Breast cancer chemotherapy study benefits hundreds at MUSC Health

For some women facing the “big C,” a big R for relief has come their way in terms of the treatment they’ll need. Sara Giordano, M.D., a breast cancer specialist at MUSC Health, calls it exciting to be able to omit chemotherapy for a lot of women with early-stage breast cancer. The change is based on the findings of a major international study called TAILORx.

“I've been anxiously awaiting these results for quite some time,” Giordano said. “Throughout the years, it has become clear that we were over-treating many women with early-stage breast cancer. Until now, I’ve been uncertain about what treatment strategy to take in this intermediate risk group. And now we finally have more clarity. Most women in the intermediate risk group receive zero benefit from chemotherapy.” 

She said the change will affect hundreds of women each year at MUSC Hollings Cancer Center, a National Cancer Institute-designated cancer center. It has the only breast care program in South Carolina that is accredited by the National Accreditation Program for Breast Centers. 

The federally sponsored TAILORx trial enrolled more than 10,000 women. Their breast cancer was fueled by hormones, had not spread to their lymph nodes and didn’t contain the protein HER2. Researchers followed the women’s progress as they had surgery to remove the tumors and got follow-up treatment to try to keep the cancer from coming back. 

The tumors were analyzed with a test called the Oncotype DX that looked at the activity of 21 genes. It gave the women a score ranging from 0 to 100, rating the risk of the cancer returning.  Earlier studies found women with scores of 10 and under don’t need chemotherapy and women with scores over 25 do.

The question was, what about the women between those two numbers? To find the answer, researchers treated some of the women in the intermediate risk category with both chemotherapy and hormone medication. Others just got the hormone medication, also known as endocrine therapy. 

The results were clear, Giordano said. “Most women do not have a higher recurrence from breast cancer or die from their breast cancer if they omit chemotherapy.” Being able to skip chemotherapy is huge in terms of the women’s comfort and even their future health.

“Chemotherapy has short-term side effects including nausea, vomiting, diarrhea, hair loss, risk of infection or blood transfusion, numbness and tingling in the fingers and toes, among others. It may also have long-term toxicities for survivors including heart damage, kidney damage, fatigue, memory loss and risk of secondary malignancies.” 

However, it’s important to note that some women in the intermediate risk category may still need chemotherapy, Giordano said. “When researchers reviewed the results from the trial, they found premenopausal women and women less than 50 years old whose recurrence score was 16 to 25 may have a small benefit from chemotherapy.” 

The study results have been published in the New England Journal of Medicine and were presented at a gathering of the American Society of Clinical Oncology earlier this month. The research is part of a global, ongoing push to find safer and better treatments for breast cancer. At MUSC, researchers are testing frankincense as a possible treatment  and zeroing in on a protein that helps breast cancer tumors grow and spread.  “We are making strides in precision medicine, tailoring treatment for each woman individually,” Giordano said.