Millions of women with breast cancer could be spared chemotherapy thanks to a groundbreaking genomic test, according to an international trial led by University College London. The Optima trial followed more than 4,000 patients across six countries and found that those with a low score on the test could be treated safely with hormone therapy alone, with near-identical outcomes to those who received chemotherapy.
The Prosigna test, developed by Veracyte, analyses the activity of 50 genes in tumour tissue to determine the risk of cancer returning within a decade. Patients with a low score can avoid chemotherapy and its toxic side-effects, which include hair loss, nausea, fatigue, infertility and cognitive impairment. The findings are due to be presented at the American Society of Clinical Oncology's annual meeting in Chicago.
Professor Rob Stein, chief investigator of the trial, said: 'Optima addresses a longstanding challenge in breast cancer care: identifying who truly benefits from chemotherapy and who does not. Our findings show that many patients can safely avoid chemotherapy without compromising their outcomes.'
One participant who took the test and skipped chemotherapy described the relief as 'like Christmas'. Nine years after diagnosis, she remains healthy and active. The trial involved patients aged 40 and over with hormone-positive breast cancer, the most common form, accounting for up to 80% of cases globally.
Five years after treatment, 95% of those who had chemotherapy and hormone therapy were alive and free from recurrence, compared with 94% of those who skipped chemotherapy. The results suggest that for low-scoring patients, chemotherapy offers little or no additional benefit, paving the way for more personalised treatment.
