Surgery may be waived in breast cancer patients responding to neoadjuvant chemo

A recent study has raised the possibility of removing surgery in the management of nonmetastatic breast cancer patients with a complete clinical response (cCR) to neoadjuvant chemotherapy (NACT). 

“Traditional breast cancer management involves surgery followed by systemic therapies,” the authors said. “However, advancements in NACT raise questions about the necessity of surgery in cases with an excellent response to NACT.” 

To address this, a retrospective study was carried out using the SEER database. The authors reviewed records from 2010 to 2020 for patients with nonmetastatic breast cancer treated with NACT, associated with a clinical response, followed by radiotherapy alone. 

A total of 123 patients were stratified into cCR and non-cCR (partial or unspecified clinical response) cohorts. Using Kaplan-Meier and Cox proportional hazards models, the authors analysed the overall (OS) and cancer-specific survival (CSS). 

Over a median follow-up of 41 months, 17 patients (13.82 percent) achieved cCR. At 5 years, the OS was 65.8 percent and the CSS was 71 percent for the entire cohort. Of note, the cCR group achieved 100-percent rate for both, with older age (>60 years) and larger tumour size (T3 to T4) correlating with a lower OS. 

On the other hand, the non-cCR group had an OS of 61.5 years and CSS of 67.1 percent at 5 years. 

“These promising results support further research into less invasive breast cancer management,” the authors said. “However, prospective studies must validate these findings and identify suitable patients for nonsurgical approaches.”