Breast surgery after neoadjuvant chemotherapy: time for a change?
Mené aux Etats-Unis entre 2017 et 2021 sur 50 patientes atteintes d'un cancer du sein triple négatif ou HER2+ et présentant une réponse pathologique complète vérifiée par biopsie après un traitement systémique néoadjuvant (âge médian : 62 ans ; durée médiane de suivi : 26,4 mois), cet essai multicentrique de phase II évalue l'efficacité, du point de vue du taux de récidive ipsilatérale, d'un traitement ne comportant qu'une radiothérapie
The efficacy of neoadjuvant systemic therapy for triple-negative breast cancer and HER2-positive breast cancer continues to improve. Recent trials of platinum chemotherapy, immunotherapy, and novel targeted drugs have brought incremental improvements in the likelihood of pathological complete response, and, in several cases, improvements in event-free survival. As we push the frontiers of complete response to systemic therapy, a natural next question is whether surgery can be omitted in selected patients. Potential benefits of such an approach include avoidance of complications from surgery and anaesthesia, improved cosmesis, increased patient satisfaction, and reduced cost and resource use. In a study published in The Lancet Oncology, Henry M Kuerer and colleagues 1 omitted surgery in patients with an exceptional response to neoadjuvant chemotherapy. They yielded excellent survival with no local recurrences among 31 patients with a complete pathological response to neoadjuvant chemotherapy at a median follow-up of 26·4 months (IQR 15·2–39·6).
The Lancet Oncology 2022