Charting the Course for Preoperative Breast Cancer Therapy
On March 26 and 27, NCI hosted the conference "Preoperative Therapy in Invasive Breast Cancer: Reviewing the State of the Science and Exploring New Research Directions."
Preoperative systemic chemotherapy has become firmly established as part of the standard of care for locally advanced invasive breast cancer and inflammatory breast cancer. In many patients, a full course of systemic therapy before surgery allows for removal of what would otherwise be an inoperable tumor, or downstaging of the required operation from mastectomy to breast-conserving surgery.
There is also considerable interest in the community in using preoperative therapy - also known as neoadjuvant therapy - in a wider population of women with earlier stages of breast cancer. Randomized controlled clinical trials have demonstrated pre-operative chemotherapy increases the rate of breast conservation without a decrease in survival. However, additional research is needed to address questions that arise when applying the principles of preoperative therapy to women whose tumors have a diverse set of biological properties and prognostic factors.
"What we've all seen is that over the past years, there has been more and more preoperative therapy given in clinical practice...and the rules by which we take care of patients when we use preoperative therapy are far less well worked out than in the setting of the standard [postoperative] approach," said Dr. Eric Winer from Dana-Farber Cancer Institute, co-chair of the conference. "Much of what we're trying to do [at this conference] is to come to some agreement about what we know, what we don't know, and then, perhaps most importantly, what we need to know and how we're going to use the setting of preoperative therapy to answer important clinical and biological questions about breast cancer."
If Memory Serves...
In 1927 - a decade before NCI was established to stimulate cancer research - Senator M. M. Neely of West Virginia proposed a bill that would offer a $5 million reward for the discovery of a cure for cancer. Senator Neely's "reward" bill did not pass, but it was among the first in a series of proposed legislation that laid the groundwork for the 1937 National Cancer Institute Act. (Read more)
For more information about the birth of NCI, go to http://www.cancer.gov/
Conference presenters reviewed the existing data on preoperative therapy in operable breast cancer and the most pressing questions impeding the wider adoption of preoperative therapy for breast cancer. Issues addressed included incorporating endocrine and biologic therapy into preoperative treatment regimens; how to best use imaging methods - both established and experimental - to measure the response to preoperative therapy; how to determine the optimal local treatment after preoperative therapy; the role and timing of sentinel lymph node biopsy; how to best select patients who will benefit from preoperative systemic therapy; and whether or not the response of a tumor to preoperative therapy can be used to guide further treatment.
After a panel discussion to address questions collected over the 2 days of presentations and question-and-answer sessions, the conference culminated in a "statement of the science" prepared by the conference chairs, which identified the key unresolved clinical issues that need to be addressed in the next generation of clinical trials.
The statement, which focused on issues such as the timing of surgery, the potential for alteration of treatment mid-regimen, and the need for additional therapy in patients at high risk of recurrence, also highlighted an issue that came up repeatedly during the conference - the need for multidisciplinary participation in this area from medical oncologists, surgeons, radiation oncologists, plastic surgeons, and other specialists.
"It's vital that we work together, not only in the development and analysis of clinical trials but in the clinic, in every step of care for women receiving preoperative therapy for breast cancer," said Dr. Jo Anne Zujewski, a breast cancer specialist with NCI's Division of Cancer Treatment and Diagnosis and organizer of the conference.
The conference videocast, including the statement of the science, is available to the public at http://videocast.nih.gov.
By Sharon Reynolds