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Erschienen in: Annals of Surgical Oncology 11/2018

26.07.2018 | Breast Oncology

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

verfasst von: Henry M. Kuerer, MD, PhD, FACS

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2018

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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.18 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. …
Literatur
1.
Zurück zum Zitat Kuerer HM, Hunt KK, Newman LA, Ross MI, Ames FC, Singletary SE. Neoadjuvant chemotherapy in women with invasive breast carcinoma: conceptual basis and fundamental surgical issues. J Am Coll Surg. 2000;190(3):350–363.CrossRef Kuerer HM, Hunt KK, Newman LA, Ross MI, Ames FC, Singletary SE. Neoadjuvant chemotherapy in women with invasive breast carcinoma: conceptual basis and fundamental surgical issues. J Am Coll Surg. 2000;190(3):350–363.CrossRef
2.
Zurück zum Zitat Kuerer HM, Newman LA, Buzdar AU, et al. Pathologic tumor response in the breast following neoadjuvant chemotherapy predicts axillary lymph node status. Cancer J Sci Am. 1998;4(4):230–236.PubMed Kuerer HM, Newman LA, Buzdar AU, et al. Pathologic tumor response in the breast following neoadjuvant chemotherapy predicts axillary lymph node status. Cancer J Sci Am. 1998;4(4):230–236.PubMed
3.
Zurück zum Zitat Kuerer HM, Newman LA, Fornage BD, et al. Role of axillary lymph node dissection after tumor downstaging with induction chemotherapy for locally advanced breast cancer. Ann Surg Oncol. 1998;5(8):673–680.CrossRef Kuerer HM, Newman LA, Fornage BD, et al. Role of axillary lymph node dissection after tumor downstaging with induction chemotherapy for locally advanced breast cancer. Ann Surg Oncol. 1998;5(8):673–680.CrossRef
4.
Zurück zum Zitat Kuerer HM, Newman LA, Smith TL, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17(2):460–469.CrossRef Kuerer HM, Newman LA, Smith TL, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17(2):460–469.CrossRef
5.
Zurück zum Zitat Kuerer HM, Sahin AA, Hunt KK, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg. 1999;230(1):72–78.CrossRef Kuerer HM, Sahin AA, Hunt KK, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg. 1999;230(1):72–78.CrossRef
6.
Zurück zum Zitat Caudle AS, Yang WT, Krishnamurthy S, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol. 2016;34(10):1072–1078.CrossRef Caudle AS, Yang WT, Krishnamurthy S, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol. 2016;34(10):1072–1078.CrossRef
7.
Zurück zum Zitat Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16(8):2672–2685.CrossRef Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16(8):2672–2685.CrossRef
8.
Zurück zum Zitat Shin K, Caudle AS, Kuerer HM, et al. Radiologic Mapping for targeted axillary dissection: needle biopsy to excision. AJR Am J Roentgenol. 2016;207(6):1372–1379.CrossRef Shin K, Caudle AS, Kuerer HM, et al. Radiologic Mapping for targeted axillary dissection: needle biopsy to excision. AJR Am J Roentgenol. 2016;207(6):1372–1379.CrossRef
9.
Zurück zum Zitat Hennessy BT, Hortobagyi GN, Rouzier R, et al. Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol. 2005;23(36):9304–9311.CrossRef Hennessy BT, Hortobagyi GN, Rouzier R, et al. Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol. 2005;23(36):9304–9311.CrossRef
10.
Zurück zum Zitat Houssami N, Macaskill P, von Minckwitz G, Marinovich ML, Mamounas E. Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer. 2012;48(18):3342–3354.CrossRef Houssami N, Macaskill P, von Minckwitz G, Marinovich ML, Mamounas E. Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer. 2012;48(18):3342–3354.CrossRef
11.
Zurück zum Zitat von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796–1804.CrossRef von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796–1804.CrossRef
12.
Zurück zum Zitat Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13(1):25–32.CrossRef Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13(1):25–32.CrossRef
13.
Zurück zum Zitat Dominici LS, Negron Gonzalez VM, Buzdar AU, et al. Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2-positive breast cancer. Cancer. 2010;116(12):2884–2889.CrossRef Dominici LS, Negron Gonzalez VM, Buzdar AU, et al. Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2-positive breast cancer. Cancer. 2010;116(12):2884–2889.CrossRef
14.
