Is Chemo Always Necessary for Breast Cancer?

Not every woman will benefit from chemotherapy for breast cancer. But it’s hard to determine who will and who will not.

Illustration of women with abstractions of data layered across them.

Illustration by Gordon Studer

Researchers have discovered at least one group that appears not to benefit from chemotherapy: postmenopausal women with a specific, fairly common type of breast cancer.

Those women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer that has spread to a limited number of lymph nodes, and whose recurrence risk is relatively low, were shown not to benefit from chemotherapy when it is added to hormone therapy, according to initial results from a clinical trial by an Emory researcher. 

Chemotherapy infusions take time and money and can have harmful side effects.

This is the first evidence in a randomized phase III trial that postmenopausal women with HR-positive, HER2-negative breast cancer that has spread to one to three lymph nodes can safely forgo chemotherapy if their recurrence score on a genomic tumor tissue test is 25 or less. 

“Every day in clinics around the world, physicians wrestle with the question of how to best treat women with this common form of breast cancer,” says the study’s lead author Kevin Kalinsky, acting associate professor in hematology and medical oncology and director of the Glenn Family Breast Center at Emory’s Winship Cancer Institute. “These results are practice-changing and demonstrate that some postmenopausal women can be spared unnecessary chemotherapy and receive only hormone therapy. This should bring more clarity to physicians and some relief for patients.”

The trial also demonstrated, after a median of five years, that premenopausal women with the same disease characteristics benefited from chemotherapy.

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