Ask the Doctors: A Genetic Tool Evaluates Cancer Treatment Options | The Bennington banner

By Robert Ashley, MD

Q: A friend of mine has recently been diagnosed with bad cancer and is terrified by the chemotherapy recommended by his doctor. I've read that some women can ignore it. Is it true?

To: Your friend's fear of chemotherapy is understandable. Its severe side effects and its risk of toxicity to body organs are well known. However, survival rates improve significantly with chemotherapy. This too is well known – and has been shown even in women with bad cancer who has not spread to the lymph nodes.

A recent study in the New England Journal of Medicine, however, questioned the need for chemotherapy in some women with bad cancer without lymph node metastasis. The trial involved 9,719 women aged 18 to 75 years with hormone receptor positive cancer and negative HER2. This type of cancer is often treated with hormone therapy, although chemotherapy can also be used. In this trial, the authors evaluated the need for a genetic tool-based chemotherapy called the 21-gene bad cancer test, which evaluates the risk of recurrence based on 16 cancer-related genes and five other genes. Women who have higher scores in screening have shown a higher risk of recurrence of bad cancer compared to those with lower scores.

In this study, women with a score of 21 genes of 26 or higher received chemotherapy and endocrine therapy (drugs that block the estrogen receptor in bad cancer). Those with scores from 11 to 25 received either chemotherapy with endocrine therapy (chemoendocrine therapy) or endocrine therapy alone. Those with a score of 10 or less received only endocrine therapy. The majority of women participating in the study (6,711) had scores between 11 and 25. All patients were followed for eight years.

In the group with scores of 11 to 25, no statistically significant difference was found between those who received chemo-endocrine therapy and those who received endocrine therapy alone. Although there was a small, nonsignificant increase in the rate of recurrence at a local or distant site with hormone treatment, there was no difference in survival rates between those who received the chemotherapy and those who have not received it. Extrapolating the data to nine years, the survival rate without invasion by chemo-endocrine treatment would have been 84.7%, while it would have been 83.1 with endocrine therapy alone. The small difference suggests that chemotherapy may not be necessary in all patients with average scores.

For some, however, it could be. In women under 50, people with an badysis score of 21 genes from 16 to 25 showed a decrease in the rate of recurrence with chemotherapy. Yet, no difference was observed in survival rates.

I can not say what your friend should or should not do. Perhaps – unlike this study – his bad cancer involves lymph nodes and is a negative hormone receptor or HER-2 positive. Plus, if she is under 50 and she has a gene score of 16 or higher, she would almost certainly benefit from chemotherapy.

But, overall, the study shows that for many women with localized bad cancer, and an badysis score of 21 genes of 25 or less, chemotherapy may not be necessary.

Robert Ashley, M.D., is an internist and badistant professor of medicine at the University of California at Los Angeles. Send your questions to [email protected], or write: Ask the Doctors, c / o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Mail volume, personal responses can not be provided.