Deciding on chemotherapy

Breast cancer is the most common cancer in the UK, but survival rates are improving and have doubled in the last 40 years. An estimated 691,000 women are alive in the UK after a diagnosis of breast cancer and this is expected to rise to 840,000 by 2020.

The advent of personalised medicine offers hope of increasing survival rates even further, while improving quality of life for those living with cancer.

Genomic Health, the world’s leading provider of genomic-based diagnostic tests, has harnessed the potential of molecular technology to provide doctors with information about who will, and who will not, benefit from chemotherapy.

Although chemotherapy is an important and potentially life-saving cancer treatment, it is toxic to normal cells as well as cancer cells. Patients commonly experience painful and arduous side effects. Treatment with chemotherapy can cause lethargy, nausea, hair loss and it can leave patients with an increased vulnerability to infections. Chemotherapy can also take an emotional, psychological and economic toll that sometimes lasts long beyond the course of treatment.

With genomic testing, we can now confidently reassure many of these women that chemotherapy is not required

Personalised medicine, and Genomic Health products in particular, can help to identify those patients who will benefit from chemotherapy. This means that those who do not need it can be spared this treatment. Improved targeting also offers clear benefits to the NHS by directing finite resources to those who need them.

Genomic Health’s Oncotype DX Breast Recurrence Score® test for early-stage breast cancer patients has been available in the UK and Ireland since 2006, and in 2013 the National Institute for Health and Care Excellence (NICE) published guidance advising that the Oncotype DX test is clinically and cost-effective for use in the NHS. It is now established as the most commonly used genomic test in breast cancer and is a routine part of the diagnostic process for patients diagnosed with early-stage breast cancer.

The Oncotype DX Breast Recurrence Score test works by examining the activity of 21 genes within the tissue of cancer tumours. Data about this activity yield the Recurrence Score® result, on a scale between 0 and 100, assessing the likelihood of chemotherapy benefit and ten-year risk of distant recurrence to inform adjuvant treatment decisions in women with early-stage invasive breast cancer.

Clinical data has shown that the Oncotype DX test can serve to guide treatment decisions after breast cancer surgery. A growing body of evidence supports the benefit of applying the test to patients with breast cancer which has spread to the lymph nodes, as well as to those where it has not spread.

The test’s accuracy and effectiveness has been confirmed in multiple large, independently run international studies taking in more than 63,000 patients. For example, the TAILORx study, involving 1,626 patients, found that 99.3 per cent of patients with a low Oncotype DX Recurrence Score result were relapse-free after five years of treatment with hormone therapy alone, confirming that the decision to avoid chemotherapy was appropriate.

Dr Mark Verrill, head of the Department of Medical Oncology at the Newcastle upon Tyne Hospitals NHS Foundation Trust, and deputy lead clinician for breast cancer in the North of England Cancer Network, says: “Being diagnosed with cancer is a distressing experience and patients have so many questions.

“One of their main concerns is the impact of chemotherapy on their lives. When you are able to tell them that they don’t need to have chemotherapy, the sense of relief is immense.”

Dr Verrill says the Genomic Health platform is an example of the positive impact of personalised medicine for patients and healthcare systems. “In the days before Oncotype DX, many women with a moderate risk of breast cancer recurrence underwent chemotherapy, with all its unpleasant side effects, because of anxiety around that risk,” he says. “With genomic testing, we can now confidently reassure many of these women that chemotherapy is not required and that anti-oestrogen drugs like tamoxifen are all that is needed to reduce the chance of the cancer returning.”

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