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Breast Cancer Chemotherapy Benefit After Surgery

>>> DR. DAVID MARGILETH: Chemotherapy after surgery is decided by looking at the characteristics

of that particular patient’s breast cancer. Things like, especially positive lymph nodes,

indicate that there’s a possibility of microscopic cells circulating in that patient’s system

that at some later date, may cause metastasis.

One of the tasks that we don’t have, that needless to say would be great, is a test

that tells us, after a primary therapy or after a local therapy that doing mastectomy

or lumpectomy radiotherapy, are there circulating tumor cells that have metastatic potential?

There are many patients, even many with no positive breast cancer, from the past we know

were cured by local therapy alone. But with various factors, namely hormone receptor-negativity,

positive nodes, larger tumors, and especially a higher number of positive nodes, indicate

that there are cells in that patient’s body that have metastatic potential that we have

no test for.

Patients often ask, “Well, can I get a PET scan and an MRI and a CAT scan and a brain

scan and bone scan, and prove that I don’t need chemotherapy?” Unfortunately, none

of those tests are sensitive enough to pick up the cells that will eventually cause metastasis.

So that we are left with looking at large trials, large databases, with different characteristics

of patient’s cancers, that is a low number of positive nodes or a high number of positive

nodes or HER2-positive, or HER2-negative, etc, and running different trials with different

adjuvant therapies. And in those trials that are often randomized, that is neither the

patient nor the doctor picks the treatment, but randomized between, for instance an older

treatment and a newer treatment. And in those large settings, when we have positive data,

it shows us that in a particular group of patients given a new treatment or a different

treatment, their long-term cure rate is higher than the older treatment.

The dilemma continues to be that even though we know group A maybe better than group B,

there are obviously people in group B that did not benefit because they might not had

needed treatment in the first place, and that unfortunately, even patients in group A with

a new or better treatment that recur in spite of that treatment.

What we continue to need is an individual test that determines whether a particular

patient, after their local therapy, is destined to recur or not. I don’t see that test occurring

in the next five years certainly, but one would hope in the next ten years one might

have that test so that many of the people we now treat with adjuvant chemotherapy we

would prove don’t benefit by it and therefore, we wouldn’t give it.

Hi, I am Dr. Jay Harness and I want to share with you important information that I believe

that every newly diagnosed patient with breast cancer needs to know.

Susan Denver: And I want every woman to know…

Katherine Stockton: …about personalized breast cancer treatment…

Susan Denver: …and the genomic test.

Coree: A test that helps guide a woman and her doctor…

Katherine Stockton: …to the best treatment options for her.

Susan Denver: Pass it on!