Henry Kuerer, MD, PhD
A prospective study is investigating whether breast cancer surgery can be eliminated in patients who respond well to neoadjuvant systemic therapy.
State of the Science Summit on Treatment of Metastatic Breast Cancer. In an interview, he discussed the goals of the prospective trial and how it could impact these exceptional responders.
OncLive: Could you give an overview of your discussion on surgical management in breast cancer?
: We are very excited about a new trial at The University of Texas MD Anderson Cancer Center that is just about to open. It is potentially groundbreaking for patients, in that we are going to try to eliminate breast cancer surgery for those who have an exceptional response to neoadjuvant therapy. We've known for quite some time that there are some patients with exceptional responses, even after a few cycles.
The 1 patient where the core biopsy and the FNA did not show any residual disease, but actually did have residual disease, was a limited sampling with only 4 core biopsies. We learned from that trial that we are going to need to do extensive vacuum-assisted biopsy for the clinical trial where we eliminate the surgery.
What does surgery look like to you in the next 5 to 10 years?
What has changed so much over the years is the integration of neoadjuvant systemic therapy with surgery. Even for patients who present lymph node¬–positive disease, we now have a new technique called targeted axillary lymph node dissection. Here, we test the lymph node that had cancer prior to neoadjuvant therapy along with what we call the sentinel lymph nodes. We found that to be a very accurate method. We are eliminating more extensive surgery and lymph node surgery as well in probably 40% to 50% of cases.
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