25 percent of women with aggressive breast cancer may not need chemotherapy. Their immune system would be strong enough to handle the tumor. This is evident from a study by doctor Roberto Salgado, affiliated with the Antwerp Hospital aan de Stroom (ZAS).
“If their immune system has enough cancer-killing cells, women with early-stage triple-negative breast cancer have a high chance of survival and a small chance of recurrence even without chemotherapy,” the study concludes. In principle, these women can skip chemotherapy without negative consequences.
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Currently, the number of immune cells is not yet taken into account when considering whether someone needs chemotherapy. Yet that would be an important element, according to Salgado. Today, doctors only consider two factors when deciding whether someone needs chemotherapy: the size of the tumor and whether the cancer has spread to the lymph nodes.
About one in seven women with breast cancer has triple-negative breast cancer. That aggressive type of cancer does not respond to medications that target hormones. Because triple-negative breast cancers are more difficult to treat, most women with this tumor undergo chemotherapy at an early stage, which often has serious side effects.
Currently, the number of immune cells is not yet taken into account when considering whether someone needs chemotherapy
TIL test
Salgado’s research shows that a quarter of women with triple-negative breast cancer benefit little from chemotherapy. The immune cells in their body are able to attack the cancer cells. A test that checks whether or not the woman has tumor-infiltrating lymphocytes (TIL) could determine whether chemotherapy is useful.
“The results may provide a recommendation for including TILs in breast cancer pathology reports,” says Salgado. “A simple check can better inform doctors and patients about treatment options. So no expensive investigations are necessary.”
The study led by Dr. Salgado was published in the medical journal JAMA (Journal of the American Medical Association). The researchers collected data from almost two thousand women all over the world. The patients were followed for an average of 18 years. The researchers now plan to test whether TILs can be used as a touchstone to assess the need for chemotherapy.
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