Omitting Surgery May Be Safe in Early Breast Cancer (BC) After Neoadjuvant Pathologic Complete Response (pCR)

• A small trial headed by MD Anderson Cancer Center, Houston, has helped to further identify women who can safely skip surgery after neoadjuvant therapy for early breast cancer.
• Among 50 women in the study with cT1, cT2, cN0, cN1, M0 triple negative or HER2-positive disease:
  • 31 (62%) had a complete pathologic response (pCR) to neoadjuvant therapy on image-guided vacuum-assisted core biopsy (VACB)
• They went onto whole breast radiation with a boost, but given their response to neoadjuvant treatment and the accuracy of VACB, the women did not have surgery
• So far, it seems to have been the right call:
  • At 3 years, there’s been no tumor recurrences and disease-free and overall survival are both 100%
• Eliminating breast surgery in highly-selected patients with image-guided VACB-determined pCR following” neoadjuvant systemic therapy has “very promising 3-year results:
  • This was presented by Henry M. Kuerer, MD, PhD, a breast cancer surgeon at MD Anderson, who presented the findings at the European Society for Medical Oncology (ESMO) 2023 annual meeting.
• The study speaks to a trend in breast cancer toward deescalation of treatment:
  • Particularly surgery:
    • To save women from the side effects of treatments they don’t need
• With the success of modern systemic therapy, it’s only natural that we think this way:
  • This study is really important:
    • It’s addressing a very important question whether we can omit surgery in certain groups of patients:
      • We do want to deescalate surgery, and the study results are “very good:
      • However, larger trials with longer follow-up are needed to draw any firm conclusions.

Study details

• Women in the trial were a median of 60.4 years old
• 58% had HER2-positive and the rest triple-negative unicentric breast cancer
• Mean baseline tumor size was 2.8 cm
• Just 12% of the participants had lymph node involvement
• Neoadjuvant systemic therapy was clinician’s choice
• Breast lesions had to shrink to less than 2 cm on imaging after systemic therapy to be eligible for the study
• A minimum of 12 cores had to be obtained on VACB
• The 38% of women in the study with residual disease after systemic treatment went on to surgery
• Two patients were circulating tumor cell (CTC)-positive at baseline, two were positive at 6 months, and one at 12 months
• No patients had CTCs detected at more than one timepoint
• The work was funded by the National Cancer Institute