Breast Cancer: Can You Avoid Chemotherapy? | News | Loyola Medicine
Monday, September 28, 2015

Breast cancer patients whose tumors score low on multigene test can safely avoid chemotherapy, study finds

Loyola oncologist Kathy Albain, MD, is co-author of a landmark trial published in the New England Journal of Medicine

MAYWOOD, Ill. — A major study published in the New England Journal of Medicine is providing the best evidence to date that a 21-gene test done on the tumor can identify breast cancer patients who can safely avoid chemotherapy.

Oncologist Kathy Albain, MD, FACP, FASCO of Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine is among the main co-authors of the international multicenter trial. Dr. Albain also is a member of the trial’s steering committee.

The test examines 21 genes from a tumor sample to determine how active the genes are. The tumor then is assigned a score between 0 and 100; the lower the score, the lower the chance the cancer will recur in distant organs if treated with only a pill such as tamoxifen. In previous studies involving fewer patients, a low score also suggested that chemotherapy does not work well and does not add to the survival benefit of tamoxifen.

The clinical trial enrolled 10,253 women, including 41 at Loyola, who had a certain type of breast cancer (hormone-receptor positive, HER2 negative) that had not spread to lymph nodes. Although the lymph nodes were not involved, the tumors had other features that indicated chemotherapy should be given, followed by tamoxifen or other endocrine therapy pills.

In the trial, women whose tumors scored 10 or lower on the 21-gene test received standard hormone therapy such as tamoxifen, but did not undergo chemotherapy. After five years of being followed closely, there was a less than a 2 percent risk the cancer had spread to nearby or distant sites. The five-year overall patient survival was 98 percent.

These findings, researchers concluded, provide the highest level of evidence that the multigene test can spare the use of chemotherapy in women with low-scoring tumors who otherwise would receive chemotherapy. “This should provide a lot of reassurance to women and their physicians,” Dr. Albain said. “In women whose breast cancer scored low on the multigene test, there was outstanding survival with endocrine therapy alone. The test provides us with greater certainty of who can safely avoid chemotherapy.”

In the trial, 15.9 percent of the women had a multigene test score of 10 or lower. An additional 68 percent had a mid-range score of 11 to 25. These women were randomly assigned to receive either hormone therapy plus chemotherapy or hormone therapy alone. Continued follow-up still will be needed to determine whether any women in this larger group, with tumors in the intermediate-score range, can safely forgo chemotherapy.

The multigene test, Oncotype DX Recurrence Score®, is made by Genomic Health, Inc.

The study is titled “Trial Assigning Individualized Options for Treatment (TAILORx)”. First author is Joseph Sparano, MD, of Albert Einstein College of Medicine. The study is supported by the National Cancer Institute, Breast Cancer Research Foundation and Komen Foundation.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.