Is it possible to avoid chemotherapy in Breast Cancer?
Breast cancer is a heterogeneous disease.
This heterogeneity was initially assessed by clinical factors comprising of age, stage, grade, hormone-her2nu status and presence or absence of lymphovascular invasion.
Patients with Early Breast cancer (T1-T2 N0-3) of luminal A type (ER positive ;PR more then 20% and her nu negative and ki67 less 10%) is a subset comprising of 1/3 rd of patients.
In this clinical group of patients we have gene expression panel which can further help in prognosticating and predicting benefit of hormonal treatment alone.
1st generation gene panel includes Mammaprint and Oncotype Dx.
2nd generation gene panel includes Prosigna, Endopredict.
So yes it is possible to omit chemotherapy in selected group of Breast cancer patients. Gene panels should be used in combination with classical clinical factors.
Cost is a limitation for the use of these gene panels in Indian context.