Assisting Community-Based Oncologists and Surgeons in Making Neoadjuvant Treatment Decisions for Patients with Early Breast CancerTumor size and the decision to use neoadjuvant treatment in patients with triple-negative disease and a negative axilla clinically
2:46 minutes.
TRANSCRIPTION:
DR LOVE: As you talk about tumor size, assuming there’s a negative axilla, at what point do — Terry’s point is 2 centimeters, where for sure he’s going to use neoadjuvant therapy. Is that your point also? DR BLACKWELL: For triple-negative, probably 1 centimeter. If I’m really having a tough time as a medical oncologist, deciding should I give a second-generation TC or third generation — I’ll just say TAC, for brevity’s sake. If it’s a very small tumor with completely clinically negative axilla, sometimes we’ll take those patients to the OR. At that point, if you really believe it’s less than 1 centimeter, then you really have to question whether there’s a role for systemic chemotherapy at all. But anything greater than 1 centimeter that’s triple-negative, you know that patient’s going to get chemo. I mean, at least in our group. You’ve got at least 1 centimeter of invasive, true triple-negative breast cancer in a patient who will be able to, for lack of a better descriptor, survive chemotherapy, they’re healthy enough to receive chemotherapy, then I think that patient’s going to get neoadjuvant chemotherapy in our practice. DR LOVE: I mean, what’s the argument for using in that situation, or triple-negative in general, a neoadjuvant as opposed to adjuvant therapy? DR BLACKWELL: There’s not a real strong argument for it. Again, if I’m seeing a patient and I would give TAC, a third-generation, however you want to — whatever recipe you want to use, no matter what — and that’s usually 2 or 3 centimeters and greater — then I’ll tend to prefer to give it in the neoadjuvant setting and it’s usually a multitude of reasons or one reason. We’re waiting for the genetic testing result to get back to make a surgical decision. There’s a small breast and a larger tumor. An A-cup breast with a 3-cm tumor, cosmetically, will not look good unless that tumor is shrunk down. So I think there’s a variety of reasons why, frequently, I would recommend giving it in the neoadjuvant setting. And there’s certainly not a harm to doing it in the neoadjuvant setting. DR MAMOUNAS: Yes, and also, as we talked before, potential for downstaging the axilla, even if you think it’s clinically negative. It may be positive, and then commit them to an axillary dissection at the time. You can argue Z11, but yet with triple-negatives, if there’s a little bit more disease, you may want to dissect, particularly if they have a mastectomy, obviously. So yes, for all those reasons, I think, if you know you’re going to do it anyways, it helps you to really temporize about all those decisions, seeing plastic surgery, make the decisions about what kind of surgery they’re going to get, while they’re getting neoadjuvant chemotherapy. |