Select patients with early-stage invasive breast cancer may be able to safely forgo surgery after completing neoadjuvant systemic therapy without increasing the risk of disease recurrence, according to study results published in JAMA Oncology. 

Henry Kuerer, MD, PhD, professor of breast surgical oncology at The University of Texas MD Anderson Cancer Center, and colleagues conducted a nonrandomized phase 2 trial to determine whether patients who achieved pathologic complete response after radiotherapy alone could maintain disease control without surgery. Initial results showed that patients whose responses were identified through percutaneous image-guided vacuum-assisted core biopsy had no local or distant disease recurrences at 2-year and 3-year intervals after treatment. 

The current, preplanned analysis presented 5-year outcomes from a cohort of 50 patients (median age, 62 years) who enrolled in a vacuum-assisted core biopsy program after neoadjuvant systemic therapy. In total, 58% of patients had HER2-positive breast cancer and 42% had triple-negative breast cancer. 

Using vacuum-assisted core biopsy, Kuerer and colleagues identified a pathologic complete response in 31 patients. These patients proceeded to radiotherapy as determined by protocol and omitted breast surgery.

An additional 8 patients had pathologic complete responses in the breast with initial nodal metastases. These patients proceeded to axillary dissection, and no patient exhibited signs of residual nodal disease. 

Median follow-up for the current analysis was 55.4 months. Kuerer and colleagues reported an ipsilateral breast tumor recurrence rate of 0% in patients who omitted surgery. In addition, the researchers observed 100% disease-free survival and overall survival rates in this cohort.

The researchers identified the small patient size, limited follow-up, and nonrandomized trial design as potential limitations. 

“The absence of detectable breast cancer recurrences at the 5-year mark highlights the tremendous potential of this surgery-free approach to breast cancer management. Our innovative, precise method of detecting cancer in these patients has successfully demonstrated that we can treat them while avoiding surgery for this group.

 “These continued promising results suggest that eliminating breast surgery for invasive breast cancer could become the new standard of care, offering women the opportunity to preserve their bodies. While we are hopeful that this approach will become routine, further clinical trials are necessary before this is a standard therapy.”

- Henry Kuerer, MD, PhD, professor of breast surgical oncology at The University of Texas MD Anderson Cancer Center, said in a press release.

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Reference: https://jamanetwork.com/journals/jamaoncology/fullarticle/2832067; https://www.newswise.com/articles/surgery-may-not-be-necessary-to-treat-invasive-breast-cancer/?sc=sphr&xy=10019289

Disclosures: Some authors declared financial ties to drugmakers. See full study for details.

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