‘Prospective Validation
Aga Khan Hospital
Joyce Owour
Miriam Mutebi
Moi Teaching and Referral Hospital
Naftali Busakhala
New England Journal of Medicine

Hormone-based cancer drugs ease chemo pain

Early tests and monitoring enhance survival rates of patients who undergo alternative anti-tumour treatment. Some women only require hormone-based anti-tumour drugs and could still enjoy 98 per cent survival.

Breast cancer is a leading cause of death among women suffering from the terminal illness. PHOTO | FOTOSEARCH

Thousands of women with early stages of breast cancer may not need to go through chemotherapy to treat their cancer, a new study reveals. According to a report published in the New England Journal of Medicine, some women only require hormone-based anti-tumour drugs and could still enjoy 98 per cent survival.In the study, the researchers conducted a gene-based test called Oncotype DX which scans 21 genes in a tumour and that is a big hurdle to overcome since the test is not universally used.The test costs about Sh350,000 and based on how expensive it is doctors around the world and Kenya rely on logical features such as the size of a tumour and grade to determine whether the patient should undergo chemotherapy.

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Dr Naftali Busakhala, the director of oncology at the Moi Teaching and Referral Hospital who advocates the alternative test says a PET scan would suffice in giving an accurate progression of cancer.“To do this, we have to do a PET scan which will tell us about the strengths and weaknesses of a tumour. Having this would allow doctors to determine whether a woman should be treated with chemotherapy or other targeted therapies,” says Dr Busakhala.Kenya does not have a functional PET scan, however, the is one available at the Aga Khan Hospital which will commence operations soon.Dr Miriam Mutebi, Consultant Surgical Oncologists at the Aga Khan Hospital says although the PET scan cannot be used in early breast cancer detection they have a role in advanced or metastatic stages of the disease to assess the extent of spread. Dr Busakhala says the study is not very new and if the tests were available in Kenya then it could save many women a lot of pain.“We need to stop lumping breast cancer in one basket and instead of looking for ways to treat individual patients with the type of disease,” he says.Dr Busakhala says when a woman is in the early stages of breast cancer which is diagnosed correctly and on time then the hormone-based drug therapies are sufficient.“A patient with oestrogen-receptor-positive breast cancer, for example, needs Herceptin (trastuzumab) which is a cancer medication that interferes with the growth and spread of cancer cells in the body. “The standard recommended is 18 cycles which is much better than being over treated with chemotherapy,” he says.Breast cancer is the leading cause of death among women and close to 5,000 new cases are detected in Kenya. Dr Busakhala says many would no longer need chemotherapy if Kenya had the capacity to conduct gene tests.The research titled ‘Prospective Validation of a 21-Gene Expression Assay in Breast Cancer’ that analysed 10,273 women states that although chemotherapy saves lives the side-effects of the toxic drugs range from vomiting, fatigue and infertility to permanent nerve pain.In rare cases, it could lead to heart failure and leukaemia.Joyce Owour, a cancer survivor, says if she had the alternative treatment she would have opted out of chemotherapy given the pain she endured.“I was at the early stages of breast cancer. I experienced hair loss, fatigue diarrhoea and mouth sores when I underwent the treatment. At some point I thought the chemo would kill me,” she says.Of the 10,253 eligible women enrolled, 1,626 women (15.9 per cent) who had a recurrence score of zero to 10 were assigned to receive endocrine therapy alone without chemotherapy. At five years, in this patient population, the rate of invasive disease-free survival was 93.8 per cent.Experts cautioned, however, that the findings may not apply to those who have larger tumours or those with cancer that has started to spread or metastasize.

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