214 Wichita-area women part of treatment-changing breast cancer study

When Wichitan Wanda Zinn found out she had a form of breast cancer that was likely to come back, she was devastated.

“That was not a good day,” she said, letting out a sigh as she remembered getting that news in April 2009.

But fortunately for her, her cancer had been caught early during a mammogram, and her oncologist, Bassam Mattar, told her about a national study that she could participate in locally.

Zinn was one of 214 women from the area who participated in the study conducted through the National Cancer Institute’s Community Oncology Research Program, based at Via Christi Hospital St. Francis. The NCI-sponsored study involved 10,253 women nationally.

Results of the study – the first to assign breast cancer treatments based on a genetic test score for re-occurrence rates and to track the re-occurrence – were just released, showing that women like Zinn can skip chemotherapy and have a less than 1 percent chance of the cancer coming back within five years.

The study involved the most common type of breast cancer – early stage, with no spreading to the lymph nodes; hormone-positive, meaning the tumor’s growth is fueled by estrogen or progesterone; and not the type that grows because of a protein called HER2. Every year, more than 100,000 women in the U.S. are diagnosed with this.

The study categorized each participant’s risks based on a score from a gene-activity test called Oncotype DX, one of only a few such tests available. The test was done on the tumors removed from the women.

Women were classified as low risk if they scored between 1 and 10, intermediate risk if the score was between 11 and 25 and high risk if they scored above 25. The 16 percent of women in the low-risk category got only anti-hormone therapy treatment, with either tamoxifen or one of three aromatase-inhibiting drugs, another hormone-blocking treatment. The 67 percent in the middle group were randomly assigned to get the anti-hormone therapy alone or add chemo, while the 17 percent in the high-risk group were treated with the hormone-blocking drugs and chemo.

Zinn barely qualified as a low risk, scoring 10. Her tumor had been so small, the size of an eraser head on a pencil, that it took the surgeon two tries to find it.

“If it wasn’t for the study, I would have had chemo, period,” Zinn said. She counts herself blessed that she didn’t have to suffer the “devastation of chemo,” particularly since it wouldn’t have made a difference, according to the study results.

After five years, 99 percent of the low-risk women had not relapsed and 98 percent were alive. About 94 percent were free of any invasive cancer.

Zinn took tamoxifen – a drug that starves a hormone-positive cancer of the estrogen it feeds on – every day for five years. She finished her hormone-blocking treatments in March 2014.

“I have a friend who’s going through breast cancer and chemo now, so I’m seeing the effects of chemo with her. And it’s tough – really tough,” she said.

Change in care

The study results were published in the New England Journal of Medicine, with Cancer Center of Kansas oncologist Pavan Reddy as a co-author. Reddy also is 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.

Being co-author of an article in a highly respected medical journal is a “once-in-a-lifetime” feat for any physician, said Reddy. He got the coveted role because he had the highest number of patients, 55, out of the 214 Kansas women who participated in the study.

But that’s not what gets him excited. It’s the fact that the study will lead to a change in breast cancer treatment.

Retrospective studies – in which the charts and records of patients are reviewed – showed that women who fit the criteria that this study targeted probably weren’t benefiting from chemotherapy, which is meant to kill any stray cancer cells that can cause new cancer growth. But that wasn’t enough to change the standard of care, Reddy said. So oncologists were offering chemotherapy to women if the tumor was 1 centimeter (about 0.4 inches) or greater.

“Doctors could say in their opinion that (chemo) wouldn’t help but that they didn’t know that for sure,” he said. “In these women now, this has to be the standard of care. You have to do an Oncotype or some sort of gene profile, and if their score is less than 10, we shouldn’t offer chemo. It changes the paradigm. We’re looking at more personalized care, based on individual tumor characteristics.”

The Oncotype test costs more than $4,000, but Medicaid and other insurers cover it.

More results to come

According to Reddy and Keisha Humphries, service line administrator for Via Christi Oncology, not all the results of the study are in. Investigators will also determine the best course of treatment for the women who were classified as having intermediate risk, plus a quality-of-life study is being done on participants.

When asked how she’s doing now, more than six years after her cancer diagnosis, the 60-year-old Zinn answered, “Life is excellent.”

While undergoing treatment, she continued working at Spirit AeroSystems, retiring after 35 years in 2013. She felt well enough to take on a time-consuming volunteer position working with youths at Glenn Park Christian Church and now volunteers at two other youth-focused organizations.

This story was originally published October 11, 2015 at 9:52 PM with the headline "214 Wichita-area women part of treatment-changing breast cancer study."