Dr Kuerer on Selective Surgery Omission After Response to Neoadjuvant Therapy in Invasive Breast Cancer

Our 5-year analysis of the trial demonstrated that this new paradigm for the management of highly selected patients with HER2-positive and triple-negative breast cancer is both safe and effective."

Henry M. Kuerer, MD, PhD, FACS, CMQ, a professor and executive director of the Breast Programs of MD Anderson Cancer Network in the Department of Breast Surgical Oncology at The University of Texas MD Anderson Cancer Center, discussed long-term outcomes from a phase 2 study (NCT02945579) evaluating the selective elimination of breast surgery in patients with exceptional response to neoadjuvant systemic therapy for early-stage breast cancer.

The trial assessed whether surgery could be feasibly and safely omitted in a highly selected group of patients with HER2-positive or triple-negative invasive breast cancer who achieved radiographic resolution and biopsy-confirmed pathologic complete response (pCR) following neoadjuvant therapy. In lieu of surgery, patients underwent radiation therapy as the sole local treatment modality, Kuerer explained.

At a median follow-up of 55.4 months (interquartile range, 44.0-63.5), the ipsilateral breast tumor recurrence rate was 0%, with 100% ipsilateral breast tumor recurrence–free survival,, disease-free survival, and overall survival rates observed, Kuerer reported. These findings support the oncologic safety of a nonoperative approach in select patients with breast cancer meeting stringent eligibility criteria.

This management strategy may offer a viable alternative to surgery in a subset of patients with favorable tumor biology and excellent response to therapy, Kuerer stated. The results represent a potential paradigm shift for patients with HER2-positive or triple-negative breast cancer, in whom modern systemic regimens frequently induce pCR. According to Kuerer, careful radiologic and pathologic assessment is essential to accurately identify those eligible for surgery omission.

Although these findings are promising, broader clinical application will require further validation in prospective, multicenter trials. Kuerer emphasized that patient selection remains critical, and omission of surgery should only be considered in the context of rigorous imaging, targeted biopsy, and multidisciplinary consensus. Additionally, long-term follow-up will be essential to ensure durable control and inform future guidelines on treatment de-escalation.