Currently, there are no approved therapies to target triple-negative breast cancer, however, novel chemotherapy strategies can reduce the size of tumors so that less breast tissue needs to be removed during surgery .
Results from a study conducted by a team of researchers from the Brigham and Women’s Hospital and the UNC Lineberger Comprehensive Cancer Center demonstrated that breast-conserving therapy (removal of less breast tissue via a lumpectomy) was successful in more than 90% of the patients eligible for this treatment following chemotherapy.
However, results from the study which were published in the Annals of Surgery, also revealed that 31% of patients chose to remove the entire breast via mastectomy.
“We’ve shown that we can offer breast-conserving therapy to more women using these drug combinations, and if they convert, we’re really successful,” said senior author David Ollila, MD, James and Jesse Millis Distinguished Professor of Surgery at University of North Carolina School of Medicine, co-director of the UNC Breast Program and a member of the UNC Lineberger Comprehensive Cancer Center in a recent news release. “We have more and more women eligible for breast preservation, and still we saw more than 30 percent of women choosing mastectomy.”
In the study, the researchers do not clarify why surgeons and patients chose this strategies, however, results from previous investigations showed that patients eligible for breast conserving surgeries like lumpectomy, have the same survival rates as those patients who choose mastectomy.
“In general, if possible, we try to offer breast conserving therapy as a preferred option for women with early stage breast cancer,” said corresponding author Mehra Golshan, MD, director of Breast Surgical Services at Dana-Farber/Brigham and Women’s Cancer Center in the news release. “One of the reasons we use chemo first is to potentially allow women who originally needed to have the entire breast removed because of more advanced disease to now be eligible for breast-conserving therapy. We see though that a significant number of patients who were eligible still ended up deciding to have their breast removed.”
“We don’t have an answer for why this is the case, but we hope that this work encourages more patients and clinicians to think about why this is happening and what we can do to address this,” said Golshan, who is also director of Breast Surgical Services at the Susan F. Smith Center for Women’s Cancers at Dana-Farber Cancer Institute. “It’s a work in progress.”
The researchers assessed the effect of carboplatin and/or bevacizumab combined with traditional chemotherapy regimen to treat women with triple-negative breast cancer. Results revealed that adding one or the two agents increased the eligibility of patients for breast conserving therapy. After receiving the drug treatment, 42% of the 185 patients were eligible for the procedure.
The researchers also found that breast-conserving therapy was successful for 91% of the 53 women who decided for this strategy.
“In triple-negative breast cancer patients, we continue to increase the complete pathologic response rate with our new drug combinations,” Ollila said in the news release. “On our trial, more patients were eligible for breast preservation. Despite these advances, more patients chose mastectomy as their surgical procedure. The reasons for this paradox need to be further explored.”
The researchers did not investigate factors such as fear of cancer recurrence or whether a patient harbored mutations in genes such as BRCA, however, future studies should address these important factors.