research

Chemotherapy no longer required in 70 percent of breast cancer cases

New study says no chemotherapy needed to treat common breast cancer

A 21-gene test performed on tumors could enable most patients with the most common type of early breast cancer to safely forgo chemotherapy, according to a landmark study published in the New England Journal of Medicine.

Loyola Medicine oncologist Kathy Albain, MD, is among the main co-authors of the study and a member of the clinical trial's steering committee. First author is Joseph Sparano, MD, of Montefiore Medical Center in Bronx, N.Y. The study was published in conjunction with its Sunday, June 3 presentation at the plenary session of the American Society of Clinical Oncology 2018 meeting in Chicago.

"With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70 percent of patients who are diagnosed with the most common form of breast cancer," Dr. Albain said. "For countless women and their doctors, the days of uncertainty are over."

Dr. Albain, the Huizenga Family Endowed Chair in Oncology Research at Loyola University Chicago Stritch School of Medicine, has conducted research with the 21-gene test and also used it in her practice for years.

The test examines 21 genes from a patient's breast cancer biopsy sample to determine how active they are. The tumor is assigned a "recurrence score" from 0 to 100; the higher the score, the greater the chance the cancer will recur in distant organs and decrease survival. If patients with higher scores receive chemotherapy, this risk of recurrence will be significantly reduced, enabling more patients to be cured.

Previously, the challenge doctors and patients have faced is what to do if a patient has a mid-range score. It was uncertain whether the benefit of chemotherapy was great enough to justify the added risks and toxicity. Previous studies demonstrated that patients with low scores (10 or lower) did not need chemotherapy, while women with high scores (above 25) did require and benefit from chemotherapy.The new study examined the majority of women who fall in the intermediate range of 11 to 25.

The study enrolled 10,273 women who had the most common type of breast cancer (hormone-receptor positive, HER-2 negative) that had not spread to lymph nodes. Researchers examined outcomes of the 69 percent of patients who had intermediate scores on the 21-gene test.

Patients were randomly assigned to receive chemotherapy followed by hormonal therapy or hormone therapy alone. Researchers examined the chemotherapy and non-chemotherapy groups for several outcomes, including being cancer free, having cancer recur locally or to distant sites in the body and overall survival.

For the entire study population with gene test scores between 11 and 25 — and especially among women aged 50 to 75 — there was no significant difference between the chemotherapy and no chemotherapy groups. Among women younger than 50, outcomes were similar when gene test scores were 15 or lower. Among younger women with scores 16 to 25, outcomes were slightly better in the chemotherapy group.

"The study should have a huge impact on doctors and patients," Dr. Albain said. "Its findings will greatly expand the number of patients who can forgo chemotherapy without compromising their outcomes. We are de-escalating toxic therapy."


Story Source: See this article on Science Daily: "More breast cancer patients can safely forgo chemotherapy: Study." ScienceDaily. ScienceDaily, 3 June 2018. www.sciencedaily.com/releases/2018/06/180603193614.htm. Materials provided by Loyola University Health System. Study published in the New England Journal of Medicine.

New study reveals: Women Really are Better Survivors

Women survive crises better than men Newborn girls are hardier than newborn boys during famines, epidemics
Women today tend to live longer than men almost everywhere worldwide — in some countries by more than a decade. Now, three centuries of historical records show that women don’t just outlive men in normal times: They’re also more likely to survive even in the worst of circumstances, such as famines and epidemics.
Women today tend to live longer than men almost everywhere worldwide — in some countries by more than a decade.

Now, three centuries of historical records show that women don’t just outlive men in normal times: They’re more likely to survive even in the worst of circumstances, such as famines and epidemics, researchers report.

Most of the life expectancy gender gap was due to a female survival advantage in infancy rather than adulthood, the researchers found. In times of adversity, newborn girls are more likely to survive.

The fact that women have an edge in infancy, when behavioral differences between the sexes are minimal, supports the idea that explanation is at least partly biological, the researchers say.

Led by Virginia Zarulli, an assistant professor at the University of Southern Denmark, and James Vaupel, a research professor at Duke University, the team analyzed mortality data going back roughly 250 years for people whose lives were cut short by famine, disease or other misfortunes.

The data spanned seven populations in which the life expectancy for one or both sexes was a dismal 20 years or less. Among them were working and former slaves in Trinidad and the United States in the early 1800s, famine victims in Sweden, Ireland and the Ukraine in the 18th, 19th and 20th centuries, and Icelanders affected by the 1846 and 1882 measles epidemics.

In Liberia, for example, freed American slaves who relocated to the West African country in the 1800s experienced the highest mortality rates ever recorded. More than 40 percent died during their first year, presumably wiped out by tropical diseases they had little resistance to. Babies born during that time rarely made it past their second birthday.

Another group of people living in Ireland in the 1840s famously starved when a potato blight caused widespread crop failure. Life expectancy plummeted by more than 15 years.

Overall the researchers discovered that, even when mortality was very high for both sexes, women still lived longer than men by six months to almost four years on average.

Girls born during the famine that struck Ukraine in 1933, for example, lived to 10.85, and boys to 7.3 — a 50 percent difference.

When the researchers broke the results down by age group, they found that most of the female survival advantage comes from differences in infant mortality. Newborn girls are hardier than newborn boys.

The results suggest that the life expectancy gender gap can’t be fully explained by behavioral and social differences between the sexes, such as risk-taking or violence.

Instead, the female advantage in times of crisis may be largely due to biological factors such as genetics or hormones. Estrogens, for example, have been shown to enhance the body’s immune defenses against infectious disease.

“Our results add another piece to the puzzle of gender differences in survival,” the researchers said.

The findings were published Jan. 8, 2018, in the early online edition of Proceedings of the National Academy of Sciences.


Read this article on Science Daily:

Duke University. “Women survive crises better than men: Newborn girls are hardier than newborn boys during famines, epidemics.” ScienceDaily. ScienceDaily, 9 January 2018. <www.sciencedaily.com/releases/2018/01/180109105941.htm>.