Kelly Hunt, MD, professor and chair of Breast Surgical Oncology at The University of Texas MD Anderson Cancer Center, discusses treatment approaches for patients with breast cancer who have local regional recurrence.

Chemotherapy, whether given in the neoadjuvant or adjuvant setting, has no bearing on local regional recurrence, overall survival, or disease-free survival, says Hunt. Previously, it was believed that neoadjuvant chemotherapy could lead to a higher likelihood of local regional recurrence. Now, it is known that the likelihood of recurrence has more to do with biologic factors.

For example, patients with estrogen receptor-negative breast cancer, those with a large tumor burden at the time of diagnosis, as well as those with a less than robust response to therapy are the most likely to have local recurrence, adds Hunt. This risk is compounded in patients who receive a mastectomy or breast conserving surgery. However, now there are better selection criteria in place to help determine which patients are best suited to receive breast conserving surgery after neoadjuvant therapy.

Additionally, in the past, it was unknown whether a patient’s entire tumor volume had to be resected or whether whatever residual disease was left based on imaging should be resected. Now, it is known that targeting the residual radiographic disease is key, after which any residual disease burden can be assessed.

Kelly Hunt, MD

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