As breast cancer physicians, we have the responsibility – and opportunity – to investigate new therapies that might improve patient outcomes without sacrificing quality of care and patient outcomes. Though breast cancer death rates have decreased since the 1990s, too many women still die from the disease – an estimated 40,000 in 2017 alone.
As such, clinical investigators have recognized for some
time the benefits of neoadjuvant therapy that can potentially jumpstart
treatment of the primary tumor prior to breast cancer surgery. Patients
enrolled in these trials are monitored closely as they receive the highest
standard of care.
Neoadjuvant clinical trials are not experiments but rather
measures that help us pinpoint and perfect advanced therapies that improve
patient outcomes and offer opportunities to provide less radical surgery.
Patient benefits of neoadjuvant clinical trials
Neoadjuvant therapies can help more patients beat early-stage operable breast cancers that have just begun to spread. Most patients with breast cancer present with stage I or stage II tumors that, though small, often have micrometastases – cancer spreading that is not yet visible under x-rays or other imaging. Neoadjuvant therapies potentially can target this spreading before the cancer fully invades and gets established in other organs.
Many women also benefit from neoadjuvant therapies. Some
standard and investigational drugs can shrink or completely eliminate tumors,
reducing the need for radical surgery. Patients also might be able to maintain
more breast sensitivity and natural breast tissue without sacrificing the
quality of cancer care and long-term outcomes.
Clinical trial benefits for referring physicians
Effectively using the neoadjuvant period (i.e., before breast surgery) offers opportunities for high-quality patient care. In the battle to defeat breast cancer, physicians likely treat too many patients too long with therapies that are generally aggressive and/or that significantly affect quality of life. However, neoadjuvant clinical trials might allow us to create benchmarks and track efficacy of therapies in real time based on the response of the individual patient’s tumor prior to surgery. This approach may allow physicians to be more conservative with treatment without sacrificing patient safety while simultaneously improving the patient experience.
Clinical trials are now offered to patients who have just been diagnosed with breast cancer. For some patients, surgery might not be the best initial treatment option. When surgery is necessary, some breast surgeons prefer that patients undergo systemic or targeted therapy before cancer surgery because it affords the opportunity of a less invasive operation with a shorter recovery time and improved breast conservation as well as provide prognostic information to the patient.
Clinical trials do not compromise the standard of care but actually enhance it. I encourage physicians to recommend inquiring about participation in clinical trials to patients with newly diagnosed breast cancer, even before surgery. To refer a patient or make an appointment, please contact us a 214-645-HOPE (4673).