Fewer women may need chemotherapy for breast cancer

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Washington, Dec 15 (UNI) Thousands of breast cancer patients every year could be spared from chemotherapy or get gentler versions of it without harming their odds of beating the disease, a new research suggests.

A study found that certain women are less likely to die or have a relapse, if given a less harsh drug than Adriamycin, a mainstay of treatment for decades.

Another study found that a gene test can help predict whether some women need chemo at all, even among those whose cancer has spread to their lymph nodes, which typically brings full treatment now.

The findings are sure to speed the growing trend away from chemo for many breast cancer patients and targeting it to a smaller group of women who truly need it, doctors said on Thursday at the San Antonio Breast Cancer Symposium, where the studies were reported.

''We are backing off on chemotherapy and using it more selectively'' in certain women, the Columbian quoted Dr Eric Winer of the Dana-Farber Cancer Institute in Boston as saying.

The gene test in particular ''will start changing practice nearly immediately,'' said Dr Peter Ravdin of the University of Texas MD Anderson Cancer Center in Houston.

''The results are compelling that this test helps select patients who will most benefit from chemotherapy,'' he added.

The new study, led by Dr Kathy Albain of Loyola University in Chicago, looked at whether a test, which measures the activity of 21 genes and predicts a woman's risk of recurrence, accurately predicted chemo's benefit in 367 women whose hormone-driven cancer had spread to lymph nodes.

A decade after these women were treated, those who had low scores on the gene test were found to have had no benefit from chemo.

Conversely, chemo did a lot of good for those with high scores.

Because 40 per cent of the women scored low, it means that as many as 18,000 women each year might safely skip chemo.

Dr Kelly Marcom, a Duke University cancer expert, said the test would give valuable information to guide treatment for more patients in the future. He has used it on about 50 women in the last year.

''I've had it cut both ways, ruling chemo in and out,'' Dr Marcom said.

Chemo's side effects are getting greater attention. One drug commonly used for early breast cancer - doxorubicin, sold as Adriamycin and generic brands - is known to cut the risk of having a recurrence or dying, but raises the risk of heart problems and even leukemia.

Dr Stephen Jones of Baylor-Sammons Cancer Center tested using Taxotere, a drug not linked to heart problems, in its place in more than 1,000 women with early breast cancer. After seven years, 87 per cent of those given Taxotere survived, compared with 82 per cent of those given Adriamycin. In addition, those given Taxotere were less likely to have had a recurrence.

A study in the New England Journal of Medicine in October showed that another drug, Taxol, does not work for the most common form of breast cancer.

These new studies should lead to less use of chemo, but there has been ''intense'' pushback from doctors, who fear giving up on a treatment that might help some patients, said Barbara Brenner, head of the advocacy group Breast Cancer Action.

''It's very hard to turn a ship like this,'' she said. ''Adding things never takes much, but removing things takes a mountain of data from the medical community,'' she added.


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