Many breast cancer patients can skip chemo, big study finds
大型研究發現，許多乳腺癌患者可以放棄化療
來源：美聯社 翻譯：世界播
CHICAGO (AP) — Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient』s risk.
大多數早期乳腺癌患者中最常見的女性可以安全地跳過化療而不損害他們罹患疾病的可能性，醫生報告了一項具有裡程碑意義的研究，這個研究利用基因檢測來評估每位患者的風險。
The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs.
這項研究是迄今為止在乳腺癌治療方面所做的最大的一項研究，其結果預計將使美國每年有多達7萬名患者免於這些藥物的折磨和費用。
「The impact is tremendous,」 said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don』t need treatment beyond surgery and hormone therapy, he said.
這項研究的負責人、紐約蒙蒂菲奧裡醫療中心的約瑟夫·斯帕拉諾博士說，「影響是巨大的。」他說，在這種情況下，大多數女性除了手術和激素治療外不需要治療。
The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.
該研究由美國國家癌症研究所，一些基金會和美國乳腺癌郵票收入資助。周日在芝加哥召開的美國臨床腫瘤學會會議上討論了結果，並由新英格蘭醫學雜誌發表。一些研究長官者會顧問乳腺癌藥物製造商或進行基因檢測的公司。
MOVING AWAY FROM CHEMO
遠離化療
Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it』s sometimes for shorter periods or lower doses than it once was.
癌症治療已經從化療-有著嚴酷副作用的老葯-轉向基因靶向療法、激素阻滯劑和免疫系統療法。當現在使用化療時，它有時會比以前用的時間更短或使用更低的劑量。
For example, another study at the conference found that Merck』s immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects.
例如，在會議上的另一項研究發現，默克的免疫治療藥物Keytruda（Keytruda是阻斷被稱為PD-1的細胞通路的第一個被批準的藥物，它限制機體免疫系統攻擊黑色素瘤細胞的。）對於大多數肺癌最常見類型患者的初始治療效果優於化療，並且副作用少得多。
The breast cancer study focused on cases where chemo』s value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.
乳腺癌研究的重點是化療價值日益受到質疑的病例: 早期疾病尚未擴散到淋巴結的女性是激素陽性的(意味著它的生長是由雌激素或孕酮推動的)，而不是藥物赫賽汀所針對的類型。
The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill any stray cancer cells. Doctors know that most don』t need it, but evidence is thin on who can forgo it.
通常的治療方法是手術，然後是多年的激素阻斷藥物。但許多女性也被要求進行化療，以幫助殺死任何遊離的癌細胞。醫生們知道大多數人並不需要它，但是很少有證據表明誰可以放棄它。
The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.
這項研究讓10273名患者接受了一項名為「Oncotype DX（乳腺癌適用的唯一基因檢測方法）」的測試，該測試使用活檢樣本來測量參與細胞生長和激素治療反應的基因的活性，以評估癌症複發的風險。
WHAT THE STUDY FOUND
研究發現了什麼
About 17 percent of women had high-risk scores and were advised to have chemo. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.
大約17％的女性有高風險分數，並被建議進行化療。基於這項研究的早期結果，低風險分數的16％的女性現在知道他們可以跳過化療。
The new results are on the 67 percent of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo.
最新的研究結果顯示，67%的女性存在中度風險。所有人都接受了手術和激素治療，還有一半人也接受了化療。
After nine years, 94 percent of both groups were still alive, and about 84 percent were alive without signs of cancer, so adding chemo made no difference.
九年後，兩組中94％的人仍然活著，大約84％的人沒有癌症跡象，因此加入化療沒有任何區別。
Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.
某些50歲或更年輕的女性確實從化療中獲益;在接受化療的患者中，根據他們在基因測試中的風險分數，很少有癌細胞擴散到乳房以外。
WILL PEOPLE TRUST THE RESULTS?
人們願意相信結果嗎？
All women like those in the study should get gene testing to guide their care, said Dr. Richard Schilsky, chief medical officer of the oncology society. Oncotype DX costs around $4,000, which Medicare and many insurers cover. Similar tests including one called MammaPrint also are widely used.
腫瘤協會的首席醫療官理查德·斯奇爾斯基博士說，所有研究中的女性都應該接受基因檢測以指導他們的護理。Oncotype DX檢測的成本在4000美元左右，而由醫療保險和許多保險公司的承擔。包括一個名為MammaPrint（高通量基因檢測系統）的類似測試也被廣泛使用。
Testing solved a big problem of figuring out who needs chemo, said Dr. Harold Burstein of the Dana-Farber Cancer Institute in Boston. Many women think 「if I don』t get chemotherapy I』m going to die, and if I get chemo I』m going to be cured,」 but the results show there』s a sliding scale of benefit and sometimes none, he said.
波士頓達納-法伯癌症研究所的哈羅德·伯斯坦博士說，測試解決了一個確定誰需要化療的大問題。他說: 「如果我沒有接受化療，我將會死亡，如果我得到化療，我將會得到治癒」。但研究結果顯示，化療的益處在不斷變化，有時根本沒有。
Dr. Lisa Carey, a breast specialist at the University of North Carolina』s Lineberger Comprehensive Cancer Center, said she would be very comfortable advising patients to skip chemo if they were like those in the study who did not benefit from it.
麗莎·凱裡(Lisa Carey)博士是北卡羅萊納大學萊因伯格綜合癌症中心(University of North Carolina s Lineberger Comprehensive Cancer Center)的一名乳房專家，她說，如果病人像研究中的那些沒有從化療中受益的人一樣，她會很樂意建議他們不要接受化療。
Dr. Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: 「Risk to one person is not the same thing as risk to another. There are some people who say, 』I don』t care what you say, I』m never going to do chemo,』」 and won』t even have the gene test, she said. Others want chemo for even the smallest chance of benefit.
位於休斯頓的安德森癌症中心的珍妮弗·利頓博士對此表示贊同，但他說:「對一個人的風險評估與對另一個人的風險是不一樣的。有些人說"我不在乎你說什麼，我不會去做化療，"」甚至連基因測試都不會做，她說。而另一些人想要做化療，哪怕是只有最小的獲益機會。
Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo.
現年78歲的Adine Usher生活在紐約的哈茨代爾。10年前，他在蒙特菲爾參與了這項研究，並被隨機分配到化療組。
「I was a little relieved. I sort of viewed chemo as extra insurance,」 she said. The treatments 「weren』t pleasant,」 she concedes. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, 「but it was over fairly quickly and I』m really glad I had it.」
「我鬆了一口氣。我覺得化療是一種額外的保險，」她說。並且她承認「治療過程並不愉快。她的頭髮脫落了，她感染了病毒，並因白血球不足而住院，「但它很快就結束了，我真的很高興我擁有了它。」
If doctors had recommended she skip chemo based on the gene test, 「I would have accepted that,」 she said. 「I』m a firm believer in medical research.」
如果醫生建議她基於基因測試放棄化療，「我會接受的，」她說。「我堅信醫學研究。"
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