In this latest episode of the VJOncoAlert Journal Club, Icro Meattini, MD, University of Florence, Florence, Italy, discusses multimodal de-escalation strategies in early breast cancer treatment, based on a recently published ASCO educational book paper. Dr Meattini emphasizes that while excellent cure rates set high standards, therapy de-escalation must occur within a comprehensive multimodal framework to avoid escalating other treatments. Key points include: sentinel node biopsy can be safely omitted in select hormone receptor-positive patients after neoadjuvant therapy; surgical and radiation adaptations based on systemic treatment response require quality assurance; modern targeted agents necessitate radiotherapy timing adjustments; and gene expression tools enable chemotherapy omission in intermediate-risk patients.
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