Some breast cancer patients may avoid surgery in future

In a pilot study conducted at MD Anderson Cancer Center, image-guided biopsies identified select breast cancer patients who achieved pathologic complete response (pCR) after chemotherapy and/or targeted therapy, neoadjuvant systemic therapy (NST). Should the findings be replicated in future studies, this research would be the first indication that as the field moves toward more selective, personalized treatment, surgery may altogether be eliminated for a large group of patients.

Worldwide, triple negative and HER2 positive breast cancers account for about 370,000 women diagnosed annually, says Henry Kuerer, M.D., Ph.D., professor of Breast Surgical Oncology and the study’s principal investigator. With recent advances in neoadjuvant systemic therapy for both subsets of cancer, the pCR rates found at the time of surgery in these patients can be as high as 60 percent. This naturally raises the question of whether surgery is required for all patients, particularly for those who will receive adjuvant radiation.

“We believe surgery may potentially be redundant — at least for these two subtypes of breast cancer — because of such a high chance for no evidence of disease at the time of pathological review,” says Kuerer. “If there’s no cancer left after the patient has received chemotherapy and the patient is going to receive local radiation therapy, is surgery actually needed?”

The challenge has been that standard breast imaging methods cannot accurately predict residual disease after NST.

“However, by doing the same image-guided, percutaneous needle biopsies after NST that we do at time of diagnosis, our preliminary research reveals we may be able to accurately predict which women will have cancer or not,” says Kuerer. “If further studies prove these findings to be true, it would be groundbreaking for patients – both physically and psychologically.”

Read more about this study in MD Anderson's newsroom.