Some women can reduce breast cancer chemo: study
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Many women with breast cancer may be able to safely skip at least one step in chemotherapy, saving themselves time and side-effects, U.S. researchers said on Wednesday.
Women in a study with so-called estrogen-receptor positive cancers did not gain any added benefit from taking Taxol, which can cause nausea, hair loss, severe hypersensitivity reactions and other side-effects.
But those with HER2-receptor-positive cancer -- about 15 to 20 percent of women with breast cancer -- were significantly helped when Taxol was added, Dr. Daniel Hayes of the University of Michigan and colleagues reported in the New England Journal of Medicine. They had a 41 percent lower rate of having their cancer come back.
"If you ask how much longer am I going to live disease free, it's about 3 years ... and that's huge," Donald Berry of the University of Texas M. D. Anderson Cancer Center, who helped direct the study, said in a telephone interview.
While they are not recommending any changes in practice yet, the researchers say doctors should be aware of their findings in discussing treatments with patients.
"In general, chemotherapy for breast cancer has been a one-size-fits-all approach," Hayes said in a statement.
Doctors usually add more chemotherapy agents if they believe the cancer is likely to have spread. Taxol, known generically as paclitaxel, or related drugs in a class called taxanes are usually added to a cocktail of other drugs.
The researchers had been studying a group of women for years, many of whom got Taxol after going through four cycles of the drugs adriamycin and cytoxan for breast cancer that had spread to their lymph nodes.
They tested the original tumor tissue of 1,322 women to see who had estrogen-positive cancer and who had another type, called HER2-receptor-positive cancer.
Then they looked at how the women did up to 12 years later. Those with HER2 tumors got clear benefits.
"But paclitaxel did not benefit patients with HER2-negative, estrogen-receptor-positive cancer," they wrote.
"Why should we spare our patients from paclitaxel?" Dr. Anne Moore, of Weill Cornell Medical College wrote in a commentary.
Side-effects, cost and convenience, answered the researchers.
"Neurotoxicity is the big one," Berry said. "It can be very bad if you don't know your feet are there."
Breast cancer patients also have options of newer drugs, such as Herceptin, which is targeted to HER2-positive tumors.
What breastcancer.org says about this article…
Some women can reduce breast cancer chemo: study
After surgery to remove early breast cancer, a combination of chemotherapy medicines is usually recommended to reduce the risk of the cancer coming back (recurrence). One common combination is Adriamycin (chemical name: doxorubicin), Cytoxan (chemical name: cyclophosphamide), and Taxol (chemical name: paclitaxel).
The study reviewed here found that including Taxol in the chemotherapy regimen didn't seem to offer any added benefits for women diagnosed with early breast cancers that were hormone-receptor-positive and HER2-negative. While the researchers don't recommend a change in the standard of care, they do think doctors should be aware of the results and talk about them with their patients.
For breast cancers that were HER2-positive, the study showed Taxol was very effective: the risk of recurrence was reduced by 41%. It’s important to note that this study only looked at women with early breast cancer. Taxol also can effectively treat advanced and metastatic breast cancers.
It's also important to note that this research only looked at women who received Taxol. There is another, different form of paclitaxel, Abraxane. Also, Taxotere (chemical name: docetaxel) is another chemotherapy medicine that is very similar to paclitaxel. This study didn't look at either Abraxane or Taxotere so we don't know if these findings apply to those medicines.
Getting the best breast cancer treatment can feel like a balancing act: You want to do as much as you can to get rid of the cancer and lower the risk of it coming back. But you'd like to avoid uncomfortable side effects that might lower your quality of life. The side effects of Taxol may include nausea, hair loss, and tingling or numbness in the hands and feet. If Taxol isn't helping to reduce the risk of recurrence, then some women may be able to skip it and avoid the side effects.
If you've been diagnosed with early breast cancer that is hormone-receptor-positive and HER2-negative and are considering chemotherapy that includes Taxol, talk to your doctor about these research results. Until more research is done with larger groups of women, your doctor may still recommend Taxol. Together, you and your doctor can decide on the best treatment plan for YOU.