Breast cancer patients who respond well to pre-surgical treatment may be able to skip surgery: study

Patients diagnosed with early-stage breast cancer who had a good response to targeted cancer treatment prior to surgery — otherwise known as adjuvant therapy — may be able to skip surgery and receive radiation treatment, with a low chance of cancer recurring.

That’s according to a new study from researchers at The University of Texas MD Anderson Cancer Center, one of the world’s most respected centers devoted exclusively to cancer patient care and research. 

“This research adds to growing evidence showing that newer drugs can completely eradicate cancer in some cases, and very early results show we can safely eliminate surgery in this select group of women with breast cancer,” said principal investigator Henry Kuerer, M.D., Ph.D., in a news release.

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He is professor of breast surgical oncology at The University of Texas MD Anderson Cancer Center, in Houston, Texas.

The Phase II trial results were published in Lancet Oncology. 

Researchers looked at the likelihood of breast cancer recurring in patients who were considered in complete remission after receiving chemotherapy and radiation without surgery. 

Thirty-one of the 50 patients who were followed had a complete response to chemotherapy — and none had a breast tumor recurrence after a median follow-up of 26.4 months, according to the study.

Patients received specific cancer-targeted therapies and chemotherapy prior to surgery.

“These types of breast cancer usually recur in [the] first couple of years, so [the] short follow-up showed promising results,” Dr. Kuerer told Fox News Digital in an interview about the study.

The patients received specific cancer-targeted therapies and chemotherapy prior to surgery, Keurer told Fox News Digital.

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“Patients often have surgery first, but these targeted therapies increase survival. So give it first — it shrinks tumors, allowing lumpectomy vs. mastectomy,” he said in an interview.

The multi-center study involved 50 women over 40 years old with early stage triple-negative or HER2-positive breast cancer and a residual breast lesion of less than 2 centimeters after standard chemotherapy treatment. 

If cancer was not detected on biopsy, then breast surgery was not performed and patients proceeded with standard radiation treatment. 

The patients had one image-guided, vacuum-assisted core biopsy (VACB) performed. 

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If cancer was not detected on biopsy, then breast surgery was not performed and patients proceeded with standard radiation treatment. 

Of the participants, the VACB identified 31 patients as having a pathologic complete response — meaning a pathologist does not detect cancer in the tissue where the tumor was located.

“Patients who had a good response to therapy and evidence on imaging that the tumor was responding well — instead of operating, we used imaging biopsy and skipped surgery in those patients,” Kuerer said.

He also explained that the high response rates, combined with the selective image-guided VACB and stringent histologic processing (studying the tissues and cells), have improved physicians’ ability to determine the patients who may not need surgery.

He said the biopsy protocol designed by MD Anderson Clinic was found to be quite accurate in the researchers’ previous research. 

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“We designed, tested and implemented the technique in 2018 and found an accuracy of 98% in this biopsy protocol,” he said. 

Kuerer also cautioned that more research is needed before this process is made the standard of care.

“For the time being, standard breast cancer surgery is still necessary,” Kuerer said. 

“While these results are remarkable and quite promising, it’s important for patients to know this is the very beginning of a new type of treatment for select patients.”

He added, “Much longer follow-up and further studies will be necessary before this approach can be integrated into routine breast cancer care.”  

Keurer said researchers would continue to follow these patients to monitor their long-term outcomes.

His team noted that this is a small nonrandomized study — and that larger randomized studies are needed before changes to standard of care can be considered. 

“This is a very interesting and thought-provoking trial.”

“This is a very interesting and thought-provoking trial,” Sarah P. Cate, M.D. and director of the breast surgery quality program at Mount Sinai Health System in New York, told Fox News Digital.

“Nationally, there are a few clinical trials looking at avoiding surgery for breast cancer,” said Cate, who was not involved in the study.  

“However, long-term follow up is needed for these trials to be extrapolated to the general breast cancer patient and for us to know it’s safe to offer.”

Added Cate, who is also director of the special surveillance and breast program at Mount Sinai Health System, “This trial also had a very small number of patients who were treated without surgery. Changes to the standard of care would involve a much larger trial with many more patients.”