Gene test cuts the need for chemo by half

The number of Irish women forced to undergo chemotherapy treatment for early stage breast cancer more than halved over an 18-month period, following the HSE’s approval of a new genetic test.

Most of those who undertook the Oncotype DX analysis, which identifies whether or not a patient will need chemotherapy after surgery, were found not to need such aggressive treatment, a medical conference in Vienna heard yesterday.

Studies presented at the 14th St Gallen Breast Cancer Conference included results from an observational study in Ireland — the first European country to publicly reimburse the cost of the US$4,000 (€3,705) test.

The study, led by Dr Janice Walshe, consultant medical oncologist at St Vincent’s University Hospital in Dublin, revealed a 59% net reduction in chemotherapy use following the test, and net savings of around €800,000 to the HSE since its introduction in 2011.

The findings were presented to the conference by oncology specialist registrar Dr Lillian Smyth.

The research project on its use here was carried out for the All-Ireland Co-Operative Oncology Research Group (ICORG) in collaboration with the National Cancer Control Programme (NCCP).

From the 583 patients with cancer — that had not spread to the lymph nodes — who were included in the analysis, the results found that 345 patients (59%) underwent a change in their treatment decision.

Based on Oncotype DX Recurrence Score® results, 339 patients who were likely to derive minimal or no benefit from chemotherapy but would have been recommended this form of treatment prior to testing, were changed to hormone therapy alone, while six patients, who would otherwise not have been recommended chemotherapy in the absence of testing, were advised to receive it following testing.

“The results from Ireland demonstrate not only the impact of the personalised information Oncotype DX provides on treatment decisions, but also the significant cost savings associated with the use of the test over time,” said Dr Walshe.

According to the study, less than 10% of patients with hormone sensitive early-stage breast cancer benefit from chemotherapy.

“Chemotherapy is a blunt instrument as it attacks both good and bad cells, so any method that reduces its need is welcome,” said Dr Walsh.

However, early detection is crucial, and not all cancers are created equally: “We have patients who will initially present with large tumours and will be flying 10 years later but those with much smaller tumours can have a relapse. It is very important if one develops any form of lump to have it checked out.”

Emma Gorman, from Dublin, has more reason than most to support the new test. She had a malignant tumour removed from her right breast in 1996, followed by six weeks of radiotherapy.

Following routine screening, another tumour emerged in her left breast in November 2011, apparently unrelated to the previous incident.

“Whilst a breast cancer diagnosis is never positive news, I had a hugely positive experience in St Vincents, cared for by my multidisciplinary team of experienced women — Dr Janice Walshe, oncologist, Dr Jane Rothwell, breast surgeon, and Dr Catriona Lawlor, plastic surgeon.

“The nursing staff were also wonderful and full of empathy, which I found very supportive at the time.”

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