Some may not need breast cancer chemo


first_imgDoctors who treat women with breast cancer are glimpsing the possibility of a vastly different future. After years of adding more and more to the regimen – more drugs, shorter intervals between chemotherapy sessions, higher doses, longer periods of taking of harsh drugs – they are now wondering whether many women could skip chemotherapy altogether. If the new ideas are validated by large studies, like two that are just beginning, the treatment of breast cancer would markedly change. Today, national guidelines call for giving chemotherapy to nearly every one of the nearly 200,000 women whose illness is diagnosed as breast cancer each year. In the new approach, chemotherapy would be mostly for the 30 percent of women whose cancers are not fueled by estrogen. So far, the data are tantalizing but the evidence is very new and still in flux. And no one can yet say for sure which women with hormone-dependent tumors can skip chemotherapy – the advice a woman gets often depends on which doctor she sees. It could be a decade before the new studies, one American, one European, will provide any answers. “We finally tell people at the end of the day, `You’re going to get a lot of information. Trust your gut; nobody has the answers,”‘ Brenner said. Doctors are also concerned. It took two years before the National Cancer Institute and its researchers could even agree on a study design to test the idea that many women might safely forgo chemotherapy. The study, which will start enrolling patients at the end of this month, will involve women whose cancers are fueled by the hormone estrogen and have not spread beyond the breast. They will be randomly assigned to have the standard treatment, chemotherapy followed by a drug like tamoxifen that starves tumors of estrogen, or to skip chemotherapy and only have treatment with a drug like tamoxifen. In Europe, researchers are planning a similar study. But, unlike the American one, it also will include women whose cancer has spread beyond their breasts into nearby lymph nodes. The American study may eventually add such women too, said Sheila Taube, who directs the cancer diagnosis program at the National Cancer Institute. It is a time, Taube says, that reminds her of a debate a few decades ago, when the question was whether all women with cancer needed mastectomies or whether many could have a lumpectomy instead. “To me, the situations are analogous,” Taube says.160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set! AD Quality Auto 360p 720p 1080p Top articles1/5READ MOREBasketball roundup: Sierra Canyon, Birmingham set to face off in tournament quarterfinals“It’s a slightly uncomfortable time,” said Dr. Eric P. Winer, who directs the breast oncology center at the Dana-Farber Cancer Center, which is affiliated with Harvard. “Some of us feel like we have enough information to start backing off on chemotherapy in selected patients, and others are less convinced.” The latter characterization describes Dr. John Glick, director of the Abramson Cancer Center of the University of Pennsylvania. He tells his patients about the new data but he does not suggest they skip chemotherapy. After all, he notes, the national treatment guidelines were based on results from large randomized clinical trials. And the recent studies indicating that some women can skip chemotherapy are based on an after-the-fact analysis of selected clinical trials. “We’re in an era where evidence-based medicine should govern practice,” Glick said. For women with breast cancer, of course, the uncertainty is excruciating. Faced with a disease that already causes uncertainty and anxiety, they are now confronted with incomplete data, different opinions from different doctors and choices that can seem almost impossible: Can they – or should they – give up a treatment when all the answers are not in and they have what may be a fatal disease? “If the medical profession is not even close to being of one mind, how is the woman to know?” said Donald Berry, a statistician at M.D. Anderson Cancer Center and the lead author of a recent paper questioning chemotherapy’s benefits in many women. “There’s a real problem,” said Barbara Brenner, who has had breast cancer and is the executive director of Breast Cancer Action, an advocacy group. last_img

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