Have you heard recently in the news about a breakthrough in breast cancer
that better helps us determine whether you may or may not benefit from
chemotherapy for your unique breast cancer it involves breast cancer
genomics the Oncotype DX test and the TAILORx clinical trial don't be
confused we will teach you all about it
if you recently have been diagnosed with a small favorable hormone sensitive
estrogen receptor-positive and no cancer in your lymph nodes early
stage breast cancer your breast cancer specialists may order if appropriate for
you a genomic test called an Oncotype DX assay a test that looks deeper into your
cancer cells to better determine whether or not you may benefit or not benefit
from chemotherapy in addition to hormonal therapy today a large clinical
trial just presented and released and published results in the New England
Journal of Medicine that better helps us as breast cancer specialists guide
patients with favorable early-stage breast cancers that have an Oncotype DX
test result in what we call the intermediate range there was lack of
clarity before today and now we have better clarity to guide patients toward
or away from chemotherapy in this breast cancer school for patients lesson we're
going to tell you about breast cancer genomic assays what this information
tells us and how it can affect your breast cancer treatment decisions I'm
going to tell you what the new information from the Taylor X clinical
trial provides us and what it tells us as treating physicians and what you must
know as a newly diagnosed breast cancer patient I'm gonna go over how we now
interpret the intermediate recurrence score results which we have more clarity
on now however this interpretation may evolve
over time as we all or more of the information from this clinical trial and
I'm also going to go over who may qualify for genomic assay in general if
you have been diagnosed with breast cancer so let's get started so what is a
breast cancer genomic test well these are sophisticated tests that
we've been using over the last 10 to 15 years that help us take a deeper look
into your breast cancer cells to better determine
whether your breast cancer is a higher chance of recurring meaning threatening
your life and also gives us information about whether or not you may or may not
benefit from chemotherapy for your early favorable breast cancer it is so
important to state that the decision to undergo chemotherapy is one of the most
difficult decisions in all of healthcare for your physicians your
multidisciplinary team and obviously you as a patient and a genomic test simply
doesn't give you a yes-or-no answer it's a piece of a puzzle a large puzzle that
is you as a human being a person and also your unique breast cancer situation
the tailor X clinical trial gives us better clarity of those that have had a
genomic test an Oncotype DX test and a lot of
patients that would get that test had a middle-range and intermediate recurrence
score and now we have better clarity about how to guide patients whether or
not they benefit or do not benefit from chemotherapy and I'm going to tell you
about the tailor X trial that's so what is the tailor X clinical trial well the
results were just presented today and they're published in the New England
Journal of Medicine but it is breaking news because it's powerful information
that in general tells us that we can take more women with early-stage
favorable breast cancer and in the future give less women chemotherapy to
get great outcomes I'm gonna walk you through this clinical trial and tell you
about something called a recurrence score so the tailor X trial one of the
largest breast cancer trials ever perform
10,000 women early-stage favorable breast cancer I'm gonna go over who
qualifies for a genomic assay next but patients that qualify for a genomic
assays and they use the Oncotype DX assay to better determine some of the
patient's sort of in the middle that we weren't sure what to do it offer
chemotherapy or not so what a recurrence score is a score after looking deeper
into your cancer cells from one to a hundred and we already know from the
taylor x trial they release some preliminary information several years
ago that if you have a recurrence score between 1 and 10 you have such a
favorable breast cancer that if you take hormonal therapy the chance of your
cancer coming back in the next five to ten years is probably in the range of
one to three percent no benefit at all from you came up there the next group is
our intermediate group I'm going to jump ahead and tell you that if you have a
recurrence score above 31 we generally recommend and there's good data to
support that you'll benefit from chemotherapy if appropriate for you so
now we're back to score of 11 in this case 225 an intermediate group and
that's what the Taylor X trial really studied do all these patients need
chemotherapy do none of them meet chemotherapy or where do we draw the
line so the Taylor X trial reported its
results and this is some general conclusions if you have a recurrence
goal with an early favorable breast cancer 11 and 25 in general you will
likely not benefit from chemotherapy there are a couple of caveats I'll cover
them in a minute if you have a recurrence score between 26 and 30
right below you benefit from chemotherapy we don't have clarity and
now in that small group but it's pushing towards keema they're most likely if you
came back after sending off an Oncotype DX and got your recurrent score and
you're less than 50 meaning premenopausal or less than 50 a younger
patient then there is a small benefit to chemotherapy if you have a recurrence
score between 16 and 20 it's small but it's there and they found that in the
study and if you have a recurrence score between 21 and 25 now the upper end of
this intermediate range there's a moderate benefit to you from
chemotherapy so it's small and moderate and those need to be individualized
decisions for patients and their medical oncologist and larger breast cancer team
to make when we step back in this 11 to 25 range we now can look at patients and
tell more of them you do not benefit from chemotherapy whereas in the past we
would have offered chemotherapy in some unique situations so it really spares
many women from getting chemotherapy in the future same test we just understand
the test better and we'll utilize it to better benefit to patients and one of
the things we talked about breast cancer is giving you what you need but not over
treating it's called personalized medicine and that's what defines
excellent breast cancer care so who qualifies for a genomic assay for their
breast cancer well this is obviously a very complex topic but I'm going to give
you some general principles of all women and all cancers
probably about 25 to 50% of them may qualify for genomic assay but that does
not mean it's appropriate for all of them the decision to order genomic assay
is a complex one made with you and your medical oncologists and or your breast
cancer surgeon I'm going to give you a few concepts of those that do not
qualify for a genomic assay if you have / - positive breast cancer or triple
negative breast cancer you're probably going to benefit from chemotherapy and a
genomic assay simply does not apply to you if you have a more advanced breast
cancer and inflammatory breast cancer we're gonna give you chemotherapy anyway
well if you have a very large breast cancer and multiple lymph nodes involved
you're gonna likely get chemotherapy and a genomic asset plays no role in your
unique situation on the other hand who does qualify generally smaller breast
cancers four or five centimeters or less favorable estrogen receptor positive and
her2 negative breast cancers and also a favorable sign is that there's no cancer
in your lymph nodes at the time of surgery there's some caveats about
applying a genomic assay to someone has one or two lymph nodes but we don't
really cover that in this discussion today so when you step back a genomic
assay is so helpful but you need to be also willing to consider to undergo
chemotherapy and healthy enough to undergo chemotherapy to justify ordering
and expensive tests because if you are not at all interested in chemotherapy
you say even if doctor of you recommend it I will never take it you don't need
to do the test because it might point to chemotherapy and it's not going to
change your decision also if you're unhealthy or would not tolerate
chemotherapy it's probably not a good idea to order a genomic assay make these
decisions by engaging your breast cancer surgeon and medical oncologists and ask
them about whether a genomic assay whether it's an Oncotype DX assay a
mammoth print in to predict and their others whether they may play a role in
making treatment decisions for your unique breast cancer if you qualify for
a genomic assay for your breast cancer such as an Oncotype DX test we can now
better identify whether or not you'll benefit from chemotherapy with the
results of the tailor X clinical trial of which the results were just presented
today and published today in the New England Journal of Medicine the decision
to undergo chemotherapy is one of the most difficult decisions in all of
healthcare but this clinical trial allows us to identify more women who can
avoid chemotherapy with an early favorable breast cancer to learn more
about breast cancer genomics the taylor x clinical trial clinical trials will i
need chemotherapy hormone therapy visit the breast cancer school for patient
at breast cancer course or where we actually teach you everything you need
to know we're here to help you get the best possible breast cancer care in your
community register on our website to get our list of questions to prepare you for
your next doctor visit
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