Considering Timing Options for Breast Cancer Treatment: Chemotherapy First or Surgery First?
Article:
A prevailing question in the treatment of breast cancer is whether to administer chemotherapy before or after surgical intervention. This decision hinges on several factors and is a topic of discussion between surgeons, oncologists, and patients.
Cleveland Clinic, a renowned non-profit academic medical center, sheds light on the matter with breast cancer specialist Halle Moore, MD. Moore suggests that for certain patients, receiving chemotherapy before breast surgery can yield favorable results.
This approach, known as neoadjuvant therapy, involves shrinking the tumor with chemotherapy before moving on to any subsequent treatment, such as surgery. By doing so, not only does it broaden surgical options, but it also offers a more accurate assessment of the patient's response to chemotherapy and informs decisions on follow-up treatments.
However, not all breast cancers necessitate chemotherapy, and not all tumors are eligible for neoadjuvant chemotherapy. In the past, neoadjuvant therapy was primarily used for locally advanced or inoperable cancers to improve the likelihood of successful surgery.
Recent studies, though, have shown that for operable tumors, administering chemotherapy prior to surgery enhances the chances of breast-conserving surgery, often eliminating the need for a mastectomy in numerous patients.
Several factors are taken into account when deciding to employ neoadjuvant chemotherapy, such as tumor size, indications of lymph node involvement, and the specific type of breast cancer. Certain types of breast cancer, such as triple-negative and HER2-positive, tend to respond favorably to neoadjuvant chemotherapy.
In the best-case scenario, this therapy eradicates all visible tumor from the breast, producing what is called a pathologic complete response. This outcome, characterized by a pathologist finding no trace of invasive tumor in the breast or lymph nodes after treatment, signals a promising outlook for the patient both in the short and long term.
For those who do not achieve a complete response to neoadjuvant chemotherapy, additional treatments can still be administered in the post-operative or "adjuvant" setting to improve long-term outcomes. In this way, treatments can be individualized, often favoring more intensive treatments for those at higher risk.
For women with estrogen receptor-positive breast cancer, neoadjuvant chemotherapy may not always be the optimal choice. In select cases, anti-estrogen therapy may instead help decrease tumor size before surgery.
Neoadjuvant therapy is not limited solely to chemotherapy. For instance, anti-HER2 medications like trastuzumab and pertuzumab—injectable antibody treatments—have been shown to enhance outcomes in HER2-positive breast cancer when combined with chemotherapy.
When dealing with breast cancer, consulting with a multidisciplinary team before initiating treatment is essential, asserts Moore. The aim is to customize the therapy, avoiding both undertreatment and overtreatment of the cancer. Your medical team will guide you through the best options tailored specifically for you.
- In the treatment of breast cancer, neoadjuvant therapy involving chemotherapy before surgery may present favorable results for certain patients, providing a more accurate assessment of their response to chemotherapy and broadening surgical options.
- Recent studies have shown that for operable tumors, neoadjuvant chemotherapy enhances the chances of breast-conserving surgery, eliminating the need for a mastectomy in numerous patients.
- Factors such as tumor size, indications of lymph node involvement, and the specific type of breast cancer are considered when deciding to employ neoadjuvant chemotherapy, with certain types of breast cancer, like triple-negative and HER2-positive, tending to respond favorably to this approach.
- For women with estrogen receptor-positive breast cancer, anti-estrogen therapy may instead help decrease tumor size before surgery, while for HER2-positive breast cancer, anti-HER2 medications like trastuzumab and pertuzumab, when combined with chemotherapy, have been shown to enhance outcomes.
