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Can some menopausal women with breast cancer skip chemotherapy? – Harvard Health Blog

Can some menopausal women with breast cancer skip chemotherapy?  – Harvard Health Blog


Breast cancer remains the most common cancer among women. Over the past two decades, the treatment of breast cancer has become more personalized. This has been possible due to the subtyping of breast cancer. Breast cancers have been subsumed by breast cancer cell recipients. The most clinically significant receptors – targeted therapies – are estrogen and progesterone receptors and the human epidermal growth factor 2 receptor (HER2). Cancers with estrogen and progesterone receptors are called hormone receptor (HR) positive cancers.

The development of hormonal therapy against breast cancer in HR means that the risks of chemotherapy may outweigh some of the benefits of chemotherapy. Developments in genomic testing, tests that look at genes indicated for cancer, have provided a way for doctors and women to help decide which benefits will benefit the most from chemotherapy.

How does genomic analysis help personalize breast cancer treatment?

Increasing knowledge about breast cancer has led to the development of personalized therapy. In addition to knowing your type and stage of cancer, genomic studies have further determined how we assess the risk of recurrence of breast cancer. A genomic test, Oncotype Dx, is a useful tool that can help predict the likelihood of benefit from chemotherapy, as well as the risk of recurrence of invasive breast cancer.

Not all women will need chemotherapy, but for some women hormone therapy alone is not enough. The Dx Oncotype analyzes the expression of 21 genes based on HR-positive breast cancer, HER2-negative, and assigns a recurrence score (RS) based on risk of recurrence. The Oncotype Dx test places women in three groups: low, medium, or high, and high risk of recurrence. Women with low scores do not need chemotherapy and benefit the most from hormone therapy, while women with high repetition scores receive the most chemotherapy. in addition ra hormone therapy.

There is new research to help women make decisions about chemotherapy

Until recently, it was not clear to women with an intermediate risk score obtained from chemotherapy. A randomized clinical trial trial Tailor Rx test, answers this question. The randomized trials in node-negative women (not yet cancer that has spread to lymph nodes), HR-positive, HER2-negative breast cancer-only hormone therapy, or chemotherapy in combination with hormone therapy. The results showed that most women at intermediate risk for invasive cancer did not get any added benefits from chemotherapy. However, the women’s subgroup did the benefit of chemotherapy was that women under the age of 50 were menopausal.

Although the results of the Tailor Rx trial were changing in practice, questions about the benefit of chemotherapy arose in women who had HER2-negative breast cancer that had spread to the lymph nodes and had breast cancer. The RxPonder trial answered that question.

The RxPonder trial randomized randomized stage 1 / III HR-positive, HER2-negative women to 5,015 women with one or three positive lymph nodes and an intermediate RS (≤ 25). Patients were randomized to receive hormone therapy alone or hormone therapy with chemotherapy. The main goal of the study was to determine how many women did not have a recurrence of invasive breast cancer while following them.

There were many ways to compare women in the study, but the main features chosen for comparison were the state of menopause, RS, and the type of surgery they received. At a median follow-up of 5.1 years, there was no link between the benefit of chemotherapy and the RS value between zero and 25 for the entire population. However, the link between the benefit of chemotherapy and the status of menopause was seen. This trial demonstrated that women in the lymph nodes with cancer can also avoid chemotherapy if they have low or intermediate RS.

Menopausal women responded better to hormone therapy and chemotherapy

Among enrolled women RxPonder trial, there were 3,350 menopause and 1,665 menopause. Further studies based on the status of menopause revealed that there was no difference in five-year survival with hormone therapy treated with hormone therapy alone with hormone therapy.

However, the risk of invasive disease was reduced by 46% in pre-menopausal women. For this subset of women, five-year disease-free survival rates were 94.2% in women treated with hormone therapy and chemotherapy, compared with 89% in women treated with hormone therapy alone. Both women who received both chemotherapy and hormone therapy had an additional benefit of about 5%. It is not clear whether the survival benefit seen in pre-menopausal women is primarily due to the effect of chemotherapy or indirectly due to the removal of the ovary as a result of chemotherapy.

What does it mean to make decisions about treating breast cancer?

Breast cancer treatment has become truly personalized. It has always been important to know the stage of your canker, but now it is also important to know what type of cancer you have. With this information, women can have an informed discussion with the oncologist about the risks and benefits of chemotherapy.

If you are a breast cancer woman who is positive for breast cancer and positive for the node, chemotherapy and hormone therapy can give you the greatest chance of reducing your risk of getting cancer again. However, for a woman with menopause who has an HR-positive breast cancer, chemotherapy may not add any beneficial treatment to hormone therapy, and it carries risks that can affect your quality of life. Research such as the TailorRx and RxPonder trials has provided more information to help make an informed decision.



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