Genomic Test Could Spare Many Women from Chemotherapy
New findings suggest that millions of women battling breast cancer might avoid chemotherapy due to a revolutionary genomic test, indicating a significant shift in healthcare protocols around the globe.
Typically, breast cancer treatment starts with surgery to remove tumors, followed by chemotherapy if there’s concern about recurrence. However, the harsh side-effects of chemotherapy—think hair loss, rashes, nausea, insomnia, and fatigue—are tough on patients. In some cases, women face long-lasting impacts like infertility or premature menopause.
For a long time, options for patients were pretty limited. Now, though, scientists have created a genomic test that helps identify who truly needs chemotherapy. This development could usher in a new era of personalized medicine.
Results from an international study indicate that countless women might be able to bypass chemotherapy safely, thus avoiding its unpleasant side-effects without heightening the possibility of cancer returning. The study’s findings will be shared at the American Society of Clinical Oncology’s annual meeting in Chicago this Saturday.
Conducted by University College London, the Optima trial involved over 4,000 newly diagnosed breast cancer patients from the UK, Norway, Sweden, Australia, New Zealand, and Thailand. Those with low scores on the genomic test were shown to be able to receive hormone therapy alone without risks.
One participant expressed that skipping chemotherapy felt “like Christmas.” Nine years post-diagnosis, she has remained healthy and is living an active life—having benefited significantly from the test.
Prof Rob Stein, leading the trial and a breast oncology professor at UCL, noted that Optima tackles a significant issue in breast cancer treatment—figuring out who genuinely gains from chemotherapy. “Our research shows that many patients can avoid chemotherapy without sacrificing their health outcomes,” he stated.
“This is a critical step towards more tailored treatments. It uses tumor biology for decision-making instead of relying solely on traditional clinical evaluations,” he added. For many patients, this could mean dodging the physical and emotional toll of chemotherapy along with its possible long-term effects. Additionally, healthcare systems might benefit from a more efficient allocation of resources.
The Prosigna test, developed by Veracyte, examines the activity of 50 genes within tumor tissue. It assesses the molecular subtype and provides a score indicating the likelihood of breast cancer recurrence within ten years. This aids doctors in determining whether chemotherapy is necessary.
Involving 4,429 patients aged 40 and older with hormone-positive breast cancer—this common type accounts for up to 80% of cases worldwide—the trial split participants into two treatment groups. Those in the standard group received chemotherapy followed by hormone therapy, while the second group underwent genomic testing.
For those scoring high on the test, both chemotherapy and hormone therapy were administered; conversely, those with low scores received only hormone therapy, alongside standard radiotherapy and other treatments.
Results from the latter group showed similar outcomes regardless of whether chemotherapy was given. Five years post-treatment, 95% of patients who had both chemotherapy and hormone therapy were alive and free from recurrence, while 94% who avoided chemotherapy also enjoyed the same outcome.
The findings imply that for individuals with low test scores, chemotherapy adds little to no benefit, allowing them to avoid both the treatment and its side effects.
Some men participated in the study, funded by the National Institute for Health and Care Research (NIHR), Veracyte, and various cancer charities; however, there weren’t enough to draw definitive conclusions for that group.
Prof Iain MacPherson, co-chief investigator and breast oncology professor at the University of Glasgow, remarked, “Optima delivers solid, transformative evidence that we can reduce chemotherapy for many patients with hormone-sensitive breast cancer safely.”
“This research signifies a meaningful advancement in providing more tailored, precise care that focuses on what actually enhances patient outcomes while minimizing unnecessary harm. The potential impact for patients and healthcare systems is considerable,” he emphasized.
