Breast cancer patients who respond to chemo may not need surgery

Select breast cancer patients who after undergoing chemotherapy as their first line of treatment show no residual cancer – a state known as pathologic complete response (pCR) – may be able to avoid follow-up breast and lymph node surgery, according to an MD Anderson study. The study identifies patients known as “exceptional responders” who are at lowest risk for local metastases and therefore are candidates for less invasive treatments.

Henry Kuerer, M.D., Ph.D., professor of Breast Surgical Oncology, is principal investigator of the study that enrolled 527 women diagnosed with triple negative and HER-2 positive breast cancers. All the participants received neoadjuvant chemotherapy, in which chemo was their initial treatment, followed by standard breast and lymph node surgery. Clinical staging was determined prior to chemo by core biopsy or fine-needle aspiration, followed by clinical exam, mammography, and ultrasound of the breast and lymph nodes. 

Kuerer set out to identify which patients in the group could have safely avoided surgery. To do so, he first needed to identify those who achieved a pCR following neoadjuvant chemo. 

Kuerer had recently completed a trial investigating the utility of image-guided biopsies to predict breast pCR. The preliminary results of that study revealed the technique to have 100 percent accuracy and 100 percent predictive value for determining residual disease following neoadjuvant chemo.

“By doing the same image-guided needle biopsies after neoadjuvant chemo that we do at time of diagnosis, our preliminary research revealed we can accurately predict which women will have a complete response,” said Kuerer. 

The current study tested participants using this technique, and showed that patients achieving a breast pCR were seven times less likely to have residual cancer in the lymph nodes

“Based upon these findings, we anticipate women with initial lymph node-negative disease may avoid breast and lymph node surgery if they achieve a pCR after neoadjuvant chemo and move on to standard radiotherapy,” said Audree Tadros, M.D., fellow in Breast Surgical Oncology and the study’s lead author.

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