Now, the choice is getting easier for some patients.
Researchers studied their outcomes, including whether or not cancer recurred, and their overall survival. A high recurrence score, above 25, means chemo is necessary to ward off a recurrence while a low score, below 10, means it is not.
He estimates 3000 women a year in the United Kingdom would no longer need chemotherapy because of this trial.
The new study, called TAILORx, is a large, randomized trial involving thousands of patients. After an average of nine years, 83.3% of those who did not undergo chemotherapy remained cancer-free, compared to 84.3% of those given chemo. Women younger than 50 still saw some benefit from chemotherapy, especially with scores between 21-25.
"With the results of this groundbreaking study, we can now safely avoid chemotherapy in about 70 per cent of patients who are diagnosed with the most common form of breast cancer". However, this left the majority of women with the condition (those who fall into the 11 - 25 range) and their doctors without clear treatment guidance.
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This researchers split the middle-scoring group into two randomized subgroups: one treated exclusively with estrogen-blocking hormone therapy, and one with chemo combined with hormone therapy.
For the TAILORx study, scientists recruited over 10,000 women with the most common type of breast cancer, called oestrogen-receptor positive (ER+) HER2-negative breast cancer. Twenty-five percent of those patients won't qualify for chemotherapy because of age or medical problems.
Commenting on the findings, Dr Simon Vincent, director of research at Breast Cancer Now, said the research was "world class". "The trial was created to address this question, and provides a very definitive answer". There is still a long way to go, he said, but it's an approach that isn't specific to a certain cancer type, meaning it could evolve into an effective therapy for many forms of the disease, he said.
Nell Barrie from Cancer Research UK, said: "It's exciting to see this cutting-edge science at work".
Once a tumor is removed, 21 genes are analyzed and patients receive a low - intermediate - or high risk of reoccurrence.
"They are attacking their own cancers", Rosenberg said in an interview. "But we need to be precise on when to use it and who to recommend it to".
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"It's a great news story".
Other experts said the results confirm what many patients and doctors are already doing.
Knowing a patient's recurrence risk can spare them from enduring chemotherapy, but also can direct them towards it if they discover that they are at a higher risk, Sparano says. Most of the time, insurance will cover these costs, and Genomic Health offers a program to help assist those who don't have adequate insurance. Or was it sufficient for them to be treated only with endocrine therapy, which blocks the cancer-spurring properties of hormones? She enrolled in the TailorX trial and was relieved to be randomly assigned to the group that did not get chemotherapy.
Albain is excited to share the study results with her clients in her practice. "I had given up fighting", Perkins said.
He added that it was important that the federal government funded the study because the pharmaceutical industry has little interest in sponsoring trials that result in a reduction of treatment.
"Part of the excitement is because all cancers contain mutations, it's a technique that could potentially be applied to any tumor type", Rosenberg said.
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Chosen for their ability to home in on four mutant proteins present in all of her cancer cells, the TILs broke down and carried off the two large tumors growing on her chest wall, along with four tennis-ball-sized tumors lodged in her liver.