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5,000 breast cancer sufferers could be spared chemotherapy if offered gene testing, study suggests

Laura Donnelly
A consultant analyzing a mammogram - PA

THOUSANDS of women with breast cancer could be spared chemotherapy if they were offered gene tests which show whether their disease is likely to spread, a major trial has found.

The British study suggests that up to 5,000 women a year could avoid the toxic treatment, which can cause nausea and fatigue, through wider use of genetic risk profiling.

Currently a test called Oncotype DX is offered to around 9,000 patients a year by the NHS when disease has not spread to the lymph nodes.

But the new study suggests that the tests could also be used to tailor treatment for around 10,000 patients in whom disease has progressed, identifying which cases require chemotherapy and which can be helped by hormone therapy alone.

Scientists said the research by The Royal Marsden Hospital could mean around 5,000 such women are spared chemotherapy, and its associated side-effects.

Charities said the results were “promising” - but said further research was needed to assess the long-term outcomes of patients who were put only on hormone treatment.

The study examined the use of the tests on breast cancer which is oestrogen receptor positive (ER+),  human epidermal growth factor receptor 2 negative (HER 2-), where disease had spread to be between one and three lymph nodes.

Before the test was used, chemotherapy was recommended for 70 per cent of patients.

But after the genetic analysis, just 28 per cent of cases were found to need the treatment.

The rest were referred for less aggressive hormone therapy.  

Researchers said the analysis, from 582 patients at 30 hospitals, was also able to identify some cases in need of chemotherapy, who would not have been picked up using traditional assessments.

Dr Sophie McGrath, Consultant in Medical Oncology at The Royal Marsden NHS Foundation Trust, said that use of the test saw more than half of cases which would have been recommended for chemotherapy spared it.

“This data shows that the Oncotype DX test provides valuable information in guiding treatment decisions for patients whose cancer has spread to the lymph nodes,” she said.

More effective targeting of chemotherapy could be particularly valuable among older women, for whom the regime could prove punishing, she said.

The test allows scientists to examine the genetic make-up of samples of tumours which are removed during surgery, to discover whether it is likely to spread to other parts of the body.

If adopted by the NHS, the tests could reduce expenditure on chemotherapy by around £22 million, and cut waiting times.

Latest figures show one in four cancer patients is waiting more than two months to start treatment.

Baroness Delyth Morgan, chief executive at Breast Cancer Now, said such tests had

“real potential to personalise breast cancer treatment and enable some women to be safely spared the gruelling side-effects of chemotherapy.”

“The early findings from this UK access programme are promising, and suggest that this test could change whether chemotherapy is recommended for a large proportion of node-positive patients. But we need to see long-term data to know that forgoing chemotherapy would not affect the chances of their breast cancer coming back or their survival outcomes,” she said.

Currently, the test is only recommended by the National Institute for Health and Care Excellence (Nice) for cases which have not progressed to the lymph nodes but are at “intermediate” risk of spreading. Nice is not expected to update its guidance until 2021.

A course of chemotherapy typically costs the health service £4,500. The list price of the Oncotype DX test is £2,500 each, but the NHS pays less for its use under a confidential deal with the manufacturer, Genomic Health.

 

The findings were presented at the St Gallen International Breast Cancer Conference, in Switzerland.

Earlier this week, the Health Secretary called for a wider rollout of gene testing on the NHS, as he revealed that tests had found he is at increased risk of prostate cancer.

Matt Hancock called for a national debate about the biggest ethical questions concerning a revolution in genomics, as he revealed that he was shocked by his own results.The tests found he has a 15 per cent chance of suffering prostate cancer by the age of 75 - which was described as a risk about 1.5 times greater than the average man.

The Health Secretary said he would pursue a blood test with his GP, and ensure he did not miss any screening appointments.

But some scientists criticised his statements, with one accusing him of “an astonishing level of ignorance” and suggesting he had “massively misinterpreted” the findings.