EBCC-11: Mastectomy and Axillary Dissection and Neoadjuvant Targeted Treatment in HER2-Positive Breast Cancer

Key Points

  • 129 (81%) were candidates for mastectomy based on the size of the tumor and other clinical characteristics. All the patients were given a drug treatment before surgery including standard chemotherapy and at least one anti-HER2 drug such as trastuzumab.
  • As a result, 61 women (47.2%) who might otherwise have been offered mastectomy were instead treated with less extensive surgery.
  • The treatment also resulted in 71% of women having no signs of cancer in their lymph nodes, meaning they could have less extensive axillary dissection.

Extensive surgery involving mastectomy and removal of several lymph nodes may be safely avoided for more women with some types of breast cancer if they receive targeted drugs before surgery, according to research presented at the 11th European Breast Cancer Conference (EBCC-11) (Abstract 19). The study focused on women with HER2-positive breast cancer who were given a targeted drug treatment in the neoadjuvant setting.

Previous research has shown that women who have less extensive surgery suffer fewer long-term side effects and enjoy better quality of life. The researchers say their work shows that even women with aggressive tumors can be safely treated with breast-conserving surgery, if the cancer responds to targeted treatment.

The research was led by Isabel Rubio, MD, PhD, Co-Chair of EBCC-11 and former Head of the Breast Surgical Oncology Unit at the Breast Cancer Centre at Vall d’Hebron University Hospital in Barcelona, where she carried out the work. Dr. Rubio explained, “In this study, we have looked at women with HER2-positive breast cancer. This is an aggressive form of the disease, but it is also one where a new class of drugs has successfully been developed. These drugs recognize and target HER2 receptors on the surface of cancer cells. We wanted to see whether the known benefits of these targeted drugs could be extended to spare women from the undesirable effects of radical surgery.”

Study Findings

The researchers studied a group of 160 women with HER2-positive breast cancer treated at Vall d’Hebron University Hospital between October 2007 and December 2016. Of these, 129 (81%) were candidates for mastectomy based on the size of the tumor and other clinical characteristics.

All the patients were given a drug treatment before surgery including standard chemotherapy and at least one anti-HER2 drug such as trastuzumab (Herceptin). As a result, 61 women (47.2%) who might otherwise have been offered mastectomy were instead treated with less extensive surgery. This meant that overall, 92 (57.5%) of 160 women were treated with breast-conserving surgery. The treatment also resulted in 71% of women having no signs of cancer in their lymph nodes, meaning they could have less extensive axillary dissection.

Dr. Rubio explained, “This study shows us that treating HER2-positive breast cancer with a targeted drug before surgery can mean fewer women need to undergo mastectomy and removal of several lymph nodes. It also shows us that we can use biopsies to see which cancers are responding best to anti-HER2 treatments and therefore which patients can be safely treated with breast-conserving surgery.”

“Breast cancer [medical] treatments have advanced tremendously in recent years. What this means is that surgery should evolve too, so that it is tailored to the individual patient and takes account of the effects of their particular treatment,” she concluded.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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