Zurück zum Zitat Masuda N, Lee SJ, Ohtani S, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376(22):2147–2159.CrossRef Masuda N, Lee SJ, Ohtani S, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376(22):2147–2159.CrossRef
16.
Zurück zum Zitat Rauch GM, Kuerer HM, Adrada B, et al. Biopsy feasibility trial for breast cancer pathologic complete response detection after neoadjuvant chemotherapy: imaging assessment and correlation endpoints. Ann Surg Oncol. 2018;25(7):1953–1960.CrossRef Rauch GM, Kuerer HM, Adrada B, et al. Biopsy feasibility trial for breast cancer pathologic complete response detection after neoadjuvant chemotherapy: imaging assessment and correlation endpoints. Ann Surg Oncol. 2018;25(7):1953–1960.CrossRef
17.
Zurück zum Zitat Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(3):188–194.CrossRef Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(3):188–194.CrossRef
18.
Zurück zum Zitat Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev. 2007;2:CD005002. Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev. 2007;2:CD005002.
19.
Zurück zum Zitat Early Breast Cancer Trialists’ Collaborative G. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27–39.CrossRef Early Breast Cancer Trialists’ Collaborative G. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27–39.CrossRef
20.
Zurück zum Zitat van la Parra RF, Kuerer HM. Selective elimination of breast cancer surgery in exceptional responders: historical perspective and current trials. Breast Cancer Res. 2016;18(1):28.CrossRef van la Parra RF, Kuerer HM. Selective elimination of breast cancer surgery in exceptional responders: historical perspective and current trials. Breast Cancer Res. 2016;18(1):28.CrossRef
21.
Zurück zum Zitat Kuerer HM, Rauch GM, Krishnamurthy S, et al. A clinical feasibility trial for identification of exceptional responders in whom breast cancer surgery can be eliminated following neoadjuvant systemic therapy. Ann Surg. 2018;267(5):946–951.CrossRef Kuerer HM, Rauch GM, Krishnamurthy S, et al. A clinical feasibility trial for identification of exceptional responders in whom breast cancer surgery can be eliminated following neoadjuvant systemic therapy. Ann Surg. 2018;267(5):946–951.CrossRef
22.
Zurück zum Zitat van la Parra RFD, Tadros AB, Checka CM, et al. Baseline factors predicting a response to neoadjuvant chemotherapy with implications for non-surgical management of triple-negative breast cancer. Br J Surg. 2018;105(5):535–543.CrossRef van la Parra RFD, Tadros AB, Checka CM, et al. Baseline factors predicting a response to neoadjuvant chemotherapy with implications for non-surgical management of triple-negative breast cancer. Br J Surg. 2018;105(5):535–543.CrossRef
23.
Zurück zum Zitat Tadros AB, Yang WT, Krishnamurthy S, et al. Identification of patients with documented pathologic complete response in the breast after neoadjuvant chemotherapy for omission of axillary surgery. JAMA Surg. 2017;152(7):665–670.CrossRef Tadros AB, Yang WT, Krishnamurthy S, et al. Identification of patients with documented pathologic complete response in the breast after neoadjuvant chemotherapy for omission of axillary surgery. JAMA Surg. 2017;152(7):665–670.CrossRef
25.
Zurück zum Zitat Caudle AS, Kuerer HM. Targeting and limiting surgery for patients with node-positive breast cancer. BMC Med. 2015;13:149.CrossRef Caudle AS, Kuerer HM. Targeting and limiting surgery for patients with node-positive breast cancer. BMC Med. 2015;13:149.CrossRef
26.
Zurück zum Zitat Kuerer HM, Vrancken Peeters M, Rea DW, Basik M, De Los Santos J, Heil J. Nonoperative management for invasive breast cancer after neoadjuvant systemic therapy: conceptual basis and fundamental international feasibility clinical trials. Ann Surg Oncol. 2017;24(10):2855–2862.CrossRef Kuerer HM, Vrancken Peeters M, Rea DW, Basik M, De Los Santos J, Heil J. Nonoperative management for invasive breast cancer after neoadjuvant systemic therapy: conceptual basis and fundamental international feasibility clinical trials. Ann Surg Oncol. 2017;24(10):2855–2862.CrossRef
Metadaten
Titel
Increasing Breast Cancer Systemic Therapy Use Before Surgery in the United States: Scaling Down and the Promise of Selective Elimination of Surgery
verfasst von
Henry M. Kuerer, MD, PhD, FACS
Publikationsdatum
26.07.2018
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2018
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6643-y

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