Groundbreaking genomic test could spare millions of breast cancer patients from chemotherapy
An international study has been published indicating that a significant portion of early-stage hormone receptor-positive breast cancer patients can be safely treated without chemotherapy. According to Guardian Health correspondent Andrew Gregory, the results of the randomised trial known as OPTIMA, published in the Annals of Oncology, showed a 5-year metastasis-free survival of 96.8% in patients classified as low-risk by the OncoMasTR genomic test.
The trial was conducted on 5,000 patients across 30 countries. Patients were randomised to receive or not receive chemotherapy based on the genomic risk profile shown by their tests. The lead author of the study, Professor Robert Stein of Queen Mary University of London, said the results form 'a substantial body of data that warrants changes in clinical practice'.
The OncoMasTR test calculates recurrence risk based on the expression of 6 genes. The test was developed by Manchester-based OncoMark Biotech and has been in limited use within the NHS since 2024. According to the details of the study, patients the test classified as low-risk maintained a 5-year survival rate of 97% even when chemotherapy was omitted — statistically indistinguishable from the control group that did receive chemotherapy.
The medical significance of the intervention lies in chemotherapy's devastating impact on quality of life. 65% of patients included in the study reported income loss, fatigue, nerve damage and immune system weakness. NHS England Oncology spokesperson Dr Naomi Smith said in a statement, 'This test has the potential to significantly improve the quality of life of NHS patients.'
On cost, the OncoMasTR test costs about £1,800 per patient under NHS contract. Given that the average NHS cost of a full chemotherapy course is reported at £24,000, system-level deployment of the test could deliver budget savings. NHS England Financial Director Julian Kelly said, 'Our cost-effectiveness analysis indicates that broad use of OncoMasTR could save £84 million annually.'
The European Society for Medical Oncology (ESMO) announced in a statement that the study's results would be reflected in upcoming treatment guidelines. ESMO Genomic Medicine Commission chair Prof. Andrea Bonaventura said, 'These results represent a shift in the treatment paradigm for hormone receptor-positive breast cancer; however, each patient should have a detailed discussion with their oncologist about their individual risk profile.'
In the US, the OncoMasTR test does not yet have commercial approval; existing standard tests include Oncotype DX and MammaPrint. These tests operate on similar principles but with different price ranges and insurance coverage. American Cancer Society (ACS) spokesperson Dr Arif Kamal said, 'Genomic test selection depends on the oncologist's clinical evaluation and the patient's individual risk profile.'
In Turkey, the breast-cancer genomic-test market is still developing. Turkish Oncology Society chair Prof. Dr Mert Basaran said, 'The introduction of OncoMasTR and similar tests in Turkey could accelerate following SGK coverage evaluation. First, the results of the studies in Turkish patients need to be assessed.'
A patient story featured in the Guardian's report (Caroline Brown, a 47-year-old English teacher diagnosed with early-stage breast cancer) recounts how a significant improvement in her quality of life followed the OncoMasTR test determining that chemotherapy was not needed. 'The thought of chemotherapy was making me ill; this test gave me my life back,' she said.
The study was funded by Cancer Research UK and the European Commission's Horizon Europe programme. The results will now be integrated into NHS guidelines; review by regulatory bodies in the US and other countries is also expected. This article is not a substitute for individual medical advice; consult your oncologist for breast cancer treatment decisions.