You Mean I Might Not Need Chemo?
Understanding the TAILORx Study
Martha McCormick, To Life!
In early June 2018, the news broke - “Many Women with Early Breast Cancer Can Avoid Chemotherapy”. It’s hard to argue that this is anything but good news. But what exactly does it mean? Does this mean I can stop my chemo or that I didn’t need it after all?
The eye catching headline represents results from a study of specific breast cancer treatment over nine years. Like any research, it addressed a specific question pertaining to a specific situation. In this case, researchers looked at the Oncotype DX test commonly done on breast cancers that are hormone positive, to predict likelihood of recurrence and benefits of chemotherapy. The test results are framed as a continuum from low likelihood of recurrence with little benefit from chemotherapy, to high likelihood of recurrence and likely benefit from chemotherapy. Scores of 0 – 10 are considered low and scores of 26 – 100 are considered high. But the scores of 11 – 25 are considered a mid-range area where there exists neither clear benefit of chemotherapy nor the relief of not needing it. The majority of patients tested fell in that midrange.
The TAILORx (Trial Assigning Individualized Options for Treatment) was designed to address those patients and try to learn more about how to help them. It also addressed women with low scores of 0-10, to affirm their low risk of recurrence if treated with Endocrine (hormone) therapy alone.
Subjects enrolled in the study were women aged 18 – 75, with early stage invasive cancer (not DCIS) that was ER positive, HER2 negative and had no lymph node involvement. All had the Oncotype DX test. Subjects with Oncotype scores lower than 10 received endocrine therapy alone. Subjects with scores of 26 or higher received chemotherapy plus endocrine therapy. Subjects with Oncotype scores from 11 - 25 (midrange) were divided randomly into two groups. One group received chemotherapy and endocrine therapy and one received endocrine therapy alone.
Results of the study updated earlier findings for the low and high ends of the scale as to statistical likelihood of recurrence and survival rates for those groups. The study results for the midrange group is what all the excitement is about, however. Results for that group indicated that for the group with Oncotype scores of 11 – 25, subjects who were treated with endocrine therapy alone statistically did no worse than subjects treated with chemotherapy plus endocrine therapy. One exception to that conclusion is that for subjects under the age of 50, there seemed to be more benefit to chemotherapy as related to survival rates and recurrence rates, than for older women.
As with nearly all things related to breast cancer, it can be stated that this study is not going to be relevant to everyone or apply to everyone. Yet again, it’s all individual. But as stated by Harold Burstein, MD, PhD, FASCO, of Dana-Farber Cancer Institute,“The goal of this study was not to just use less treatment. The goal was to tailor treatment.”
What is the take-away for any individual looking ahead to treatment for breast cancer? It’s always good to ask the question. And if you are over the age of 50, with early stage invasive breast cancer, that is ER positive and node negative (meaning no cancer found in the lymph nodes) with an oncotype score between 11 and 25, you may fall into the category where chemo might previously have been indicated but now might be avoided.
TAILORx: Many Women With Early Breast Cancer Can Avoid Chemotherapy, Tim Donald, ELS, ASCO Daily News, 2018 ASCO Annual Meeting