PBS高端访谈:多数乳腺癌早期妇女可以安全规避化疗（在线收听）

AMNA NAWAZ: New findings show women with early stage breast cancer can avoid chemotherapy.

The question of whether to be treated with chemotherapy is a key question women face after surgery and hormone treatment.

Researchers now say most women with smaller tumors can safely skip chemo and avoid its side effects, such as fatigue and nausea.

The findings may change clinical practice for as many 70,000 women a year in the U.S.

Dr. Larry Norton is a leading breast-cancer specialist and senior vice president of Memorial Sloan Kettering Cancer Center, which participated in the study.

Dr. Norton, thank you your time.

Can you just tell us, big picture, off the bat now, why is this such an important breakthrough?

DR.LARRY NORTON, Memorial Sloan Kettering Cancer Center: Well, now we know that we can identify patients who have a very good prognosis and don't need chemotherapy.

So these patients will be spared chemotherapy.

That's a wonderful, wonderful result.

AMNA NAWAZ: And you're able to know this now because of a gene test.

You can kind of assess people's risks.

And you're talking about women with what you call intermediate risk.

Explain to me what that means.

DR.LARRY NORTON: Yes.

Well, we do this test of 21 genes.

It's called the Oncotype DX test.

And it tells us a scale from zero to 100 which relates to the risk of the cancer spreading to another part of the body.

Very low scores, up to 10, it's a very low chance that these patients get hormone therapy, and chemotherapy doesn't help them.

We have known that for a long time.

Very high scores are at increased risk of the cancer spreading, and those patients have benefited a lot by chemotherapy.

And we have known that also.

But the intermediate patients with scores of 11 to 25, we have not known what's best for them.

Should we give them chemotherapy?

Should we not give them chemotherapy?

What is the best option for these individuals?

We haven't had guidance.

Now we do.

This very large, very important study is telling us that people with those intermediate scores have a very good prognosis and that prognosis is not improved by chemotherapy.

So they don't have to receive chemotherapy.

And that's just a wonderful thing, to look somebody in the eye and say, you have got a great prognosis.

Your odds of being cured are terrific, and you don't need chemotherapy because you don't need it.

You have got a great prognosis and chemotherapy won't help.

It's a wonderful thing to be able to look somebody in the eye and give them that information.

AMNA NAWAZ: Dr. Norton, help me understand.

For all the women who have been following standard practice up until now and were receiving chemotherapy who you now say wouldn't have needed it, was there a risk associated with being overtreated?

DR.LARRY NORTON: Well, I mean, it depends on the chemotherapy they received.

With some chemotherapies, there is a slightly increased risk of some bad effects.

With other chemotherapies, such as the one we have been using at Memorial Sloan Kettering, which is the CMF combination, there's no evidence of long-term toxicity.

So there's some variation in that regard.

But the risks are very small.

The long-term risks are very small.

And the people that I have spoken to who, in this trial, randomized to get chemotherapy are feeling good about these results, because they had the chemotherapy.

They're disease-free.

It hasn't hurt them.

But they have helped thousands and thousands of other women.

Maybe 100,000 women per year, in the United States alone, are going to benefit from these results.

And people are very altruistic.

The volunteers in this trial are altruists.

They're real heroes.

And they have made a massive contribution to helping people with cancer throughout the world.

AMNA NAWAZ: Dr. Larry Norton, thanks for your time.

DR.LARRY NORTON: My pleasure. Thank you.

阿姆纳·纳瓦兹：新发现表明乳腺癌早期的妇女可以避免化疗。

是否接受化疗是女性术后以及激素治疗的关键问题。

现在研究人员说，大多数肿瘤较小的妇女可以安全地避免化疗，避免其副作用，如疲劳和恶心。

这一发现可能会改变美国每年多达70,000名女性的临床治疗实践。

拉里·诺顿博士是著名的乳腺癌专家和斯隆-凯特林癌症中心的高级副总裁，他参与了这项研究。

诺顿博士，感谢您做客节目。

您能不能告诉我们，大局来讲，现在，为什么这是一个重要的突破？

拉里-诺顿博士，斯隆-凯特琳癌症中心：现在我们知道，我们可以确定那些预后良好并且不需要化疗的病人。

因此，这些患者将不用化疗。

这是一个非常非常好的结果。

阿姆纳·纳瓦兹：你现在能知道这点，是因为基因测试。

你可以评估人们的风险。

你说的是你称之为具有中间风险的女人。

请给我解释一下这意味着什么。

拉里·诺顿博士：好的。

我们对21个基因进行了测试。

它被称为Oncotype DX测试。

它为我们提供了一个从0到100的数值区间，这个指数与癌症在身体其他部分的扩散风险有关。

10以下非常低的数值，表明这些患者不太需要进行激素治疗，并且化疗对她们也没什么帮助。

这一点我们早就知道了。

非常高的数值增加了癌症扩散的风险，而这些患者通过化疗获益良多。

这一点我们也知道。

但检测数值介于11到25的中间患者，我们还不知道什么对他们最好。

我们应该给她们做化疗吗？

还是不应该给她们化疗？

这些人最好的选择是什么？

曾经我们没有指导方向。

现在我们有了。

这项非常非常重要的研究告诉我们，那些中间分数的人预后很好，化疗不能改善预后。

所以他们不需要接受化疗。

能看着某人的眼睛说，你的预后很好，这是一件美妙的事情。

你的治愈几率很大，你不需要化疗，因为你不需要它。

你的预后很好，化疗也无济于事。

能看着某人的眼睛并将这些告诉她们，是一件很美妙的事情。

阿姆纳·纳瓦兹：诺顿博士，帮我解读一下。

对于那些一直遵循标准治疗方法并接受化疗的妇女，你现在说不需要它，是否存在过度治疗的风险？

拉里·诺顿博士：嗯，我的意思是，这取决于他们接受的化疗。

在一些化疗中，一些不良影响的风险略有增加。

其他化疗，比如我们在纪念斯隆-凯特琳癌症中心使用的化疗方法，这是CMF的组合，不存在长期毒性的证据。

所以在这方面有一些变数。

但风险非常小。

长期风险非常小。

我跟她们说，在这个试验中，接受化疗是随机的，他们对这些结果感觉很好，因为他们接受了化疗。

现在她们是无病状态。

这并没有伤害她们。

但是他们帮助了其他成千上万的女人。

美国每年可能有100,000名女性将从这些结果中受益。

而且人们非常利他。

本次试验的志愿者是利他主义者。

她们是真正的英雄。

她们为帮助全世界的癌症患者做出了巨大的贡献。

阿姆纳·纳瓦兹：拉里·诺顿博士，感谢您的参与。

拉里·诺顿博士：不客气。谢谢你。