TAMPA – Two major studies released Sunday show that many people withbreast and lung cancers may forgo chemotherapy and still live longer,signaling a waning need for what was long seen as the standard of cancercare.
The findings were released at the American Society of Clinical Oncology(ASCO) meeting in Chicago, the world’s largest annual cancer conference.
The first study, described as the largest breast cancer treatment trial todate, found that the majority of women with a common form of breast cancermay be able to skip chemotherapy and its toxic, and often debilitating,side effects after surgery depending on their score on a genetic test.
As many as 65,000 women in the United States alone could be affected by thefindings.
Until now, women have faced considerable uncertainty about whether to addchemo to hormone therapy after a diagnosis with hormone-receptor positive,HER-2 negative breast cancer when found at an early stage, before it hasspread to the lymph nodes.
“With results of this groundbreaking study, we now can safely avoidchemotherapy in about 70 percent of patients who are diagnosed with themost common form of breast cancer,” said co-author Kathy Albain, anoncologist at Loyola Medicine in a Chicago suburb.
A 21-gene test called Oncotype DX, available since 2004, has helped guidesome decisions on proper care after surgery. A high recurrence score, above25, means chemo is advised to ward off a recurrence, while a low score,below 10, means it is not.
The current study focused on those whose scores were in the middle range,from 11 to 25.
More than 10,000 women, aged 18 to 75, were randomly assigned to receivechemotherapy followed by hormone therapy, or hormone therapy alone.
Researchers studied their outcomes, including whether or not cancerrecurred, and their overall survival.——————————
*‘No significant difference’*——————————
“For the entire study population with gene test scores between 11 and 25 –and especially among women aged 50 to 75 — there was no significantdifference between the chemotherapy and no chemotherapy groups,” said thefindings, published in the New England Journal of Medicine.
The results show that all women over 50 with a recurrence score of 0 to 25can be spared chemotherapy and its toxic side effects.
For women under 50 with a score of 0 to 15, chemo can be skipped.
However, among younger women with scores 16 to 25, outcomes were slightlybetter in the chemotherapy group, so in those cases doctors may urgepatients to consider a chemo regimen.
The results “should have a huge impact on doctors and patients,” Albainsaid.
“We are de-escalating toxic therapy.”
According to first author Joseph Sparano of Montefiore Medical Center inNew York, “any woman with early-stage breast cancer 75 or younger shouldhave the test and discuss the results” with her doctor.
Breast cancer is the leading cause of cancer death in women worldwide,causing some 1.7 million new cases annually and over half a million deaths.
The study’s primary funding came from the US National Institutes of Health(NIH).——————————
*Lung cancer *——————————
The second study tested a form of immunotherapy against chemo, in the mostcommon lung cancer worldwide, known as non-small-cell lung cancer.
It found that Merck pharmaceutical’s drug Keytruda (pembrolizumab) — whichfamously helped former US president Jimmy Carter stave off advancedmelanoma that had spread to his brain — helped lung cancer patients livefour to eight months longer than chemo.
More than 1,200 people enrolled in the study, the largest clinical trial todate of pembrolizumab as a stand-alone therapy for lung cancer. The drugwas approved in 2014 for melanoma and in 2015 for lung cancer.
“These are responses that are unlike anything we have seen in the past fornon-small-cell lung cancer,” said lead author Gilberto Lopes, a medicaloncologist at the University of Miami Health Center.
Still, he acknowledged that most patients with this form of advanced cancerwill die within months, and “we need to do a lot more work.”
Lung cancer is the leading cause of cancer death worldwide, taking 1.7million lives per year.
John Heymach, a professor at the University of Texas MD Anderson CancerCenter who was not involved in the Merck-funded study, described it as a”true milestone” and “a real important advance for patients.”
“We are now leaving an era where the only choice for non-small-cell lungcancer patients was to start with chemotherapy,” he told reporters at theASCO conference.
“Now, the vast majority of patients can potentially receive benefits fromimmunotherapy instead,” he added.
“Immunotherapy is here to stay for the vast majority of non-small-cell lungcancer patients as a first-line treatment.” – APP/AFP