A groundbreaking study recently published in the New England Journal of Medicine found that women with early stage breast cancer may not actually need chemotherapy. Dr. Camelia Lawrence is a breast surgeon with the Hartford HealthCare Cancer Institute:
Q: Tell us more about this promising study and its findings.
A: The TailorX clinical trial followed over 10,000 women diagnosed with breast cancer between 2006 and 2010. Approximately 6,700 women had recurrence scores between 11 and 25, which placed them in the intermediate-risk group. Past research showed that women with scores between 0-10 can skip chemotherapy and those with scores greater than 25 benefited from adding chemotherapy to their hormonal regimen.
The recurrence score is derived from a 21-gene assay that analyzes the activity of a group of genes that can affect how a cancer is likely to behave and respond to treatment. This information helps your physician to determine how likely you will benefit from chemotherapy. The 6,700 women were randomized to either receive hormonal therapy alone or hormonal therapy and chemotherapy. They were followed for nine years. The study results showed that the overall survival was about the same in both groups and there was no benefit to adding chemotherapy for most patients in the intermediate group.
Q: How does this dovetail with precision medicine?
A: This study echoes the trajectory of precision medicine. It takes into account individual variability in genes and uses that information to select a treatment approach tailored specifically for that patient. It is in contrast to a one-size-fits-all approach. Moving forward, many cancers will be treated in this manner — taking into consideration cancer genetic variations, environment and lifestyle of the patient.
Q: What’s next in terms of breast cancer research and treatment?
A: Breast cancer treatment is gravitating toward less invasive approaches. With advances in screening, early detection and patient education, we will begin to identify most cancers at it earliest stage which offers the best chance for cure. As evident by the TailorX trial, we will change our line of thinking to better understand that sometimes less is more. We now know that size may not be as critical as we once thought and that tumor biology trumps the size of the lesion. In addition, with novel chemotherapeutic options, I think we will see less aggressive surgical interventions – perhaps even total elimination of complete axillary dissection and mitigation of the associated risk of chronic upper extremity lymphedema.
Dr. Camelia Lawrence is the director of breast surgery for the Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut, 201 North Mountain Road, Suite 102, Plainville. To make an appointment or for more information, please call 860.224.5416.