Breast Cancer Therapy: How to Choose the Optimal Solution

The diagnosis of breast cancer evokes fear. Patients wonder: is chemotherapy necessary or can it be avoided? Despite its potential to save lives in some cases, chemotherapy often isn't strictly necessary and can cause side effects that outweigh its benefits.

"For a long time, doctors struggled to determine for whom chemotherapy would truly be beneficial," says breast cancer specialist Professor Ulrike Nitz. She explains how a new diagnostic strategy gives patients more confidence in deciding whether to undergo chemotherapy or not:

- Professor, you were awarded the German Oncology Prize for clinical research in 2023. What makes these two studies, which you led, so special?

- The aim of the studies was to provide patients with more confidence in choosing therapy. The best therapy achieves maximum therapeutic effect with minimal burden on the body. In the German studies Plan B4 and ADAPT2, we investigated how to "target" chemotherapy in hormone-dependent breast cancer so that only those patients who truly need it receive it.

- How does your research help patients make decisions about therapy?

- By using the Oncotype DX Breast Recurrence Score® multi-gene test in our studies, both in Germany and the US, we arrive at a more accurate assessment of which patients will benefit from chemotherapy and which will not. According to modern data, a maximum of 20% of women without lymph node involvement need chemotherapy. The same applies to postmenopausal women with involvement of up to 3 lymph nodes.

- Does this also apply to premenopausal women?

- In such cases, decision-making is still difficult. Here, the ADAPT concept helps: in addition to Recurrence Score® results before surgery, the effectiveness of anti-hormonal therapy is checked. We have proven that for women with medium risk, if anti-hormonal therapy is effective, additional chemotherapy can be omitted. Thus, we can provide younger patients with well-founded and reliable assistance in decision-making.

Additional Information:

The Oncotype DX Breast Recurrence Score® test is suitable for patients with early invasive hormone-positive and HER2-negative breast cancer who do not have (N0) or have up to 3 affected lymph nodes (N1). Large German and American studies have confirmed its reliability in over 20,000 patients.

References:

Sparano J. A. et al., New Engl J Med, 2018

Nitz U et al. J Clin Oncol 2022 Aug 10;40(23):2557-2567

Kalinsky K. et al., New Engl J Med, 2021

Nitz et al., Breast Cancer ResTreat, 2017

Source: Mamazone