Oncotype Score Game Changer for Early Stage Breast Cancer

Striving for NED…Chemotherapy is one of the most stressful elements of any cancer treatment. One of the major pieces of news out of this year’s ASCO meeting applies to a personalized medicine approach to an old therapy. Is chemotherapy necessary for early stage breast cancer? It’s hard to find something these days that doesn’t fall into the category of personalized medicine. Cancer drug trials now characterize patients based on what’s driving their disease.

The American Society of Clinical Oncology (ASCO) holds an annual meeting each year in Chicago. Tens of thousands of people with a stake in cancer research gather in the nation’s largest convention center to learn about the latest developments in treating the disease. The updates shared at the American Society of Clinical Oncology conference are practice-changing for doctors, and life-changing for patients. Research presented at the meeting often results in oncologists adopting significant treatment protocol changes.

At this year’s ASCO meeting (2019), a study published in the New England Journal of Medicine was presented. Researchers reported that chemotherapy may be unnecessary for many women with early-stage breast cancers. Findings showed that hormonal therapies, which women typically take for five years, are enough. Both the women taking hormone treatment alone and those taking the combination of hormone treatment and chemotherapy had a nearly 94% chance of surviving their cancer after nine years. The take-home message for oncologists was that an unprecedented level of evidence shows chemotherapy is not necessary for these patients.

Who would benefit? Findings presented were for early stage, Her2 and node negative breast cancer with mid-range oncotype DX scores. (Refer to my earlier blog on this genetic test) Previously women and their doctors wondered if those patients with an intermediate Recurrence Score of 11 to 25 could skip chemotherapy? For this type of breast cancer that accounts for nearly half of all cases, chemotherapy was traditionally administered followed by five years of hormonal therapy.

 

Up until now, it hasn’t been clear whether certain women benefited from chemotherapy after surgery. A study funded by the National Cancer Institute as well as other groups found that chemotherapy in this setting only benefits about 30 percent of women in this group. The remaining 70 percent are likely to see the same outcome without chemotherapy. Women with mid-range oncotype scores who were prescribed chemotherapy will now be spared the process.

“Practically speaking, this means that thousands of women will be able to avoid chemotherapy, with all of its side effects, while still achieving excellent long-term outcomes,” ASCO expert Burstein said in a press release about the trial, which is dubbed TAILORx.

When I was diagnosed nine years ago, the oncotype score as a predictor for recurrence had recently been accepted. Since I had a low score, I was spared chemotherapy. I remember at the time feeling uneasy about not adding chemotherapy to my treatment plan as a precaution. Chemotherapy was the accepted protocol for all cancers before the oncotype score, and I thought it would give me more “insurance” to avoid recurrence. This study now proves that survival rates for not only low oncotype but also mid-range scores are no different without chemotherapy. This is amazing and wonderful news for women who have been newly diagnosed since the process and side effects of chemotherapy can be devastating. It’s wonderful to see the paradigm shift from the “one fits all” treatment to an "individualized oncology" approach.