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For half a century, doctors have decided who needs the treatment based on often crude factors such as the size of the tumour, if it has spread to nearby lymph nodes and its appearance under a microscope. But chemo has side effects such as fatigue, nausea and neuropathy – with some patients better suited to hormone tablets instead.
Now The Christie Hospital in Manchester has successfully trialled the Prosigna test under their Optima (optimal personalised treatment of early breast cancer using multi-parameter analysis) process, helping patients avoid unnecessary and gruelling chemo.
Prosigna uses a machine to look at a tissue sample removed in a biopsy or surgery and analyses 50 genes in the cancer cells.
Dr Anne Armstrong, consultant oncologist leading the Optima trial, said: “To have a test that can tell us who can be spared chemotherapy is very exciting.” Mum of three Aileen Pritchard describes in the Daily Express today how the trial helped her.
And Dr Armstrong added: “Although it can’t help all breast cancer patients, it could be extremely beneficial to patients like Aileen with the hormone-driven type of the disease.
“If the Prosigna test was approved to be routinely used, it may reduce the use of chemotherapy without having any effect on rates of successful treatment.
“This is another example of how we’re moving towards more targeted and personalised treatments, meaning patients aren’t unnecessarily exposed to the toxicity of chemotherapy.
“We are still recruiting patients with breast cancer to the Optima clinical trial from across the UK.
“We hope that once results are published this could lead to a change of practice for around 10 per cent of women diagnosed with breast cancer each year.”
Molly Newman, an Optima research nurse, explained how the Christie ensured the trial was not impeded by the pandemic. She said: “We worked hard to ensure recruitment to the trial didn’t slow down – to enable as many patients as possible to avoid chemotherapy, which would weaken their immune system and leave them more susceptible to the symptoms caused by contracting Covid.
“It also helped reduce the number of patients going for chemotherapy, which helped the department at a challenging time.”
The study, led by University College London (UCL) and
University College London Hospitals NHS Foundation Trust (UCLH), is looking at the use of a molecular test to determine which patients need chemotherapy.
It has recruited more than 3,000 patients in the UK, Sweden and Norway and is looking to add a further 1,500 by the end of 2024.
The study is designed for patients where the cancer has spread to up to nine lymph nodes, where there is a higher risk of the disease spreading. So far about two thirds of patients tested in the trial have avoided chemo. It could benefit up to 5,800 people diagnosed with breast cancer annually in the UK if approved by The National Institute for Health and Care Excellence (Nice), once the results of the study are published.
Over the past few years, scientists have developed tests like Prosigna which probe beyond what can be seen with a microscope.
Any patients interested in taking part in the trials should discuss it with a consultant or GP. Not all will fit the criteria for it.
‘I’ve felt fit and well throughout – It’s such a bonus’
Mum of three Aileen Pritchard is clear of breast cancer without having chemo, thanks to the test being trialled ATTHE Christie NHS Foundation Trust in Manchester.
Aileen, 62, who owns a drycleaning business with her husband Kevin, felt a lump in her right breast in July 2018. She went to her GP who referred her for a scan which showed she had a 7.2 cm tumour and was diagnosed with Stage 3 breast cancer, undergoing a mastectomy a few weeks later.
In October 2018, Aileen was referred to the Christie for radiotherapy and given the option of taking part in Optima.
Because her cancer had spread to a lymph node under her arm, she was suitable for the study and randomised to the group that had the Prosigna test. It revealed a low score indicating chemotherapy was not needed – so instead she was given a course of radiotherapy and is now in remission. Aileen, of Darwen, Lancs, who was able to carry on working during treatment, said: “There were two reasons I said yes to the trial.
“I was not looking forward to chemotherapy. I don’t take drugs unless I really have to, so to avoid any treatment that isn’t necessary is a real bonus. I also wanted to do something to help other women. If the results can help other people’s future treatment then I’m all for that.
“I’m so glad I took part in the clinical trial and would encourage other patients in my position to do so. I’ve felt fit and well throughout.
“I’ve had the mindset that having cancer wouldn’t impact on me and I’ve been determined to keep a positive outlook.”
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