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Local oncologist, women participate in treatment-changing breast cancer study

Dee Nolting is the executive director of Kansas Gastroenterology. She recently used hormone treatment to fight cancer.
Dee Nolting is the executive director of Kansas Gastroenterology. She recently used hormone treatment to fight cancer. The Wichita Eagle

Thanks to a major breast cancer study, Wichitan Dee Nolting was able to make the decision she wasn't putting herself at greater risk of getting breast cancer again if she skipped chemotherapy.

The study involved more than 10,270 women and several researchers and doctors worldwide, with one of the doctors and 200 of those women from Wichita.

The results of the long-term study were announced last week. The study found that the 70 percent of women – about 60,000 women annually – diagnosed with a common form of early-stage breast cancer can safely avoid chemotherapy treatment and not increase their risk of the cancer coming back.

Wichita oncologist Pavan Reddy is among the 16 co-authors of the study called TAILORx, which is being published in the New England Journal of Medicine. Reddy landed a co-author spot since Wichita was one of the largest study sites. Reddy, with the Cancer Center of Kansas, is also co-medical director of Via Christi Health's Cancer Outreach and Risk Assessment program and a clinical associate professor with the University of Kansas School of Medicine-Wichita.

In Wichita, the study was conducted through the National Cancer Institute's Community Oncology Research Program based at Via Christi Hospital St. Francis.

“I don't know if people realize the research that happens in Wichita, Kansas,” said Nolting, who said she was fortunate to benefit from the study's findings.

The study involved 10,273 women at about 1,000 sites in the U.S., Australia, Canada, Ireland, New Zealand and Peru, Reddy said.

The study's participants had to meet the following criteria: Early-stage cancer that was fueled by estrogen and not the HER2 protein and that hadn't spread to the lymph nodes; and having a tumor of less than 5 centimeters. All the women received the Oncotype DX genetic test to determine a recurrence risk score. Free to study participants, the test costs about $4,000 and is covered by Medicare and all major insurance companies.

Women were classified as low risk if they scored from 1 to 10, intermediate risk if the score was 11 to 25, and high risk if they scored above 25. Two years ago, the study released findings that women with the low risk score were safe to choose just hormone therapy.

A little more than 6,700 women in the study fell into the intermediate risk. They were randomly assigned to receive either hormone therapy alone or chemo and hormone therapy. Five years later, researchers analyzed the survival rate and found both groups had about the same survival rate statistically – about 93 percent, Reddy said.

While Nolting didn't participate directly in the study, she benefited from the study's findings that were already becoming evident at the time of her diagnosis.

After Nolting was diagnosed with breast cancer last October, tests on the removed tumor showed a recurrence score of 13. She also met the other criteria to qualify for hormone therapy alone.

“I feel very, very fortunate that I didn't have to go through chemo,” said the 49-year-old Nolting, the executive director of Kansas Gastroenterology. “A very good friend of mine went through it years ago.”

Chemotherapy comes with significant risks, often causing debilitating side effects and putting one at risk for other medical conditions.

“The sickness, the nausea, the missing of work, the toll it takes on a body” are all things Nolting said she was grateful to avoid. She took six weeks off work to recover from double mastectomy surgery and is currently taking tamoxifen, which starves a hormone-positive cancer of the estrogen it feeds on.

Who meets the criteria

Wichita oncologist Dr. Pavan Reddy, who was among the 16 co-authors of the long-term study on breast cancer treatment, said the study's findings show that women whose breast cancer fits the following criteria can be safely treated with hormone therapy alone:

early-stage tumor of less than 5 centimeters, or 21/2 inches;

has not spread to lymph nodes;

is fueled by estrogen and not the HER2 protein;

a recurrence score of 0-10, regardless of the woman's age;

a recurrence score of 11-25 for women older than 50;

a recurrence score of 11-15 for women younger than 50.

The score is determined by testing samples of the tumor with the Oncotype DX, a highly sophisticated “gene-expression profile test,” Reddy said. “This is a great test but doctors will have to also take into account other patient factors.” Patients should discuss their specific cancer case with their physician to determine their treatment options.