Her2 positive, chemo is of great benefit regardless of node status. It is also very beneficial to the triple negative women, regardless of node status.


The taxanes seem to be of absolutely no value if you are only hormone positive but it is of great value (after AC in these studies) if you are Her2+ (again - of great benefit if you are also hormone positive too - as long as you are also Her2) or triple negative. There were equal results of AC followed by taxol or taxotere.

Therefore, it is imperative that women who are hormone positive take hormone therapy AND if they are not strongly positive (but her2 negative), perhaps get their tumor tested for Her1 or get into a trial using Avastin in early stage or something like that (because they probably have something else going on as well).

This article is absolutely geared to the highly hormone positive women.

Kind regards

Becky