Extent of Breast Surgery After Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer

To the Editor The main claim of the authors of the secondary analysis of the BrighTNess randomized clinical trial is that “patients with stages II to III TNBC who are not eligible for breast-conserving therapy (BCT) at presentation have an approximately 50% likelihood of converting to BCT eligible with neoadjuvant systemic therapy (NST).” This resulted in an overall increase in BCT eligibility of 7% (from 76.5% to 83.5%). However, the actual BCT rate after NST in 599 patients with pre- NST and post-NST evaluations for BCT eligibility was 57%, which is about 20% less than initially planned, and in agreement with a meta-analysis of 12 311 patients. We understand that eligibility to BCT does not necessarily tr anslate into receiving this type of treatment also in patients not treated with NST. However, a potential increase in mastectomy rates in patients eligible to BCT and receiving NST merits further reasoning. Only 66% of BCT-eligible patients enrolled in BrighTNess underwent BCT, either because of los s of BCT eligibility (20%) or because of receipt of mastectomy despite being BCT eligible after NST (80%). Furthermore, 35% of patients who were not deemed BCT eligible after NST had pathologic complete response at final pathology. We believe that 3 issues are relevant at this point: (1) whether und ergoing mastectomy despite being BCT eligible needs to be considered an undesirable outcome; (2) whether the process of NST itself leads to a reduction in BCT rates in patient...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research