Some breast cancer patients with high responses to chemotherapy may not need surgery

Medical Xpress / University of Texas M. D. Anderson Cancer Center / The Lancet Oncology ^ | Oct. 25, 2022 | Henry M Kuerer et al

[ConservativeMind]

Patients with early-stage breast cancer who had a pathologic complete response (pCR) to neoadjuvant chemotherapy may be able to skip surgery and receive standard radiation treatment with a low chance of disease recurrence, according to a study.

The trial evaluated the likelihood of breast cancer returning in patients who are in complete remission after receiving chemotherapy and radiation without surgery. Each of the 31 patients followed had a complete response to chemotherapy and none had a breast tumor recurrence after a median follow-up of 26.4 months.

High responses are indicated by state-of-the-art breast imaging-guided, vacuum-assisted core biopsy (VACB). These results build on Kuerer's previous research using an MD Anderson-developed biopsy protocol to accurately identify patients achieving a pCR after chemotherapy. Those patients, known as "exceptional responders," are at a lower risk of breast cancer recurrence and are candidates for avoiding breast surgery.

Improved chemotherapy agents have increased pCR rates significantly, and patients with triple-negative or HER2-positive breast cancer now are achieving a pCR in 60% to 80% of cases. Combining these high response rates with selective image-guided VACB and stringent histologic processing has improved physicians' ability to determine which patients may not need surgery.

The multicenter trial enrolled 50 women older than 40 with early stage triple-negative or HER2-positive breast cancer and a residual breast lesion less than 2 centimeters as determined by imaging after standard chemotherapy treatment. Patients had one image-guided VACB. If no disease was identified on biopsy, breast surgery was omitted, and patients proceeded to standard whole-breast radiotherapy.

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

[ConservativeMind]

Surgery may not be required, or, perhaps, a lumpectomy is sufficient.

[ConservativeMind]

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[Sioux-san]

I am as unimpressed with the Cancer Treatment Protocol as with the Covid Treatment Protocol. In my experience, it’s something you do your best to survive while the “Experts” take the credit if you don’t die and have excuses out the wazoo if you do die that they did all they could... which might just be the problem: Overkill Protocol. Big Bucks prevent any rational discussion. They have no clue what happens with those of us who didn’t do what we were told.

[windcliff]

ping

[SC DOC]

You really have to go to the source article in Lancet Oncology to appreciate how impressive these results are. The patients all had either triple negative or Her-2 positive disease which are very high risk categories.