Two women wearing knit caps and face masks talk while receiving chemotherapyShare on Pinterest
Experts say advancements in chemotherapy have made surgery after early-stage breast cancer treatment less common. Fat Camera/Getty Images
  • Researchers say people being treated for early-stage breast cancer who respond well to chemotherapy may not need surgery.
  • Experts say the decline in necessary surgeries is due to the advancements in chemotherapy.
  • They say the eradication of cancer without surgery makes quality of life easier to obtain for people treated for breast cancer.

Some people with early-stage breast cancer who show a strong response to chemotherapy may not need surgery due to newer chemotherapy drugs.

The results of a phase 2 clinical trial published in Lancet Oncology reported that people whose cancer was completely eradicated through chemotherapy, known as “exceptional responders,” had a low chance of cancer recurrence and could even avoid surgery.

“The ultimate form of breast-conserving therapy is completely eliminating breast surgery for invasive disease,” said Dr. Henry Kuerer, the principal investigator and a professor of breast surgical oncology at the University of Texas MD Anderson Cancer Center, in a press statement.

“This research adds to growing evidence showing that newer drugs can completely eradicate cancer in some cases, and very early results show we can safely eliminate surgery in this select group of women with breast cancer,” he added.

Due to the advancement in chemotherapy drugs, rates of a pathologic complete response (pCR), in which no residual cancer remains after chemotherapy, have increased notably.

People with triple-negative breast cancer or HER2-positive breast cancer now achieve pCR in 60 to 80% of cases.

“That indicates that the chemotherapy was effective in eradicating all of the disease,” said Dr. Deanna Attai, an associate clinical professor in the Department of Surgery at the UCLA David Geffen School of Medicine and UCLA Health Burbank Breast Care.

“Lack of a complete response is associated with a poorer prognosis. Likelihood of pCR depends on a variety of factors, including tumor biology and treatment agents,” Attai told Healthline. “pCR is more commonly seen with the more aggressive breast cancer subtypes, including triple-negative and Her2/neu over-expressed.”

“I think these results are very promising for the patients with the breast cancer subtypes studied,” she added. “This would follow our current trends in cancer care of de-escalating care – dialing back treatment when it does not compromise outcomes. This is one of the reasons studies like this are so important. Any treatment is associated with certain risks. If that treatment (in this case, surgery) can be eliminated and outcomes are not compromised, the potential for complications will be reduced.”

However, Attai notes that the findings of the study aren’t yet applicable to the typical person who is newly diagnosed with breast cancer. She says more study is needed.

“This was a small study, short-term follow-up, and was performed at highly specialized cancer centers. The results are not at this point generalizable to a broader patient population,” she said.

Neoadjuvant chemotherapy refers to chemotherapy that is given before surgery, with the goal of having less extensive surgery.

If following neoadjuvant chemotherapy, cancer cells are found during surgery (known as residual disease), more chemotherapy may be offered.

However, Dr. Parvin Peddi, a medical oncologist and director of Breast Medical Oncology for the Margie Petersen Breast Center at Providence Saint John’s Health Center in California, says chemotherapy drugs have become so advanced, cancer is often completely gone by the time of surgery.

“Chemotherapy has become more and more targeted and effective in breast cancer. We are routinely using chemotherapy before surgery and then find out during surgery that no cancer was left. These patients are currently still undergoing surgical resection of where the tumor was only to find out after surgery that no cancer was found,” said Peddi, who is also an associate professor of medical oncology at Saint John’s Cancer Institute in California.

“I see this over and over in my clinic,” she told Healthline. “Some of these patients are likely cured with just chemotherapy and do not need surgery or radiation therapy. This study is attempting to first, eliminate surgery.”

Experts say that while more research is needed, this study is another step toward eliminating the need for surgery for some breast cancer patients.

“Surgery has traditionally been a very big part of breast cancer treatment, having transformed from women needing the radical Halsted mastectomy to less extensive surgeries and now the idea of eliminating it completely,” Dr. Bhavana Pathak, a hematologist and medical oncologist at MemorialCare Cancer Institute at Orange Coast Medical Center in California, told Healthline.

“A notable trend in oncology is de-escalating treatment as safely as possible so that patients can enjoy the benefits of treatment without some of the side effects. The idea of survivorship and life after cancer and its treatment is an important focus,” she added.