Skip to main content

Go Fund Me – I Don’t Want Chemo

As a woman I have breasts.  As a white, western, woman I have about a 1 in 8 chance of getting breast cancer.  If I get breast cancer, I really don’t want chemotherapy, if I can avoid it.  Not unless it will make a significant difference to my outcome. Until recently, knowing if this was the case, was difficult.

Rarely does a study comes out and say that chemotherapy is not needed; that it does not reduce the likelihood of the cancer coming back and does not increase survival. 

But that is exactly what has happened in a large trial on breast cancer patients with hormone-receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative, axillary node–negative breast cancer, who would have until now, been given what is known as adjuvant chemotherapy.

Adjuvant chemotherapy is chemotherapy which is given after a potentially curative procedure (in the case of breast cancer this is surgery) to mop up any remaining cancer cells in the body that we can’t see. It’s a tricky business.  We’ve always known that most women probably don’t need chemotherapy, the problem was we don’t know which ones.  So, everyone was recommended a course of adjuvant chemotherapy, with all its side effects, to benefit those who needed it.

The availability of the Oncotype DX breast cancer assay, a 21-gene expression assay that can predict which patients are most likely to derive a large benefit from chemotherapy is changing the hit and miss approach to selecting which patients benefit from receiving chemotherapy.

The test is performed on a tumour biopsy sample. Women with a low recurrence score (0–10) typically only require hormone therapy alone and those with a high recurrence score (26–100) require hormone therapy and chemotherapy. 

However, around 60-70% of women fall into the midrange recurrence score of 11-25, and until recently it was not known if there was a benefit to chemotherapy in this group.

Two weeks ago, at the American Society of Clinical Oncology meeting, the results of the TAILORx trial were presented.  TAILORx specifically looked at whether chemotherapy was of benefit in the group of women with a midrange recurrence score of 11-25.  This high-quality trial involving over 10,273 women (6,711 with a mid-range score), showed that chemotherapy could be avoided in:

  • All women older than 50 years with hormone receptor–positive, HER2-negative, node-negative breast cancer and a recurrence score of 0 to 25 (about 85% of women with breast cancer in this age group); and
  • All women 50 years or younger with hormone receptor–positive, HER2-negative, node-negative breast cancer and a recurrence score of 0 to 15 (about 40% of women with breast cancer in this age group). Note those with recurrence scores between 16-25 did get a benefit from chemotherapy.

The Oncotype DX breast cancer assay is currently not funded by Medicare; however, it is made available in Australia by international biopharmaceutical company Specialised Therapeutics Australia at a cost of approximately $4,500.

In a world where “Go Fund Me” pages for often futile treatments is common, it will be interesting to see if people are willing to help raise money to potentially save a woman from having treatment.

As for me, if I find myself in this situation, with hormone receptor–positive, HER2-negative, node-negative breast cancer, I will be without a shadow of doubt be asking for the Oncotype DX breast cancer assay.  And, if I need help, I hope my friends and family will donate through the “Go Fund Me” page I’ll set up to make getting the assay done possible.

For further information on the TAILORx trial:
Read the ASCO post -



Popular posts from this blog

Would You Like Marijuana with Your Chemotherapy?

I am frequently asked, as a pharmacist who specialises in cancer medicine, what do I think about the use of marijuana for medical conditions?

I often reflect back to dispensing dronabinol (a synthetic THC product) for chemotherapy induced nausea and HIV related wasting syndrome, when I first started working as a pharmacist in a hospital in the early 90s.  Back then it was no big deal, the hospital pharmacy imported the medication from overseas, just like we did many other medications which were not marketed in Australia, and supplied it on a doctor’s prescription.
We didn’t stop supplying it because it was difficult to get hold of, rather it just wasn’t very useful any more.  New anti-nausea medications came on the market, and these were much more effective at controlling the nausea and vomiting associated with chemotherapy, and, a new class of medications known as antiretrovirals became available and these were so effective at treating HIV we thankfully were no longer seeing the devast…

Which "Hospital" Lets Your Dog Stay With You During Chemo?

When I am asked why we started chemo@home, I often talk about how when my Dad was sick, some 20 odd years ago, that there was no “@home” services but that I was lucky enough to work in a hospital where the nursing staff taught me (the pharmacist) how to give the antibiotics my Dad needed, and this allowed us to take him home over Christmas.  This was to be his last Christmas with us and I am forever grateful that he spent it with us, his family, at home, and not in a hospital.
This is absolutely true.There are however, two other reasons that I was led down this path.Today I’ll talk about one of these.
I've worked in a number of hospitals, both public and private, for around 25 years.I loved everything about working in a hospital.There is a comradery amongst the staff, one which is built on working hard, doing a difficult job under challenging circumstances, which is hard to find outside of a hospital environment.I think, maybe, serving in the military may provide a similar feeling.