Neoadjuvant Therapy and Eligibility for Breast Conservation in Triple-Negative Disease
Posted: Friday, February 14, 2020
According to the surgical results of the BrightTNess randomized clinical trial, presented in JAMA Surgery, neoadjuvant systemic therapy appears to be able to convert many women who are ineligible for breast conservation to eligibility. However, Mehra Golshan, MD, MBA, of Dana-Farber Cancer Institute, Boston, and colleagues reported lower rates of breast conservation therapy among eligible patients as well as higher bilateral mastectomy rates among those without a germline BRCA mutation in North American women than in European and Asian women.
“New drugs and therapies are becoming available that allow us to shrink tumors prior to surgery, but we need to better understand how patients and surgeons perceive risk of disease and how this may factor into the surgical decision-making process,” commented Dr. Golshan in a Brigham and Women’s Hospital press release.
In this phase III, double-blind, randomized clinical trial, 634 women across 145 centers in 15 countries in North America, Europe, and Asia were enrolled. They had operable, stage II to III triple-negative breast cancer, and underwent germline BRCA mutation testing before starting neoadjuvant systemic therapy.
Surgeons assessed whether patients were eligible for breast conservation before and after neoadjuvant systemic therapy. Of the 604 patients with pre- and post- neoadjuvant systemic therapy assessments available, 141 patients were deemed ineligible for breast conservation. However, 75 of those women (53.2%) were converted to eligibility after neoadjuvant systemic therapy. Consequently, the percentage of those eligible for breast conservation increased from 76.5% at diagnosis to 83.8%.
“Based on these findings, women with triple-negative breast cancer who are not candidates for breast conservation at presentation should be counselled that there is a 50% likelihood they will become candidates after neoadjuvant systemic therapy,” concluded the researchers.
In addition, Dr. Golshan and colleagues believe that the lower breast conservation rates and higher mastectomy rates among patients without a germline BRCA mutation in North America merit further investigation.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.