Can Breast Surgery Be Eliminated for Patients with Pathologic Response to Neoadjuvant Therapy?

Kuerer HM, Valero V, Smith BD, et al. Selective Elimination of Breast Surgery for Invasive Breast Cancer: A Nonrandomized Clinical Trial. JAMA Oncol. 2025;11(5):529–534.

Neoadjuvant therapy for lower risk breast cancers (cT1-2, N0-1, M0 ERBB2-positive, or triple negative) results in pathologic complete response in up to 60% of patients. These results have suggested the feasibility of eliminating breast and axillary surgery in selected patients.

This study reported a nonrandomized clinical trial in patients (n = 50) treated with neoadjuvant therapy. A group of patients who had no residual disease documented by needle biopsy after neoadjuvant therapy and who were treated with post-biopsy radiotherapy were selected for follow up without breast or axillary surgery. 39 patients met the criteria for omission of surgery.

At nearly 5 years of follow up, there were no diagnoses of recurrent disease in patients selected for omission of surgery. The authors recommended additional studies to confirm these findings.