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SABCS 2022 | De-escalating surgery for patients with early-stage breast cancer

Judy Boughey, MD, Mayo Clinic Comprehensive Cancer Center, Rochester, MN, discusses de-escalation of treatment in patients with breast cancer. Following the results of the Phase II ACOSOG Z11102 Alliance (NCT01556243) trial which evaluated the impact of breast conservation therapy on local recurrence in patients with multiple ipsilateral breast cancer (MIBC), more patients can consider breast reserving surgery as opposed to a mastectomy. This interview took place at the San Antonio Breast Cancer Symposium (SABCS) 2022 in San Antonio, TX.

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Transcript (edited for clarity)

So I think de-escalation of management of breast cancer patients is really one of the current themes across all modalities of treatment. In terms of systemic therapy, we’re very much looking at trying to target our therapy and de-escalate therapy in those patients with an excellent response. And it’s very exciting to see the opportunities to de-escalate in surgery as well. So there’s a lot of different aspects in how we’re de-escalating surgery for breast cancer patients...

So I think de-escalation of management of breast cancer patients is really one of the current themes across all modalities of treatment. In terms of systemic therapy, we’re very much looking at trying to target our therapy and de-escalate therapy in those patients with an excellent response. And it’s very exciting to see the opportunities to de-escalate in surgery as well. So there’s a lot of different aspects in how we’re de-escalating surgery for breast cancer patients. With the results of the Z1102 clinical trial, more patients can potentially be considering breast conserving surgery rather than mastectomy. Furthermore, in terms of management of the axilla, we are increasingly identifying patient populations where even if they have positive lymph nodes in the axilla, that we don’t necessarily need to perform a completion axillary lymph node dissection, such as those patients who were node positive prior to chemo and have been treated with a neoadjuvant chemo and have converted to node negative.

And in patients treated with upfront surgery, we’ve been de-escalating and those patients treated with breast conserving surgery having just one or two positive nodes, and that’s now also extending into the mastectomy population. So it’s very exciting to see that as all of the branches of management of breast cancer patients improve, the systemic therapy, the targeted therapy, the radiation therapy, and the surgical therapy, we can look at trying to fine-tune what degree of treatment each patient needs. And I think that’s very much in the future going to be based on their tumor biology more than just tumor size and nodal involvement.

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