Grains of Salt: Be Careful of Media Hype Around the TAILORx study

Grains of Salt: Be Careful of Media Hype Around the TAILORx study
June 4, 2018 Alene Nitzky
media hype

It’s ASCO time again. Early June, when the American Society of Clinical Oncology meets for their annual conference. Papers are presented, new research is discussed, and there is much talk about the ongoing state of cancer care- moving forward at a snail’s pace, but that’s not all bad.

This year, though, there was presentation of the results of a study that is being hyped throughout the news media. Even reputable news media- the New York Times was hyping it this morning- “Good news for breast cancer patients” was their headline in their Monday morning briefing. And the public radio show on NPR, 1A, is talking about it tomorrow.

Remember, one study is not conclusive. And there are many different types of breast cancer, they do not all behave the same way. And the patients in this study did not have all different types of breast cancer, we are talking about a very specific set of characteristics that might be a quarter of all new diagnoses. Maybe.

A STUDY.

ONE.

The TAILORx study  being published in the New England Journal of Medicine looked at women at intermediate risk for breast cancer recurrence based on the Oncotype DX gene panel test, who had early stage (no lymph node involvement, usually classified as Stage I) estrogen receptor positive cancer, to see if hormone blocking drugs were superior to chemotherapy plus hormone blocking drugs. The study was randomized (meaning there was no bias about which subjects were placed into each of the two study groups), and there were about 10,000 women in the study, which is a good sized sample.

They found that over 10 years, there was essentially no difference in the number of recurrences between the two treatment groups, which implies that chemo is not any better than these hormone blocking drugs alone. Which further implies that all the nastiness and side effects and long term effects of chemo could be avoided for women who fall into this category- which is, ER-positive, HER2 negative, no lymph node involvement, intermediate Oncotype Dx score, breast cancer.

This is good news for some people who might otherwise get overtreated for breast cancer. They can avoid chemo. And the usefulness of the Oncotype Dx test get a boost because now it gives us the information we need to make this chemo or no chemo decision. In the patients diagnosed with this type of breast cancer at an early stage. 

Now…before you start running around telling everybody that chemo is no longer needed for breast cancer, keep in mind the following: this only applies to about a quarter of the breast cancer diagnoses each year (meaning early stage ER+, HER2-, with Oncotype Dx score of 11-25, no lymph node involvement, and in this age range). The other 180,000 or so breast cancer diagnoses that don’t fall into this category, like triple negative, or triple positive, with a higher risk for recurrence, and other factors such as familial risk and other characteristics, are not included in this study so the results don’t apply to them. The researchers also said that women under 50 may have more reason to benefit from chemo.

And furthermore, this is ONE STUDY. Albeit large, and randomized, it is one study.

And keep in mind, about one-third of all patients with this type of cancer will have a metastatic recurrence later. This means that about 70% of patients with this type of cancer will potentially benefit from the findings.

So hang onto your shorts and don’t go running around spreading misinformation that breast cancer treatment has made a huge advance and that people with breast cancer will no longer need chemo, because that is NOT the takeaway from this.

We have a long way to go in educating the public about the various forms and types of cancer even originating in one particular part of the body, and that all cancers, like all individuals, have many characteristics and may not behave the same way.

Repeat after me, there are hundreds of different types of cancer. There is not one cause. There is not one cure. And this is one study.

I can hear you. Thank you.

So, while I applaud the potential for this information to make life easier for some breast cancer patients, we can’t go shooting off fireworks yet, because there are a lot of people who are not affected by this study’s results. 

Everybody just chill.

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