Surgery following neoadjuvant chemotherapy for HER2-positive locally advanced breast cancer. Time to reconsider the standard attitude. Issue 6 (April 2015)

• Record Type: Journal Article
• Authors: Debled, Marc; MacGrogan, Gaëtan; Breton-Callu, Christelle; Ferron, Stéphane; Hurtevent, Gabrielle; Fournier, Marion; Bourdarias, Lionel; Bonnefoi, Hervé; Mauriac, Louis; Tunon de Lara, Christine
• Is Part Of: European journal of cancer. Volume 51:Issue 6(2015:Apr.)
• Page Start: 697
• Page End: 704
• Publication Date: 2015-04
• Subjects: Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2015.01.063
• Languages: English
• ISSNs: 0959-8049

Abstract

<abstract xml:lang="en" abstract-type="author" id="ab005"> <title id="st055">Abstract</title> <sec> <title id="st060">Background</title> <p id="sp0005">While the addition of targeted therapy to neoadjuvant chemotherapy (NACT) dramatically increases the rate of pathological complete response in HER2-positive breast cancer, no reduction in the rate of mastectomy has been observed in randomised studies.</p> </sec> <sec> <title id="st065">Methods</title> <p id="sp0010">A retrospective single centre analysis of all patients treated with anti HER2-based NACT for T2–4 breast cancer, focusing on patients treated with mastectomy.</p> </sec> <sec> <title id="st070">Results</title> <p id="sp0015">Among 165 patients treated between June 2005 and July 2012, surgery was performed immediately post-NACT in 152 cases (92%). Breast-conserving surgery could be performed for 108 of the patients (71%), with a 4-year local relapse-free survival of 97%. A mastectomy was performed in two cases following patients' wishes and in 37 cases based on pre-NACT findings (<italic>n</italic> = 18) or post-NACT outcomes (<italic>n</italic> = 19). For 21 out of the 37 cases, a good pathological response was observed, and multidisciplinary reanalysis suggests that breast-conserving surgery outright may have been sufficient for 12 patients. Finally, a salvage mastectomy based on post-lumpectomy pathological results was decided in five cases (11%). The 4-year metastasis-free survival was 84% for all patients operated on after NACT (<italic>n</italic> = 152).</p> </sec> <sec> <title id="st075">Conclusions</title> <p id="sp0020">Given the good efficacy of anti HER2-based NACT, breast-conserving surgery should be standard practice for most patients. Total mastectomy on the other hand should be restricted to a few patients, mainly those with positive margins on the lumpectomy specimen.</p> </sec> </abstract>