Andrea V. Barrio, MD, FACS, associate attending surgeon at Memorial Sloan Kettering Cancer Center, discusses how the use of neoadjuvant chemotherapy (NAC) can help de-escalate axillary node dissection in select patients with breast cancer. Dissection can be a morbid procedure with longterm risks of lymphoma, impacting the quality of life for many patients.

To use NAC to de-escalate surgical care in patients, Barrio says physicians must use the approach safely. Dissection can be de-escalated in those patients who have an excellent response to chemotherapy, such as those with HER2-positive or triple-negative disease. Those patients have had the best responses, and Barrio adds she has seen reductions in these patient populations.

However, Barrio warns that hormone receptor (HR)-positive and HER2-negative patients have less responses to the NAC. While surgical care may still be down-staged in a substantial amount of these patients, it is important to do so safely.

Overall, de-escalating the axillary node dissection can improve the quality of life for many patients with breast cancer, but Barrio concludes that any patients who still have residual disease following chemotherapy should not be considered for de-escalation.

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Andrea V. Barrio, MD, FACS, discusses how the use of neoadjuvant chemotherapy can help de-escalate axillary node dissection in select patients with breast cancer. Dissection can be a morbid procedure with longterm risks of lymphoma, impacting the quality of life for many patients.

Dr. Barrio on Neoadjuvant Chemo to De-Escalate Axillary Node Dissection in Breast Cancer

Andrea V. Barrio, MD, FACS, breast surgical oncologist, Memorial Sloan Kettering Cancer Center, discusses treatment options for patients with HER2-positive breast cancer.

HER2-positive disease is a subtype of breast cancer that represents about 20% of breast cancer cases, Barrio says. In 2006, adjuvant targeted therapy with trastuzumab (Herceptin) became widely used. More recently, dual HER2-targeted therapy with trastuzumab and pertuzumab (Perjeta) has shaped the landscape. The challenge remaining with this disease is determining which patients should undergo upfront surgery or neoadjuvant therapy. Barrio notes that this should depend on physician and patient goals, although it appears that surgery is becoming de-escalated in the paradigm in order to maintain patient quality of life.

For example, the goal of frontline chemotherapy for patients with node-positive disease is to make them node-negative, leading to less surgery. The biggest advantage of HER2-positive breast cancer is its high response rate to systemic therapy.

Andrea V. Barrio, MD, FACS

Articles

Dr. Barrio on Neoadjuvant Chemo to De-Escalate Axillary Node Dissection in Breast Cancer

Dr. Barrio on Treatment Options for HER2+ Breast Cancer