The traditional approach to fighting breast cancer is to deploy all the tools that modern medicine has to offer. Surgery to excise the tumor is considered a critically important step, along with drugs, radiation, and hormones Treatment and immunotherapy when appropriate.
A new study questions that approach, suggesting surgery may not always be necessary for all patients. study, an early-stage clinical trial found that a group of carefully selected patients who responded remarkably well chemotherapy Can skip surgery altogether. 50 patients older than 40 with two types of breast cancer and early-stage disease were enrolled in the trial.
All patients underwent chemotherapy, followed by biopsies to determine whether their tumors had responded well to treatment. The researchers found that thirty-one patients – about 60% – responded remarkably well and were able to undergo surgery.
The participants received radiation treatment and were still in remission after a median follow-up period of two years and two months, said the study’s principal investigator, Dr. Henry Kuer, which was published Tuesday in The Lancet Oncology.
Elimination of surgery for invasive Breast Cancer “Breast-conserving is the ultimate form of medicine,” he said.
Breast surgery can lead to complications such as infection, and even breast-conserving procedures such as lumpectomy can change the shape of the breast, leave scars or indentations, a tugging sensation or permanent nerve pain.
“Breast cancer is very common, and there will always be people who don’t want to have surgery,” said Kuer, a professor of breast surgical oncology at the University of Texas MD Anderson Cancer Center in Houston.
He said some patients prefer radical surgery, even if it does not improve survival, while for others a minor procedure to remove the tumor can be emotionally grueling, even if it does heal.
The work is part of an approach to cancer treatment called de-escalation: an attempt to differentiate treatment of a specific subtype of the disease, achieving similar results with fewer treatments and fewer interventions.
Some women with breast cancer are able to skip chemotherapy if gene tests determine it will not be helpful and other drugs are available, which can save them from short-term side effects and long-term complications. Some Lung Cancer Patients Might Also Forget chemotherapy, Breast-conserving lumpectomy instead of mastectomy is also part of de-escalation, as is undergoing a complete surgery in this trial. In a separate clinical trial, Kuerer is also examining whether radiation is always necessary.
“What I really appreciate about the study is that it takes the next step and asks a bold question: How do we take all the advances that we’ve made in more tailored and specific cancer therapy, and divide it into the number and types of cancer that we’ve come across?” convert to low. Does any one patient need to intervene?” Karen Knudsen, CEO of the American Cancer Society, said.
“asking if we can scale back” Surgery A reasonable next consideration for the future of cancer care.”
Pamela Romero, who took part in the trial and was deemed eligible to skip surgery, traveled to MD Anderson from her home in New Iberia, Louisiana, in 2018 immediately after a small lump was discovered near her breast bone. A second opinion can be taken later. Her tumor was HER2 positive and was about the size of a grapefruit.
(A HER2-positive tumor contains cells with receptors for human epidermal growth factor 2. Only women with HER2-positive tumors and triple-negative tumors, which contain cells that respond to estrogen, progesterone, and human epidermal growth factor 2. Receptors are lacking. Testing is included.)
“The doctor asked, ‘How do you feel about the surgery?’ And I said, ‘I’m afraid of dying of it,'” Romero, 66, recalled in an interview. “I said, ‘If I can get rid of it’ cancer Without surgery, I am ready for it.'”
She had never had surgery before, she said: “I didn’t want to be put down, or go under the knife.”
After four chemotherapy regimens, Romero said, the doctor told her the tumor had shrunk by about 85%, and she could have avoided surgery if she wanted. After two more treatments, the regimen was complete.
Romero underwent radiation treatment and immunotherapyand recently celebrated its third anniversary of completing treatment, remaining free of the disease.
While the surgery-free diet appears to be successful so far, only a small number of carefully screened women were included in the trial, and they have been followed for an average duration of 26 months.
This is a significant period of time, especially for specific types. cancer studied, which tend to recur within the first few years. Still, experts said a larger trial with a comparison group would be needed to see if changes to medical practice are needed.
“The big picture is that this is a small study,” said Dr. Monica Morrow, chief of breast surgery at Memorial Sloan Kettering Cancer Center in New York. “It is by no means definitive. It will not change the practice in any way.”
Patients included in the trial had smaller tumors and would be eligible for breast-conserving lumpectomy surgery, as well as biopsy of sentinel lymph nodes, she said.
“That’s hour-long outpatient surgery,” she said. “You can get it done, and yes, you will have some discomfort and pain.” But women who get a lumpectomy in the first place aren’t candidates for a major surgery like a mastectomy, he said.
Patients in the trial who were eligible to skip surgery were biopsied to determine whether they had what is called a pathological complete response, meaning the absence of any symptoms. cancer in tissue samples. Only those who had a complete response to chemotherapy were allowed to postpone surgery.
Improved chemotherapy agents have significantly increased response rates, and 60% to 80% of patients with triple-negative or HER2-positive breast tumors manage to avoid surgery. But some image-guided biopsies can produce errors, including false-negative results, and must be performed under strict protocols to achieve high levels of accuracy.
Kuerer said the new trial results were promising, but cautioned that surgery was still necessary for most. Breast Cancer Patient. “It is important for patients to know that this is the beginning of a new type of treatment for select patients,” he said.
This article originally appeared in The New York Times.
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