Dr Chagpar Discusses Neoadjuvant Chemo for cN0 Breast Cancer
Anees Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C), Yale School of Medicine, discusses her presentation of, "Neoadjuvant Chemotherapy for a 1.5 cm Clinically Node-Negative Breast Cancer," presented at the annual Miami Breast Cancer Conference.
Hi, I am Dr. Anees Chagpar. I am a breast surgical oncologist here at Yale University School of Medicine. One of the debates that I am participating in is a controversy about neoadjuvant chemotherapy for a 1.5‑centimeter, clinically node‑negative, triple‑negative breast cancer.
Now, I know what many of you are thinking. Of course, you would give neoadjuvant chemotherapy to this individual. It seems almost like a truism. Of course, somebody had to debate the con side of that argument, and that falls to me.
Where are we going to go in this debate? Well, here is a few sneak previews. One is how certain are we about tumor size, based on standard imaging if we pursue neoadjuvant chemotherapy versus adjuvant therapy?
The second is, do the regimens really change? I know, for many of you who might be medical oncologists, you might think, "Well, of course, if we give neoadjuvant chemotherapy, then if there's residual tumor, we can treat with capecitabine."
Well, some recent data came out of ASCO that suggested you might be able to give capecitabine, even in the adjuvant setting. The next piece is, well, do we really need to give chemotherapy at all?
There are some recent studies suggesting that tumor‑infiltrating lymphocytes might actually help us to decide whether patients need chemotherapy or not, and there is a trial that is in the works just being developed with the ECOG group that will look at this in T1 tumors.
Now, to be clear, you can look at tumor‑infiltrating lymphocytes on the core biopsy, but in that trial, they again will mandate surgery first to look at actual tumor size. Finally, we will talk a little bit about patient preferences and comorbidities.
Do all patients seriously need neoadjuvant chemotherapy, especially when we know that survival rates are the same? Well, it will be a debate, and I am really looking forward to that.