Moving Forward with Omission of Breast Cancer Surgery Following Neoadjuvant Systemic Therapy

Excerpt

It is hard to imagine how a surgical procedure could benefit patients with a pathologic complete response (pCR) in the breast and the lymph nodes when all disease has already been eradicated by neoadjuvant systemic therapy (NST). The main obstacle facing the field is how to accurately predict which patients will have eradication of disease without performing the actual surgical procedure. We have come to a time when we now know that a population of patients with invasive breast cancer will have a 50% or more chance of having a pCR in the breast and nodes following NST.¹ Clearly, we also know that these same patients with triple-negative or human epidermal growth factor receptor 2 (HER2)-positive disease derive a disease-free and overall survival benefit with the use of these targeted systemic therapies. The use of subtype-specific NST in these cases serves many roles, including reducing the extent of therapeutic surgery, and may also even allow for some carefully selected patients to someday avoid surgery entirely.^2‐6 …