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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 - http://www.ascopost.com/News/58904
Read the article -  https://www.nejm.org/doi/full/10.1056/NEJMoa1804710?query=featured_home
Listen to an Australian Oncologists perspective -https://www.stabiopharma.com/index.php?q=tailorx-explained-the-australian-perspective.html

Julie



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