Surgical oncologist Hahn-Tam Tran explains the benefits of neoadjuvant chemotherapy and when it is indicated.
mm hmm, mm hmm. Okay. All right. So in patients whom we know chemotherapy will be recommended as a part of the breast cancer treatment regimen. We often consider giving chemotherapy upfront. Although there is no overall survival benefit. There are noticeable treatment benefits to receiving neo adjuvant chemotherapy. The first would be to monitor tumor response for prognosis. So depending on breast cancer characteristics, when we do the surgical resection, if the patient no longer has cancer in that specimen then they achieve a pathologic complete response. If this happens then that means that moving forward the patient has a very good prognosis. The second benefit would be additional systemic treatment after surgery to improve outcomes. So in patients with triple negative breast cancers and have residual cancer that can get additional treatment called Zillow to or in patients with her two positive breast cancer there the treatment regimen can be switched from Herceptin to katasila. The third benefit would be to deescalate the surgical approach. So in certain cancers with good response they can be converted from a mastectomy to a lumpectomy or in patients with breast cancer metastatic to lymph nodes. If they had surgery up front, they would require an axillary lymph node dissection. If they showed a pathologic complete response after chemotherapy then these patients can be a candidate for a sentinel lymph node biopsy with excision of the lymph node that was previously clipped and showed cancer. Okay, yeah. New adjuvant chemotherapy is often considered when the cancer is triple negative or if it has a her two positive characteristic that is greater than two cm in size or less than two cm with nodal involvement, mm hmm. Okay. Yeah. We have good data to suggest that radiation is as good as axillary lymph node dissection for local control. Therefore in patients who achieve a pathologic complete response in the lymph nodes, they do not need axillary lymph node dissection but rather they can get excellent radiation to decrease their risk of recurrence. Okay. Yeah. As it currently stands, the standard of care is that if a patient is not enrolled in a clinical trial but has residual disease after neo adjuvant chemotherapy, they would be required to get an axillary lymph node dissection. We do have a clinical trial ongoing and it's looking at substituting Axler radiation for axillary lymph node dissection. And these patients could be randomized to accelerate radiation alone.
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