Press Releases
New Test Personalizes Breast Cancer Treatment
Crystal Brown
Publication: Weatherford Democrat
09/01/2009
For years, chemotherapy was used in breast cancer patients who met criteria based on the tumor’s size and their age. But a new study breaks down the genetic make up of the tumor itself to determine who benefits from chemotherapy and who can forego it.
The Oncotype DX Assay is a genetic test done on the cancerous tissue removed during a biopsy to determine the patient’s risk of recurrence. After looking at 21 genes in the tissue, a Recurrence Score (RS) is assigned between 0 and 100. The lower the score the less chance of recurrence and the lower need for chemo. However, this test is only for breast cancer that falls into a certain category. Cancer patients may be a candidate for this test if they are in the early stage of breast cancer that is estrogen-receptor-positive or “estrogen fed” and the lymph nodes are not involved.
Several Weatherford doctors use and encourage this test for their patients. General Surgeon Dr. Amy Gunter said knowing their recurrence risk can take the burden of chemo off of a patient’s mind. “In that group of women we know there are some that benefit from having chemotherapy and those that don’t benefit at all from it,” Gunter said. “This test helps us stratify who is who.”
Low risk patients receive a recurrence score of 17 or below. Higher risk patients are in the 31 and up category and generally have the greatest benefit from chemotherapy. Patients scoring between 18 and 30 fall in the middle and it is currently unknown who would benefit from chemo and who can go without.
While Gunter performs the surgery to remove the tumor, medical oncologist Dr. Robyn Young looks at the test results and discusses treatment with the patients. For those who receive an intermediate recurrence score, she offers them a chance to participate in the TAILORx trial being conducted to determine the need for chemotherapy for patients who fall in that gray area.
Young said about 60 percent of breast cancer patients qualify for the Oncotype DX test and of those, about 40 percent of women end up in with an intermediate score.
For those in the middle, Young sits down and discusses joining the TAILORx study. If they decide not to take part in the study, they discuss topics like the size of the tumor, their medical history and belief systems.
“I have some women come in and say ‘I have to do everything humanly possible’ and then some who say ‘I’d just die if I had to have chemotherapy,’” Young said. “We have to work with the patient, and I’m pretty direct. But most patients want to be logical.”
Dr. Ray Page, president of the Center for Cancer and Blood Disorders, said this test is a step in the right director for providing more personalized care, and is just the tip of the iceberg in personalizing care for all kinds of cancer patients.
“We are pushing to do the best we can in oncology to provide personalized care,” Page said. “Breast cancer is not just breast cancer, there is a whole Baskin-Robbins of flavors of breast cancer. You have all of these different flavors of breast cancer and they all act differently, and just now in recent years are we being able to personalize therapy.”
Page cited one patient who took the Oncotype DX test after having a 2.6 cm tumor removed. Normally, any tumor larger than 1 cm would warrant chemo, but her recurrence score came back as 0, meaning she has only a 3 percent recurrence rate and would not benefit from chemo.
He added, genetic testing is being studied for use in other cancers such as colon cancer, lung cancer and lymphoma.
“Those tests aren’t ready for prime time because you have to figure out which genes have the best predictive value and then test that with historical controls to see if you have a good model,” Page said. “They have to go through the entire clinical trial process. That can take years. But it is being actively investigated. It is not out of the question that we will see the same kind of test used in other cancers.”
According to
www.oncotypedx.com, an Oncotype DX colon cancer test is preparing to launch in the early part of next year.
Dr. David D’Spain, a medical oncologist at Texas Oncology, is also hopeful for the Oncotype DX test to cross over to colon cancer and for the same principal to be used in the treatment of other cancers. In his practice he has found the Oncotype DX test to also be particularly helpful with older patients.
He said most women who have breast cancer after age 75 fall into a low risk category with an estrogen fed cancer. In cases where the cancer is shown to not be estrogen fed, he runs the Oncotype DX test to double check.
“Older patients have difficulty tolerating chemotherapy, but you don’t want to age discriminate,” D’Spain said. “There have been a lot of studies that show if age is the only reason not to give the chemo, that you shouldn’t discriminate because they can do just as well.”
He also said older patients have a lower recurrence risk.
“Some theories of that is the recurrence rate data follows women 10 or 15 years later, and it is possible something else ends their life before breast cancer can be an issue again,” he said. “It depends on who you look at it. But a majority of women who get breast cancer in the older age bracket, 75 and plus, tend to be low risk [estrogen fed] cancers.”
Women are encouraged to have yearly mammograms starting at age 40. For women in Parker County who do not have the resources for the test, the Parker County Health Foundation can help. Call (817) 341-1946 for more information.
Gunter said there are numerous resources to assist women in all stages of breast cancer, and their is no reason they should go without care. She also said everything they need is all in town.
“Weatherford, even though it’s a small town, we’ve worked really hard to bring all the updates in breast cancer here,” Gunter said. “There’s really nothing you can get done anywhere else that you can’t get done here.”
D’Spain also stressed the advantages of staying local for health care such as drive time and accessibility, but he did encourage patients to choose a doctor they trust.
“Cancer care is more of a lifetime commitment than it use to be,” D’Spain said. “There are a lot of success stories, but there is a lot of follow up.”