Increasing Breast Cancer Systemic Therapy Use Before Surgery in the United States: Scaling Down and the Promise of Selective Elimination of Surgery

Excerpt

We are in a vastly different new era in our understanding of the biology of breast cancer and the efficacy of systemic therapies. Together with this information and the imperative of integration of multidisciplinary approaches for the management of breast cancer, over the past two decades the benefits and potential pitfalls on how to integrate and optimize neoadjuvant systemic therapy (NST) with surgery and radiotherapy has been elucidated.1‐8 Simply stated, if the molecular subtype and clinical prognostic stage of a breast cancer at diagnosis predicts that the patient will have a survival benefit with systemic therapy, then the best approach might be to administer the therapy before surgery if doing so can allow for increased patient benefits. These benefits are striking and unequivocally proven to allow for less breast and axillary nodal surgery with corresponding minimization of morbidity, while maintaining the same overall and disease-free survival benefit of adjuvant systemic therapy. It should also be noted that within molecular subtype groupings, there is interest and continued study of de-escalation of systemic therapies based on risk of recurrence and prognostic stage. …