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Mar 13, 2019 11:39AM
Mar 13, 2019 11:39AM
Adjuvant Chemotherapy for ER+ Breast Cancer - A Sea Change Is Underway
Adjuvant breast cancer treatments—chemotherapy, human epidermal growth factor receptor 2 (HER2)–targeted therapies, and endocrine therapy—prevent recurrence and extend survival. Unfortunately, because risk assessment is imprecise and treatments are not uniformly effective, many women are treated to benefit a small number. Chemotherapy has the most onerous short-term side effects and is the treatment that patients most wish to avoid.
Over the past 15 years, multiple genomic assays have been developed that more precisely characterize the risk of developing recurrent breast cancer.
...use of adjuvant chemotherapy for patients with stage I–II ER+/HER2- disease declined from 26.6% to 14.1% and 81.1% to 64.2% among node-negative and node-positive patients, respectively, between 2013 and 2015.
With the advent of targeted therapy for breast cancer, both oncologists and their patients appear less willing than in the past to take a toxic treatment for a very small benefit.
...a National Comprehensive Care Network database study demonstrated excellent outcomes for patients with small ER+/HER2- tumors not treated with chemotherapy with distant recurrence-free survival rates of 98% (T1a) and 96% (T1b). These data suggest that most patients with small ER+ tumors should not receive chemotherapy and may have also led to a decline in chemotherapy use.
Genomic expression assays may ultimately have an even greater impact on the management of young women with ER+ breast cancer, a population that faces the long-term consequences of treatment toxicities.
Whether we are focusing on traditional chemotherapy or targeted approaches, we must strive to integrate prognostic biomarkers such as pathologic complete response and develop new prognostic and predictive biomarkers. Our goal is to provide the adjuvant treatment that allows each patient to remain cancer free and, at the same time, avoid unnecessary toxicity.
Philip D. Poorvu; Eric P. Winer
J Natl Cancer Inst. 2018;110(5):443-445. © 2018 Oxford University Press
"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride."
2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC)
1/13/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
1/14/2016 Herceptin (trastuzumab)
2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+