Breast cancer hit the headlines again this weekend following new research showing that a genetic test could spare many more women chemotherapy. So what’s the story?

Monday 4 June 2018      Health information blog Research blog

On 3 June 2018, at one of the world’s biggest cancer conferences in Chicago, exciting new research was published which found that many more women could safely avoid chemotherapy based on their risk score from the Oncotype DX test. But what is Oncotype DX? Which women could be spared chemotherapy? And what exactly does this mean for breast cancer patients? 

What is Oncotype DX?

Oncotype DX is a genetic test which is already in use on the NHS to assess the risk of breast cancer returning and to help guide chemotherapy decisions. It is used for women with early stage breast cancer, and specifically those whose disease is hormone receptor positive, HER2-negative, and node-negative. 

How is the test used to guide treatment decisions?

Using the test, women identified as having a ‘low risk’ of recurrence (with a test score between 0-11)  are typically not given chemotherapy, whereas those with a ‘high risk’ of recurrence (with a test score over 25) are given chemotherapy. However, it has been less clear what path women identified as having an ‘intermediate risk’ (with a test score between 11-25) should take. Normally, in these circumstances, patients and clinicians would discuss the options and come to a decision together – with some patients choosing to have chemotherapy and others not.   

The TAILORx trial took place to better determine the effect of chemotherapy in women classed as ‘intermediate risk’ and ultimately help guide treatment decisions for them. 

What does the research say? 

The trial, TAILORx was a large, randomized trial involving thousands of breast cancer patients. Nearly 7000 patients’ fell into the ‘intermediate risk’ category and this group was split into two randomized subgroups – one group were treated solely with hormone therapy and the other received chemotherapy and hormone therapy. The researchers tracked the patients’ outcomes and found that women who fall into the ‘intermediate risk’ category do just as well with hormone therapy alone compared to chemotherapy plus hormone therapy after surgery. 

This means that chemotherapy can be spared in:

  • Women older than 50 with hormone receptor positive, HER2-negative, node negative breast cancer and a recurrence score of 0-25 
  • Women of 50 or younger with hormone receptor positive, HER2-negative, node negative breast cancer and a recurrence score of 0-15

Importantly, the trial suggested that chemotherapy may still be vital for some younger women at intermediate risk and Breast Cancer Now would now like to see further research undertaken to fully understand which patients under 50 may benefit. 

Is this the right way forward? Isn’t chemotherapy really important?

We understand that patients may have questions about this research given that chemotherapy is a cornerstone of breast cancer treatment and often given after surgery to reduce the chance of breast cancer coming back. But we know that the side effects of chemotherapy can be gruelling for many women. They can include nausea, vomiting, hair loss and fatigue and can have a huge impact on people’s day to day lives. In fact, for many breast cancer patients, one of the most difficult treatment decisions can be whether or not to go through chemotherapy.  

Oncotype DX already helps patients identified at ‘low risk’ of recurrence by the test safely avoid chemotherapy. This research provides crucial reassurance for clinicians and patients that thousands of women receiving ‘intermediate risk’ scores could also now be spared chemotherapy.  It is another valuable step towards tailoring treatments more to patient’s needs.

What happens next? 

Whilst doctors may immediately adopt these findings into their day to day clinical practice, it’s important that these findings are also reflected in guidance for the NHS so that patients across the country can benefit from the best available evidence. 

The National Institute for Health and Care Excellence (NICE) has been looking at the use of genetic tests like Oncotype DX to guide adjuvant chemotherapy decisions. The most recent consultation on this has now closed, and the final guidance is due to published in September 2018.  We hope these exciting findings will be taken into account to help patients and their doctors in their treatment decisions. Breast Cancer Now believes it’s crucial that NICE now has the opportunity to consider these results as soon as possible and that there is a mechanism in place for this to happen. 

If you have any questions about how this could affect your treatment for breast cancer, please discuss this with your breast cancer team.