Perspectives on preoperative systemic treatment and breast conservative surgery: One step forward or two steps back?
Rubio IT (1), Wyld L (2), Cardoso F (3), Curigliano G (4), Kovacs T 5, Poortmans P (6), Cortes J (7).
(1) Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain.
(2) Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
(3) Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal.
(4) Division of Early Drug Development for Innovative Therapy, Department of Oncology and Hemato-Oncology, University of Milan, European Institute of Oncology, Italy.
(5) Surgical Oncologist, Guy's Hospital, London, Honorary Senior Lecturer King's College, London, UK.
(6) Department of Radiation Oncology, Marie Curie Professor Paris Science & Lettres, Institut Curie, Paris, France.
(7) Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Vall d´Hebron Institute of Oncology, Barcelona, Spain.
Preoperative systemic therapy (PST) has become an accepted treatment not only for locally advanced but also for early stage breast cancer patients.
Clinical trials have demonstrated that the use of PST is equally to adjuvant treatments in terms of overall survival, and has the advantage of increasing rates of breast conservative surgery and rates of pathologic complete response, a surrogate endpoint for the effectiveness of systemic therapy. Initial studies have suggested higher rates of locoregional recurrence with this approach.
However, the optimization of systemic and targeted therapy and the multidisciplinary care is key to achieving optimal outcomes in this setting.
CITATION Breast. 2018 Oct;41:133-135. doi: 10.1016/j.breast.2018.07.008. Epub 2018 Jul 23