Dr Kuerer on Advancements in Neoadjuvant Systemic Therapies in Breast Cancer

Henry Kuerer, MD, PhD, FACS, CMQ, professor of surgery, PH and Fay Etta Robinson Distinguished Professor in Cancer Research, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, discusses significant advancements in neoadjuvant systemic therapies in breast cancer.

Notably, neoadjuvant systemic therapies, which have included the introduction of immunotherapy, have shown promising results, with pathologic complete response (pCR) rates ranging from 60% to 70% in patients with T1/T2 tumors and N1 disease, Kuerer begins. This has led to the initiation of clinical trials utilizing image-guided biopsies post-treatment to potentially eliminate the need for surgery in cases where no cancer is detected.

MD Anderson launched a clinical trial (NCT02945579) that has evolved into a multicenter study evaluating the elimination of surgery in patients with HER2-positive or triple-negative breast cancer who do not have residual cancer following neoadjuvant systemic therapy. If patients have no residual disease per image-guided biopsy after systemic therapy, they can skip surgery and proceed to radiotherapy.

The success of neoadjuvant immunotherapy extends beyond breast cancer, Kuerer emphasizes, noting the importance of accurate patient selection for such therapies, facilitated by advancements in biopsy techniques, particularly in solid organ tumors.

Kuerer proceeds to highlight the importance of multidisciplinary collaboration in tailoring axillary therapy, involving medical oncologists, radiation oncologists, surgeons, and reconstructive or microvascular surgeons. This collaborative approach not only informs treatment decisions but also promotes advancements in techniques such as lymphatic flow preservation, potentially reducing the incidence of lymphedema in patients with breast cancer.

Kuerer underscores the evolving landscape of breast cancer treatment, driven by the integration of immunotherapies, advanced biopsy techniques, and multidisciplinary care. These developments hold promise for improving outcomes and reducing treatment-related morbidities in patients with breast cancer. Further research and collaboration are essential to optimize the efficacy and safety of these innovative approaches, he concludes.