Skip the Chemo?

Breast cancer treatments have made impressive strides in terms of increasing survival rates for patients; however, a huge new study reveals that chemotherapy may not be as important of a factor for some women with breast cancer as previously thought. In fact, in some categories of breast cancer, most patients who received chemotherapy may not have actually benefitted from it. In other words, these patients would have survived just as well without the addition of chemotherapy.

This new research, which was discussed at the American Society of Clinical Oncology and published in the New England Journal of Medicine, could lead to an overhaul of the decision making process, as experts rely on better research-based guidelines to decide which patients should (and which shouldn’t) have chemotherapy added to their plan of care.

Chemotherapy generally brings painful side effects for patients, although those can certainly be worth it if life is extended. In a decade-long study of more than 10,000 women with breast cancer, there was no benefit of chemotherapy for patients with the most common type of breast cancer. Specifically, this common type of breast cancer is characterized as hormone-receptor–positive, HER2-negative, axillary node–negative breast cancer with a midrange 21-gene recurrence score. Women with this most common breast cancer did not garner benefits from chemotherapy, as opposed to surgery and hormone therapy. (There were exceptions; however, for some younger women and some women older than age 50.)

What Does This All Really Mean?

Up to 70% of women with the most common type of breast cancer don’t need chemotherapy (which means these women can also skip the nausea, hair loss, and anemia that chemotherapy generally brings with it).

This new study adds to our understanding of breast cancer treatment and continues to create a clearer picture of how to personalize treatment based on each individual’s specific tumor qualities.

The take-away is this: each year in the U.S. there are now 70,000 women with breast cancer who might be able to skip chemotherapy and still have the same chance of beating this disease. Of course, it’s best for patients to discuss with their oncologists about what is the best course of treatment for their specific situation.


Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. New Engl J Med June 3, 2018 DOI: 10.1056/NEJMoa1804710