News Release 

Clinical calculator could spare breast cancer patients five years of unnecessary hormone therapy

The Royal Marsden NHS Foundation Trust

New research confirms that an algorithm, called CTS5, can accurately identify patients who are at a significantly low risk of their breast cancer returning at a later stage. In doing so it means some patients may need to take hormone therapy for five years, rather than 10, something that researchers say could have a huge impact both psychologically and physically.

The large majority of breast cancer patients will be prescribed at least five years of hormone therapy after having standard treatment (surgery, chemotherapy and/or radiotherapy) to lower the risk of cancer returning.

After five years, oncologists along with patients have to decide whether extending this type of therapy is worthwhile and appropriate. Hormone therapy can have significant side effects for some patients, including weakness of bone, blood clots, exacerbation of menopausal symptoms and the psychological burden of continuous treatment.

CTS5 was published in 2018, in a study that confirmed its prognostic value. However it had yet to be tested in a 'real world' setting, i.e. not on selected clinical trial patients, and on both pre-and postmenopausal women. The CTS5 test is the only available clinical prognostic tool for determining late distance recurrence.

In this new study researchers at The Royal Marsden NHS Foundation Trust and Queen Mary University London used the CTS5 to analyse data from 2428 non-trial patients at The Royal Marsden. The results will be presented at this weekend's American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.

The study confirmed that CTS5 was effective at predicting relapse of breast cancer after 5 years. The CTS5 test was able categorise a group of 2428 female breast cancer patients into three clear risk groups: high, medium and low. Importantly 41% of the postmenopausal women - 700 patients - were found to be at a significantly low risk of their breast cancer returning five to 10 years after their initial five year hormone therapy treatment. This risk is so low, researchers concluded; it would not warrant extending endocrine therapy to ten years. In contrast to the previously published tests on CTS5, this new analysis took into account pre-menopausal female patients as well as post.

Lead author Dr Juliet Richman, Clinical Research Fellow at The Royal Marsden NHS Foundation Trust said: "Our analysis demonstrates that this tool works well in a varied population of breast cancer patients. This is crucial; in order for it to be useful in a clinical setting we need to know that CTS5 will be accurate for a variety of women.

"We can establish those who are at a very low risk of their breast cancer recurring, and say they would be extremely unlikely to benefit from extending hormone therapy past five years. In doing so they can avoid the possible side effects - both physically and psychologically - of continuing treatment."

Senior author Dr Ivana Sestak, Queen Mary University of London said: "It is incredibly important to determine which women are at high risk of late recurrence, so that they can continue hormonal treatment. In addition to predicting late recurrence in postmenopausal women, for the first time we were able to show that CTS5 also predicts late recurrence in premenopausal women. And by testing the model on actual hospital data of women treated for their early stage breast cancer, we were able to demonstrate that the use of our calculator is feasible in the real world.

"Our online calculator is freely available for oncologists around the world to use to determine their patients' risk of late recurrence. It is very easy to use and only requires information that is readily available to clinicians. We are now investigating further whether the tool could be used by research nurses, helping to free up clinicians' time."

Further research is needed to confirm that female patients who continue on hormone therapy after having a high CTS5 score, then benefit from this extension.

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CTS5 is for use in a clinic setting or with the guidance of an oncologist, and can be accessed here: http://www.cts5-calculator.com

Notes to editors

Clinical validity of CTS5 for estimating risk of late recurrence in unselected, non-trial patients with early ER+ breast cancer will be presented in a poster presentation by Dr Juliet Richman on Sunday 2nd June 2019 8am US CDT /2pm UK BST at the 2019 ASCO Annual Meeting.

For further information, interviews or the poster contact Hannah Bransden, Senior PR & Communications Officer, Hannah.bransden@rmh.nhs.uk / 0207 811 8244. A patient case study is available

  • CTS5 was published online in 2018, with researchers from Queen Mary University leading on its development
  • The online calculator was tested in a trial patient population and results published by Royal Marsden and Queen Mary University researchers: 'Integration of Clinical Variables for the Prediction of Late Distant Recurrence in Patients with Estrogen Receptor-Positive Breast Cancer Treated With 5 Years of Endocrine Therapy: CTS5' by Dowsett et al: http://ascopubs.org/doi/abs/10.1200/JCO.2017.76.4258

About The Royal Marsden NHS Foundation Trust

The Royal Marsden opened its doors in 1851 as the world's first hospital dedicated to cancer diagnosis, treatment, research and education.

Today, together with its academic partner, The Institute of Cancer Research, London, it is the largest comprehensive cancer centre in Europe. It is a centre of excellence with an international reputation for ground-breaking research and pioneering the very latest in cancer treatments and technologies.

The Royal Marsden, with the Institute of Cancer Research (ICR), is the only National Institute for Health Research Biomedical Research Centre for Cancer. This supports pioneering research work carried out over a number of different cancer themes.

Since 2003, The Royal Marsden Cancer Charity has funded the latest developments in cancer research, diagnosis, treatment and patient care. Over recent years, supporters of The Royal Marsden Cancer Charity have funded facilities including the Oak Centre for Children and Young People, the da Vinci robots, the CyberKnife radiotherapy machine and the Reuben Foundation Imaging Centre.

HRH The Duke of Cambridge became President of The Royal Marsden in 2007, following a long royal connection with the hospital.

The Ralph Lauren Centre for Breast Cancer Research is a world-class facility, working with the latest technology to set a benchmark for cancer research around the world. The centre is funded by supporters of The Royal Marsden Cancer Charity, including a generous donation from Ralph Lauren.

About Queen Mary University of London

Queen Mary University of London is a world-leading research-intensive university with over 25,000 students representing more than 160 nationalities. A member of the prestigious Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research.

In the most recent exercise that rated research in the UK, we were ranked 5th in the country for the proportion of research outputs that were world-leading or internationally excellent. We offer more than 240 degree programmes and our reputation for excellent teaching was rewarded with a silver in the 2017 Teaching Excellence Framework (TEF) awards.

Queen Mary's history dates back to 1785, with the foundation of the London Hospital Medical College. Our history also encompasses the establishment of the People's Palace in 1887, which brought accessible education, culture and recreation to the East End of London. We also have roots in Westfield College, one of the first colleges to provide higher education to women.

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