BCNA News 05 Mar 2020
Breast Cancer 2020: the Cutting Edge
The Victorian Comprehensive Cancer Centre (VCCC) held its Breast Symposium - Breast Cancer 2020: the Cutting Edge in Melbourne on 21 February.
The day focused on neoadjuvant therapy (i.e. when treatments such as chemotherapy or hormone blocking therapy are given before breast cancer surgery).
The event proved popular with all seats sold out. Approximately 200 people attended, including surgeons, medical oncologists, radiation oncologists, breast care nurses, government representatives, health service administrator, consumer organisations as well as people affected by breast cancer.
A wide range of experts presented, including Dr Eric Winer, a medical oncologist at the Dana-Farber Cancer Institute in Boston. BCNA CEO Kirsten Pilatti also presented the views of those navigating decisions around neoadjuvant therapy.
The list of key topics for discussing included:
- When should neoadjuvant therapy be recommended?
- What are the clinical implications of neoadjuvant therapy – e.g. for surgery, for radiotherapy, for breast reconstruction?
- What are the advantages and potential disadvantages of having chemotherapy therapy first compared to surgery first?
- What are the implications for people newly diagnosed? What questions or concerns might women have? What information is available to support people to make decisions?
Numerous potential benefits of neoadjuvant therapy were discussed, including:
- How neoadjuvant therapy provides people with more time to get genetic testing before surgery. Results from the genetic testing may help guide decisions about surgery.
- Using neoadjuvant therapy to shrink large tumours, potentially enabling breast conserving surgery.
- Potentially reducing the number of lymph nodes needing to be removed during surgery.
- A possible reduction in tumour size on scans, thereby providing reassurance to patients that the treatment is working.
- Enabling treating teams to understand and monitor the effectiveness of treatments.
- Providing opportunities for clinicians to consider other treatments following surgery if tumours do not respond well to neoadjuvant chemotherapy.
Speakers stressed the importance of Breast Cancer Trials’ Neoadjuvant Patient Decision Aid as a key resource, helping women to navigate decisions about whether or not to have neoadjuvant therapy.
Thought provoking ideas for clinicians:
- Should there be dedicated neoadjuvant multidisciplinary team meetings?
- What are the implications of changing the sequence of treatment? Why is surgery so often performed first? Is there a clear rationale or is it primarily because this is how it was been done in the past?
- If radiotherapy is given before breast surgery and breast reconstruction, this may allow for better cosmetic outcomes for women, enhancing emotional wellbeing and quality of life.
- If biopsies are performed while someone is receiving neoadjuvant therapy, it may allow clinicians to detect changes to the biology of the tumour – e.g. has the subtype of the breast cancer changed?
- If neoadjuvant treatment leads to a pathological complete response, is radiotherapy still needed? Are fewer lymph nodes needed to be removed?
- Neoadjuvant therapy could allow for novel treatments to be tested because the effectiveness of a new treatment can be measured via scans.