Breast cancer patients could be SPARED from gruelling chemotherapy

More than two thirds of breast cancer patients diagnosed each year could be SPARED from gruelling chemotherapy ordeal by taking a daily pill

  • Breast cancer sufferers undergo a tiring six-month course of chemotherapy
  • Landmark study found a daily pill such as tamoxifen could stop cancer returning 
  • Researchers from Montefiore Medical Centre New York studied 10,000 women

More than two thirds of breast cancer patients a year could be spared the ordeal of chemotherapy after one of the biggest breakthroughs in the last two decades.

Around 123,000 women in the US and 23,000 in the UK are diagnosed with hormone receptor-positive, HER2-negative, axillary node-negative early-stage breast cancer (HR+HER2-AN) each year.

But for 69 per cent of these women, they do not need to go through chemotherapy and only require a daily pill – such as tamoxifen – to stop their cancer returning after surgery.

Remarkably, the researchers believe that these women can be easily identified via a simple genetic test that is already widely available on the NHS and approved by the FDA.

Oncologists have hailed the decade-long study, which involved more than 10,000 women and was led by Montefiore Medical Center in New York. The results were presented at the largest cancer conference in the world.

The study found that women with the disease need only a daily pill to stop their cancer returning after surgery

HR+HER2-AN is the most common type of breast cancer and accounts for half of all cases.

These women, whose cancer has not yet spread to their lymph nodes, will first have surgery in the form of a lumpectomy or mastectomy to remove the cancer, and may receive radiotherapy.

Then comes hormone therapy pills such as tamoxifen, which block or slow down signals in the body that trigger the growth of cancer cells, and are typically taken for five years.

Patients often also have four to six months of chemotherapy after surgery, to kill any remaining cancer cells. This is supposed to ensure their cancer doesn’t return, but it can come with debilitating side effects.

This is vital for those with the highest risk of their breast cancer returning after surgery, but it comes with side effects such as hair loss, sickness and fatigue.

However, about 69 per cent of women actually fall into a lower risk group, known as ‘intermediate’. For these, the benefits of chemotherapy have always been less clear cut.

Traditionally, it has been up to doctors to decide if they should have the harrowing treatment. The results of the new study, however, show that these women do not need chemotherapy.

It found that after nine years of taking daily hormone therapy pills, the survival rate for these patients was 93.9 per cent, which is almost exactly the same as the 93.8 per cent rate if women had undergone chemotherapy too.

Figures for those whose cancer returned were also almost identical.

Ready-made sauces boost disease risk to women

Home cooks who do not make their entire meals from scratch could be almost tripling their risk of getting the most aggressive form of breast cancer, a study claims.

Scientists have warned against turning to convenient ready-made sauces, such as those used on pasta dishes, and industrially produced baked goods.

They have been found to be part of a so-called ‘inflammatory diet’, along with red and processed meat, high-fat dairy products and eggs. A study of almost 2,000 women by Spanish researchers found those who ate the most inflammatory foods were 39 per cent more likely to develop breast cancer than those who ate the least.

And they were 2.72 times more likely to develop the triple-negative type, which is much more aggressive and difficult to treat.

The key may be to make your own food from scratch, the study suggests. Foods such as onions, garlic and tomatoes, which are found in home-made pasta sauces, are anti-inflammatory and may reduce breast cancer risk.

Professor Adela Castello, who led the study at Carlos III Health Institute in Spain, said: ‘Some of the most inflammatory dietary components are present in pasta, rice and flour, and bad fats such as cholesterol, saturated fats and trans fats, present in convenience food, industrial baking and sauces.’

But she said only women who eat large amounts of unhealthy food need to worry.

Dr Emma Pennery, from Breast Cancer Care, described the findings as ‘intriguing’. But she added: ‘There’s a long way to go until we’ve connected the dots to properly understand the effect a high inflammatory diet might have on breast cancer risk.’

Women in this intermediate group can be accurately identified with a genetic test, known as the Oncotype DX test, which detects 21 genes in breast cancer tumours and grades their risk of the disease returning from zero to 100.

The study found chemotherapy is unnecessary for all intermediate women – those with scores from 11 to 25. 

The TAILORx study also found women older than 50 with this form of breast cancer and a score of up to 25 did not need chemotherapy. Under 50s with a score of up to 15 can also be spared the treatment.

Previously, only women with scores between zero to 10 could skip chemotherapy. 

Dr Alistair Ring, a consultant medical oncologist at the Royal Marsden Hospital in London, last night described the study as the most significant breast cancer breakthrough in 20 years.

‘It is a significant step because it is about avoiding a treatment that, for most people diagnosed with cancer, is what they all fear being suggested to have,’ he said.

‘Our chemotherapy use will drop. As an oncologist, on Monday in the clinic, I will offer less chemotherapy that will not be of benefit to patients and that is very reassuring to know that when I am offering patients chemotherapy, they are likely to benefit from it.’

The genetic test, which takes two weeks to return results and has been widely available since 2013, costs £2,580 ($3,450), and the NHS gets it for a reduced rate.

Rachel Rawson, clinical nurse specialist at charity Breast Cancer Care, said: ‘This life-changing breakthrough is absolutely wonderful news as it could liberate thousands of women from the agony of chemotherapy.

‘Every day women with certain types of breast cancer face the terrible dilemma of whether or not to have the treatment, without hard facts about the benefit for them.

‘Side effects, such as hair loss, severe pain and infertility, can be utterly devastating and linger long after they walk out the hospital doors.’

The results were presented during the plenary sessions at the American Society of Clinical Oncology conference in Chicago, which is for research with the most potential to change patient care.

Lead author Dr Joseph Sparano said: ‘Our study shows that chemotherapy may be avoided in about 70 per cent of these women when its use is guided by the test, thus limiting chemotherapy to the 30 per cent who we can predict will benefit from it.’

Chemotherapy typically costs £4,500 ($6,015) per patient, so the findings could save money for both the NHS and tens of thousands of women battling the cancer in the US. 

Dr Otis Brawley, chief medical and scientific officer for the American Cancer Society who was not part of the study, said: ‘I’m delighted. 

‘I’ve been worried for a long time about unnecessary treatment for cancer, and unnecessary side effects from chemotherapy.

‘Now with these genomic tests, we are finding that we have multiple types of breast cancer, perhaps several dozen and we are being able to tailor our therapies to the type of breast cancer every woman has.’

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