September 24, 2018

‘Groundbreaking’ New Cancer Treatment Beats ‘Tennis Ball-Sized Tumors,’ Exciting Doctors

05 June 2018, 04:40 | Silvia Roy

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Many breast cancer patients can skip chemo big study finds

Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient's risk.

The treatment, which succeeded after all other conventional treatments had failed, marks the first successful application of T-cell immunotherapy for late-stage breast cancer.

New England Journal of Medicine. As welcome as the lack of spread is, it leaves patients and their doctors with a conundrum: Should they undergo chemotherapy, with the often horrendous side-effects that involves, or is surgery and hormone therapy sufficient?

The 52-year-old structural engineer had a mastectomy after she was diagnosed in 2003, but a decade later, she found out the cancer had spread and was given a few years to live. If patients with higher scores receive chemotherapy, this risk of recurrence will be significantly reduced, enabling more patients to be cured. Until now, doctors didn't know for sure whether to offer chemotherapy to a large percentage of patients with early stage cancer.

The cancer in question is driven by hormones, has not spread to the lymph nodes and doesn't contain a protein called HER2.

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Of the 9,717 women, 6,711, or 67 percent, had test scores indicating an intermediate risk of recurrence - their score was 11 to 25. This means it was aiming to see whether hormone therapy is just as good alone as it is when given in combination with chemotherapy for mid-range women, and gave no disadvantage. Among women younger than 50, outcomes were similar when gene test scores were 15 or lower.

Those who score 26 or higher on the scale do benefit and now receive chemotherapy.

The new results are on the 67 percent of women at intermediate risk. She has now been entirely free of cancer for two years.

A chemo-free treatment isn't for every patient.

Some cancer specialists have been postponing the decision to treat their newer patients with chemotherapy until the study findings were released.

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"Last week, with the data release being imminent, we chose to hold off", said Dr. William Gradishar, a professor of medicine and chief of hematology and oncology at Northwestern University's Feinberg School of Medicine. "There's a lot of things we do in medicine that are complicated: if it works, you do it. But it has only been shown to work in a single patient and we now need larger trials to investigate how the T-cell therapy and "checkpoint inhibitors" have worked together to attack the secondary tumours". The treatment can cause unpleasant side effects, some of which can put a woman's life at risk.

While the United Kingdom papers generally covered the facts of the research well, some of the headlines gave a misleading impression that the findings applied to many more women with breast cancer than is the case.

Long-term, Litton said, it can leave a woman with permanent numbness and tingling.

According to researchers from the USA, early breast cancers can be successfully treated with a new form of immune therapy instead of traditional chemotherapy.

Hwu said that in addition to finding ways to make TIL therapy cheaper, faster and simpler to administer, researchers will need to figure out which patients are most likely to respond as dramatically as Perkins did.

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Tens of thousands of women each year in North America alone fall into the categories where chemotherapy is unnecessary, accounting for 70 percent of those with the most common forms of breast cancer. By finding, isolating and multiplying the tiny subset of immune cells that are still in the fight, then demonstrating their ability to vanquish a patient's tumors, Rosenberg's group has shown that "the cells are there", Mackall said.

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