E. Shyam P. Reddy: MD Anderson study suggests surgery may be avoided in select HER2+ and TNBC cases
E. Shyam P. Reddy, Professor and Director of the Cancer Biology Program, Department of OB/GYN at Morehouse School of Medicine, shared a post on LinkedIn:
“Researchers from the University of Texas MD Anderson Cancer Center report that women who do not undergo breast surgery after a complete response to neoadjuvant systemic therapy (NST) have excellent outcomes at five years, with no recurrences seen, suggesting that selective avoidance of surgery may be a possibility.
Lead author Henry Kuerer, MD, PhD, professor of surgery and executive director breast programs at MD Anderson, told Inside Precision Medicine that the findings represent a ‘new paradigm for the management of select patients with HER2-positive and triple-negative breast cancers.’
Approximately 60% of patients with these cancers will have a pathologic complete response (pCR) to NST, indicating an excellent long-term prognosis. This high pCR rate has raised questions regarding the necessity of breast surgery for patients without residual disease after NST.
In the first study of its kind, 50 women aged 40 years or older (median age 62 years) with HER2-positive (58%) or triple-negative (42%) invasive breast cancer who had residual breast lesions of less than 2 cm after NST underwent image-guided vacuum-assisted biopsy (VAB) with a minimum of 12 cores obtained via a 9G needle.
The VAB technique was developed at MD Anderson by Kuerer and colleagues. In early studies, they showed that they could precisely biopsy the region where the cancer had shrunk to less than 2 cm. ‘Utilizing this technique, the false-negative rate was less than 5%, with an accuracy of 98%,’ he noted.
The biopsies were examined histologically for any residual abnormalities and 31 (62%) patients had a pCR, i.e., no invasive or in situ disease, including eight patients with initial nodal metastases who had an axillary pCR confirmed after targeted axillary node dissection.
These patients underwent whole-breast radiotherapy with a boost but did not have breast surgery. They were then monitored with physical examinations and mammography every six months. The remaining 19 patients with residual cancer detected on VAB had standard breast and axillary surgery.
The researchers report in JAMA Oncology that at a median follow-up of 55.4 months, none of the 31 patients who avoided surgery had experienced ipsilateral breast tumor recurrence, and the disease-free and overall survival rates were both 100% for these patients.
The standard practice for invasive breast cancer is surgical management, so all of the 31 patients would have undergone surgery if they had not been involved in the trial. Yet, Kuerer was not surprised back the lack of recurrence.
‘There was no guesswork with this new paradigm for the management of meticulously selected patients after neoadjuvant systemic therapy,’ he said. ‘We followed these patients extremely closely at six-month intervals with imaging and physical examinations and were delighted that none of the patients had a recurrence, as we had already predicted, since no residual breast cancer was noted on the needle biopsy.’ “
More posts featuring E. Shyam P. Reddy.
-
Challenging the Status Quo in Colorectal Cancer 2024
December 6-8, 2024
-
ESMO 2024 Congress
September 13-17, 2024
-
ASCO Annual Meeting
May 30 - June 4, 2024
-
Yvonne Award 2024
May 31, 2024
-
OncoThon 2024, Online
Feb. 15, 2024
-
Global Summit on War & Cancer 2023, Online
Dec. 14-16, 2023