The work is part of an approach to cancer treatment called de-escalation: an effort to individualize treatment to a specific subtype of the disease, achieving the same results with less treatment and fewer interventions.
Some women with breast cancer are able to forgo chemotherapy if gene tests determine that it will not be helpful and other drugs are available, sparing them both short-term side effects and long-term complications; some lung cancer patients are also able to forgo chemotherapy. Breast-conserving lumpectomy rather than mastectomy is also part of de-escalation, as is forgoing surgery altogether, as in this trial. In a separate clinical trial, Dr. Kuerer is also examining whether radiation is always necessary.
“What I really appreciate about the study is that it takes the next step and asks a bold question: How do we take all the advances that we’ve made in more tailored and specific cancer therapy, and convert that to reducing the number and types of interventions any one patient needs to incur?” said Karen Knudsen, the chief executive officer of the American Cancer Society.
“Asking whether we can scale back surgery is a reasonable next consideration for the future of cancer care.”
Pamela Romero, who participated in the trial and was deemed eligible to skip surgery, had traveled from her home in New Iberia, La., to MD Anderson in 2018 to get a second opinion shortly after discovering a small lump near her breast bone. Her tumor was HER2-positive, and about the size of a grape.
(A HER2-positive tumor contains cells with receptors for human epidermal growth factor 2. Only women with HER2-positive tumors and triple-negative tumors, which contain cells that lack receptors that respond to estrogen, progesterone and human epidermal growth factor 2, were included in the trial.)
“The doctor asked, ‘How do you feel about surgery?’ and I said, ‘I’m scared to death of it,’” Ms. Romero, 66, recalled in an interview. “I said, ‘If I can get rid of the cancer without having surgery, I’m all for it.’”
