Dr Mamounas on Key Advancements in the Use of Locoregional Therapy in Breast Cancer

Terry P. Mamounas, MD, medical director, Comprehensive Breast Program, University of Florida Health, Health Cancer Center at Orlando Health, discusses key advancements in locoregional therapy for patients with breast cancer, including efforts to scale back the use of radiation therapy and de-escalate surgery.

Terry P. Mamounas, MD, medical director, Comprehensive Breast Program, University of Florida Health, Health Cancer Center at Orlando Health, discusses key advancements in locoregional therapy for patients with breast cancer, including efforts to scale back the use of radiation therapy and de-escalate surgery.

The standard of care (SOC) for locoregional therapy following neoadjuvant chemotherapy in breast cancer has evolved significantly in recent years, Mamounas begins. Neoadjuvant chemotherapy is used to induce tumor responses, which is often measured through pathologic complete response. Increasingly, research is demonstrating that this elimination of invasive breast cancer from the breast tissue and conversion of positive axillary lymph nodes to negative ones can be similarly achieved in the axilla, Mamounas states.

Advancements in neoadjuvant chemotherapy regimens, including the incorporation of novel drugs tailored to different breast cancer subtypes and the selection of appropriate candidates for each regimen, had led to a notable increase in tumor responses and disease elimination in both the breast and axilla, Mamounas asserts. Enhanced responses with neoadjuvant chemotherapy have accordingly allowed for the potential modification of locoregional approaches, he explains.

Initially, one of the goals of neoadjuvant chemotherapy was to convert inoperable tumors into operable ones, allowing patients originally slated for mastectomy to become candidates for breast-conserving surgery, Mamounas continues. More recently, the focus of neoadjuvant chemotherapy has shifted onto the axilla, aiming to convert patients requiring axillary lymph node dissections to those eligible for sentinel lymph node biopsy, which is associated with lower morbidity and provides essential diagnostic information, he expands.

As a result of these advancements, surgical management has evolved to offer more options and flexibility, Mamounas says. Surgeons can now perform less aggressive procedures, operate on a basis closer to the breast, and offer more cosmetic surgery because of the reduction in tumor size achieved through neoadjuvant chemotherapy, he adds. Overall, the evolving SOC reflects the increasing effectiveness of neoadjuvant chemotherapy in achieving tumor responses and optimizing surgical outcomes for patients with breast cancer, Mamounas concludes.