Some breast cancer patients who are highly responsive to chemotherapy may not need surgery

breast cancer

Three-dimensional culture of human breast cancer cells, with DNA stained in blue and a protein in the cell surface membrane stained in green. Image provider: NCI Cancer Research Center, National Cancer Institute, National Institutes of Health

Patients with early-stage breast cancer who have had a pathological complete response (pCR) to adjuvant chemotherapy may be able to skip surgery, according to a new study from researchers at the University of Texas. received standard radiation therapy with a low chance of disease recurrence. MD Anderson Cancer Center.

Phase II trials result, published today In Lancet Oncology, evaluated the possibility of breast cancer returning in patients who were in complete remission after receiving chemotherapy and radiation without surgery. Each of the 31 followed-up patients had a complete response to chemotherapy, and none experienced breast tumor recurrence after a median follow-up of 26.4 months.

“The ultimate form of breast-conserving therapy is the complete removal of breast surgery for invasive disease,” said lead investigator Henry Kuerer, MD, Ph.D., professor of Breast Surgical Oncology. “This study adds to growing evidence that newer drugs can completely eliminate cancer in some cases, and very early results suggest that we can effectively eliminate surgery.” safe in this selected group of women with breast cancer.”

This is the first modern prospective trial of surgical omission in patients early stage breast cancer who respond favorably to chemotherapy. High response indicated by vacuum-assisted core biopsy, guided by modern breast imaging (VACB). These results build on previous research by Kuerer using a biopsy procedure developed by MD Anderson to accurately identify patients achieving pCR after chemotherapy. Those patients, known as “special responders,” have a lower risk of breast cancer recurrence and are candidates to avoid breast surgery.

Improved chemotherapy agents have significantly increased pCR rates, and patients with 3-negative or HER2-positive breast cancer are now achieving pCR in 60% to 80% of cases. Combining these high response rates with selective imaging-guided VACB and rigorous histological processing has improved physicians’ ability to identify which patients may not require surgery.

Multicenter trial enrolling 50 women over 40 years of age with HER2-negative or HER2-positive early breast cancer and imaging-defining residual breast lesion less than 2 cm after targeted chemotherapy. standard. The patient has an image-guided VACB. If no disease was identified on biopsy, breast surgery was omitted and the patient underwent standard total breast radiotherapy.

The mean age of the participants was 60.4 years old; 21 patients have triple negative breast cancer and 29 with HER2-positive breast cancer. 38 participants were white, 10 were black, and 2 were of other ethnicities/races. VACB identified pCR in 31 patients. No serious biopsy-related adverse events or treatment-related deaths occurred.

“For now, standard breast cancer surgery is still needed,” says Kuerer. “While these results are remarkable and quite promising, it is important for patients to know this is the start of a new type of treatment for a select number of patients. Longer follow-up is required and further studies before this approach can be integrated into breast cancer care.”

Investigators will continue to monitor trial participants for long-term results. As a secondary goal of the study, the researchers are also measuring minimal residual disease from liquid biopsies to determine if they correlate with pCR.

Although this is a small, non-randomized study, it demonstrates the feasibility of this approach. A larger randomized study is needed to directly compare treatments before considering any changes to the standard of care.

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More information:
Lancet Oncology (In 2022).… (22) 00613-1 / fulltext

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