Researchers in Lancet Oncology have concluded that it may be possible to eliminate surgery for invasive breast cancer in a group of highly selected ‘exceptional responders’ to neoadjuvant systemic therapy. 

In the ongoing study, approximately 60% of patients who undergo neoadjuvant systemic therapy for triple-negative breast cancer and HER2-positive breast cancer—experience pathological complete response—which predicts excellent prognosis. 

The researchers evaluated radiotherapy alone, without breast surgery, in patients with early-stage triple-negative breast cancer or HER2-positive breast cancer. These patients were treated with neoadjuvant systemic therapy and had an image-guided VACB-determined pathological complete response. 

The researchers enrolled 58 women at least 40 years of age into the trial. Participants were eligible for inclusion if they were not pregnant and had unicentric cT1-2N0-1M0 triple-negative breast cancer or HER2-positive breast cancer and a residual breast lesion < 2 cm on imaging following standard neoadjuvant systemic therapy.  

The participants all underwent one biopsy, which was obtained by image-guided VACB of the tumor bed. Breast surgery was omitted if no invasive or in situ disease was identified; these patients instead underwent standard whole-breast radiotherapy comprising either 40 Gy in 15 fractions or 50 Gy in 25 fractions, plus a boost of 14 Gy in seven fractions.  

A total of 50 patients (median age 62 years) underwent VACB following neoadjuvant systemic therapy. Of these, 21 patients (42%) had triple-negative breast cancer, while the remaining 29 (58%) had HER2-positive breast cancer.  

VACB identified pathological complete response in 31 patients (62%; 95% CI, 47.2-75.4%). What’s more, no ipsilateral breast tumor recurrences were found to occur in these 31 patients at a median follow-up of 26.4 months. With respect to safety, no treatment-related deaths or serious biopsy-related adverse events occurred. 

Eliminating breast surgery in highly selected patients with an image-guided VACB-determined pathological complete response following neoadjuvant systemic therapy is feasible and boasted promising early results. 

“The ultimate form of breast-conserving therapy is completely eliminating breast surgery for invasive disease. This research adds to growing evidence showing that newer drugs can completely eradicate cancer in some cases, and very early results show we can safely eliminate surgery in this select group of women with breast cancer,” said Henry M. Kuerer, MD, PhD, of the University of Texas MD Anderson Cancer Center in Houston, in a press release. 

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References: 
www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00613-1/fulltext#%20 

https://www.mdanderson.org/newsroom/some-breast-cancer-patients-with-high-responses-to-chemotherapy-may-not-need-surgery.h00-159543690.html 

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

Photo Credit: Getty Images.  

By Michael Vlessides, MD /alert Contributor