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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Wednesday, February 15, 2023
In a phase II trial, some highly selected patients with breast cancer appear to be able to avoid surgery after an image-guided vacuum-assisted core biopsy–determined pathologic complete response to neoadjuvant systemic therapy. These patients would receive standard radiation treatment, however. Additionally, Henry M. Kuerer, MD, PhD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues did not observe any locoregional or distant recurrence in such treated patients at 2-year follow-up. The findings were published in The Lancet Oncology.
“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 Dr. Kuerer in an MD Anderson press release.
The study enrolled women aged 40 and older with breast cancer in seven centers in the United States. The patients had either unicentric cT1-2N0-1M0 triple-negative breast cancer, HER2-positive breast cancer, or a residual breast lesion smaller than 2 cm on imaging after clinically standard neoadjuvant systemic therapy. Patients had one biopsy (minimum of 12 cores) obtained by 9G image-guided vacuum-assisted core biopsy of the tumor bed. If no invasive or in situ disease was identified, breast surgery was omitted, and patients underwent standard whole-breast radiotherapy (40 Gy in 15 fractions or 50 Gy in 25 fractions) plus a boost (14 Gy in 7 fractions).
A total of 50 patients were included in the study between March 2017 and November 2021. All patients underwent vacuum-assisted core biopsy after neoadjuvant systemic therapy. Of them, 21 (42%) had triple-negative breast cancer and 29 (58%) had HER2-positive breast cancer. The median follow-up was 26.4 months. Vacuum-assisted core biopsy identified a pathologic complete response in 31 patients. These patients did not have any ipsilateral breast tumor recurrence. There were no serious biopsy-related adverse events or treatment-related deaths.
Disclosure: For full disclosures of the study authors, visit thelancet.com.
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