Research shows that rates of cancer are increasing - partly due to more people living longer lives. Oncotype DX, a test conducted by Exact Sciences, was developed to predict which patients might be at risk of cancer returning and who may benefit from chemotherapy.
Professor Simon Holt, Honorary Professor in the Faculty of Medicine, Health and Life Sciences at Swansea University, is an active breast cancer researcher, especially on the impact of Oncotype DX testing on clinical management of breast cancer.
“Cancer has become a more common disease, mainly because of our ageing population. The understanding of how cancers arise, genetic changes that distinguish different cancers and the targeting of effective chemotherapies to only those patients that need it, have revolutionised treatment,” he says.
Here, Holt tells us more about Exact Sciences cancer research, chemotherapy, cost-effectiveness and recovery.
How can cancer care be improved, both in terms of outcomes and cost-effectiveness?
“Unfortunately, many simple healthcare messages are ignored. A sensible diet, a normal weight and regular exercise can reduce the risk of some cancers by as much as 40%. This is not helped by evolution, which left us with the survival instincts to eat the highest calorie foods on offer, to store energy in the form of fat in case of future famine and not to expend energy unnecessarily.
“Similarly, pollution and the accumulation of carcinogenic chemicals in the environment seems to be an inevitable consequence of the convenience of industrialisation. However, consistent healthcare messaging, as well as legislation and incentivisation against the excesses of the food industry, could have significant benefits.
“Prevention is the most effective strategy, but early diagnosis is the key to containing costs and improving cancer outcomes.”
What are the general side effects of chemotherapy used following surgery in early breast cancer?
“For many women receiving chemotherapy as part of their initial treatment for breast cancer, the side effects, although temporary, can be a gruelling physical and mental drain.
“Most chemotherapies given in this situation involve attending the hospital for half a day once every three or four weeks and having the treatment given by a drip. Lethargy and loss of appetite for a few days is very common. Loss of hair, loss of feeling in the fingertips and weight gain, depending on the exact drugs given, are also common concerning side effects for many women.
“However, a few women will suffer much more severe problems:
- Up to 1%, particularly if they already have poor health, will die from the complications of chemotherapy.
- There is increasing evidence that chemotherapy increases the risk of dementia and anxiety or depression.
“There are also the social implications of having chemotherapy and the stress it can put on families and their finances.”
Discuss the unnecessary use of chemotherapy in breast cancer
“Most women are cured of breast cancer by surgery alone, but in 2005 a review of a large number of chemotherapy trials in breast cancer concluded that 15% fewer premenopausal women and 6% fewer postmenopausal women will die from their breast cancer if given chemotherapy as part of their initial treatment for breast cancer in which a small number of lymph glands in the under-arm area are affected.
“The problem is that if you wait to give the chemotherapy until the cancer comes back, it is too late. Chemotherapy at that point may control the cancer for a while but it will not act as a cure.
“Testing which genes are overactive and which have been turned off in breast cancer can give a much more accurate guide as to who needs treatment and who does not. Exact Sciences’ test, Oncotype DX, which looks at the activity of 21 genes in breast cancers, was developed to predict which patients are likely to do well and which patients might be at risk of the disease returning and who might benefit from chemotherapy.
“Exact Sciences has recently concluded an independent UK multi-centre trial of 680 NHS patients with early breast cancer where 1 to 3 of the under-arm lymph glands were involved. This trial looked at how many women could be spared chemotherapy if the Oncotype DX test was used. It explored how confidence in a patient’s recommended treatment was affected and whether the test made economic sense.”
Is Oncotype DX reliable?
“The Oncotype DX test is one of the most extensively studied genomic tests available for breast cancer patients today, with outcome data gathered from trials including over 100,000 women and from more than 150 publications. This includes two major randomised controlled trials (TAILORx and RxPONDER), each with 10,000 and 5000 patients respectively in them.
“These trials all point to a similar and consistent result – so, in scientific terms, it is very reliable. The laboratory will produce an extremely similar and accurate result regardless of how many times you choose to test the same sample.”
Does Oncotype DX reduce the number of patients prescribed chemotherapy?
“Yes, dramatically. The Oncotype DX test predicts the likely benefit that breast cancer patients will gain from chemotherapy, thus allowing many patients with no, or only very small potential benefits, to avoid this unnecessary and often gruelling treatment.
“As shown in our UK trial, without the test, 80% of women were advised that they should have chemotherapy, but after the test only 27% were found to need it. This means that more than half of the patients were spared chemotherapy treatment by using the Oncotype DX test.”
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