HYANNIS – One of the most difficult conversations a woman can have with her surgeon and oncologist after learning she has breast cancer is whether or not she will need chemotherapy. The new Endopredict test is helping to change that discussion by accurately determining if a woman with early-stage breast cancer can safely avoid chemotherapy treatment.
“Chemotherapy is always the biggest conversation for me anytime I see a new breast cancer patient,” said Kathryn Dalton, DO, FACS, Cape Cod Hospital breast surgeon. “They really don’t hear anything else after we talk about chemotherapy. Sometimes, we don’t even know if they will need it because everything depends on the final results we get after their surgery.”
The decision to add chemotherapy to the treatment plan is based on the risk of distant recurrence, years after your initial diagnosis, according to Dr. Dalton. This test is also very accurate at predicting early recurrence, which occurs within five years, and late recurrence, which looks at five to 10 years after diagnosis.
Distant recurrence is cancer that spreads beyond the original area of cancer, which means metastatic or Stage IV breast cancer. Metastatic breast cancer, while treatable, is not curable, she said. Twenty-two percent of patients with stage IV breast cancer are alive after five years.
“Chemotherapy is what we use to decrease the risk of distant recurrence,” said Dr. Dalton. “We weigh the risk of distant recurrence with the risk versus benefit of chemotherapy. Our goal is to identify women who are at low risk of recurrence because, at low risk, we are not going to add chemotherapy, since the benefit would be minimal.”
The test is validated in predicting risk of recurrence in women with early-stage, stage one and stage two breast cancers, estrogen receptor positive breast cancer and HER 2 negative breast cancer, according to Dr. Dalton.
The complex algorithm takes into consideration the size of the tumor, whether there are positive or negative lymph nodes (cancer has or hasn’t spread to the lymph nodes), and test results of specific genes that contribute to the risk of recurrence.
“Genes can either add or decrease your risk of recurrence,” said Dr. Dalton. “Endopredict is also the only validated test on the market that accurately predicts risk of distant recurrence when a woman has positive lymph nodes. Historically, we were giving chemotherapy to patients with lymph node-positive breast cancer or breast cancers with aggressive features. Today, the treatment is very personalized, and now, with tests like Endopredict, down to the individual’s DNA level.”
The decision to give or not give chemotherapy treatment depends on how much it will reduce your overall risk of recurrence. If the risk is low, then the benefit will be low. If the risk is high, then chemotherapy may be beneficial.
“There is a landmark paper which combined all worldwide studies, looking at patients with early-stage breast cancer who have received chemotherapy, showing an overall benefit of chemotherapy with a 30 percent risk reduction in distant recurrence and an overall significant survival benefit,” said Dr. Dalton. “If you start out with a low risk factor of 6 percent and you have a 30 percent risk reduction with chemotherapy, your risk drops to 4 percent, which isn’t much of a difference. But if you have a 30 percent risk and you have chemotherapy, you will reduce your risk of recurrence to 20 percent.”
Soon there will be more predictive information coming out from studies looking at the long-term benefit of the current chemotherapy agents, she said.
It’s information “that medical oncologists really want because it aids them in the discussion with their patients to either add or eliminate chemotherapy. For patients, it helps them make informed decisions in their care.”
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