Eliminating the breast cancer surgery paradigm after neoadjuvant systemic therapy

• Verfasst von: Heil, Jörg [VerfasserIn]
• Verfasst von: Sinn, Peter [VerfasserIn]
• Verfasst von: Golatta, Michael [VerfasserIn]
• Titel: Eliminating the breast cancer surgery paradigm after neoadjuvant systemic therapy
• Titelzusatz: current evidence and future challenges
• Verf.angabe: J. Heil, H.M. Kuerer, A. Pfob, G. Rauch, H.P. Sinn, M. Golatta, G.J. Liefers & M.J. Vrancken Peeters
• E-Jahr: 2020
• Jahr: 6 January 2020
• Umfang: 11 S.
• Fussnoten: Gesehen am 31.03.2020
• Titel Quelle: Enthalten in: Annals of oncology
• Ort Quelle: Amsterdam [u.a.] : Elsevier, 1990
• Jahr Quelle: 2020
• Band/Heft Quelle: 31(2020), 1, Seite 61-71
• ISSN Quelle: 1569-8041
• DOI: doi:10.1016/j.annonc.2019.10.012
• Datenträger: Online-Ressource
• Sprache: eng
• Bibliogr. Hinweis: Kommentar in: Heil, Jörg, 1978 - : Patients should be the tipping point of individualizing breast cancer surgery
• Sach-SW: breast cancer
• Sach-SW: individualized treatment
• Sach-SW: neoadjuvant systemic therapy
• Sach-SW: oncology
• Sach-SW: surgery
• K10plus-PPN: 1693627698

Abstract

In patients with operable early breast cancer, neoadjuvant systemic treatment (NST) is a standard approach. Indications have expanded from downstaging of locally advanced breast cancer to facilitate breast conservation, to in vivo drug-sensitivity testing. The pattern of response to NST is used to tailor systemic and locoregional treatment, that is, to escalate treatment in nonresponders and de-escalate treatment in responders. Here we discuss four questions that guide our current thinking about ‘response-adjusted’ surgery of the breast after NST. (i) What critical diagnostic outcome measures should be used when analyzing diagnostic tools to identify patients with pathologic complete response (pCR) after NST? (ii) How can we assess response with the least morbidity and best accuracy possible? (iii) What oncological consequences may ensue if we rely on a nonsurgical-generated diagnosis of, for example, minimally invasive biopsy proven pCR, knowing that we may miss minimal residual disease in some cases? (iv) How should we design clinical trials on de-escalation of surgical treatment after NST?