An international study suggests that many women with early-stage breast cancer can safely skip chemotherapy without affecting their chances of successful treatment. The findings come from the OPTIMA clinical trial, which tested whether a genomic test could identify patients who truly benefit from chemotherapy.
The study included over 4,400 participants aged 40 and above from six countries: the United Kingdom, Norway, Sweden, Australia, New Zealand, and Thailand. Most had hormone-sensitive breast cancer that had spread to nearby lymph nodes—a group that is usually treated with chemotherapy to lower the risk of recurrence.
Genomic testing guided treatment decisions by assessing recurrence risk
Researchers used the Prosigna genomic test to analyze tumor gene activity and estimate the likelihood of cancer returning. Based on the results, patients with a score of 60 or below received only hormone therapy, while those with higher scores also received chemotherapy.
About 68% of participants were classified as low-risk. After five years, 93.6% of these patients who received only hormone therapy remained disease-free, compared with 94.8% of those who also had chemotherapy.
The difference—just over one percentage point—was below the study’s predefined threshold for clinical significance, suggesting chemotherapy may not provide meaningful additional benefit for this group. The analysis also found that only around 2% of low-risk patients were likely to gain substantial benefit from chemotherapy.
The study also included groups often underrepresented in this type of research, including premenopausal women and patients with more than three affected lymph nodes. Researchers said the findings were consistent across these subgroups.
For younger women, the researchers noted that one of the benefits of chemotherapy is typically the suppression of ovarian function. In this study, that effect was instead achieved using hormonal treatments, which may help explain why chemotherapy offered limited additional benefit in many cases.
Expert says OPTIMA trial improves personalized breast cancer care and reduces chemotherapy use
Professor Rob Stein of the UCL Cancer Institute described the results as a significant step forward in personalizing breast cancer treatment. He said the OPTIMA trial helps resolve a key challenge in care—determining which patients truly need chemotherapy—and shows that many can avoid it without affecting outcomes.
He also emphasized that tumor biology can be a more accurate guide for treatment decisions than traditional clinical factors, reducing both the physical and emotional burden of chemotherapy.
Researchers estimate that if the test becomes widely used in the UK’s public health system, over 5,000 patients each year could potentially avoid chemotherapy.
The findings are now under review by NICE, which evaluates new tests and treatments for adoption in the UK’s National Health Service.
Read the original article on: olhardigital
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