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Oncology Advances October 2015

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4 | Oncology Advances At the American Surgical Association's 135th Annual Meeting in April 2015, Mehra Golshan, MD, Dr. Abdul Mohsen and Sultana Al-Tuwaijri Distinguished Chair in Surgical Oncology at Brigham and Women's Hospital and Medical Director of International Oncology Programs at Dana-Farber/Brigham and Women's Cancer Center,, presented findings of a multicenter study evaluating the impact of neoadjuvant chemotherapy in Stage II-III triple negative breast cancer on eligibility for breast conserving surgery and breast conservation rates (Ann Surg. 2015 Jul 28; E-pub ahead of print). "Neoadjuvant systemic therapy is often used to induce tumor regression and enable breast conserving therapy in patients with breast cancer who were to have a mastectomy if they had surgery first," said Dr. Golshan, who is lead author of the study. "Our goal in this study was to quantify this benefit." Alliance for Clinical Trials in Oncology Companion Study As part of a surgical companion study to CALGB 40603 (Fig- ure 1), the treating surgeons prospectively evaluated breast conserving therapy (BCT) candidacy before and after neoad- juvant systemic therapy (NST) using clinical and radiographic information. Surgery was performed at surgeon and patient discretion. The presence of genetic mutations was not consid- ered. The researchers measured: • Conversion from BCT ineligibility to BCT eligibility; • Surgical choices in BCT candidates; • Rates of successful BCT with tumor-free margins. Among 404 patients who were assessable for surgical out- comes, 54 percent were BCT candidates prior to NST. After New Study Finds Many Patients Choose Mastectomy, Despite Eligibility for Breast Conserving Therapy NST, 90 percent remained candidates for BCT (Figure 2). Among these patients, 70 percent chose BCT, which was suc- cessful in 94 percent of cases. Of the patients who were not initially eligible for BCT prior to NST, 42 percent converted to BCT eligibility. Of these patients, 68 percent chose BCT with a 91 percent success rate (Figure 3, back cover). A Range of Significant Results The study led to substantial findings, including: • 31 percent of patients who were eligible for BCT still chose mastectomy; • 42 percent of patients who were initially deemed ineligible for BCT were found to be eligible following neoadjuvant systemic therapy. Conversion was highest among patients who received NST with carboplatin, bevacizumab, or both; • 47 percent of patients in the study overall underwent BCT, compared with 75 percent of patients with similar tumor types in a recent German study (von Minckwitz et al.); Mehra Golshan, MD Dr. Abdul Mohsen and Sultana Al-Tuwaijri Distinguished Chair in Surgical Oncology, Brigham and Women's Hospital; Medical Director, International Oncology Programs, Dana-Farber/Brigham and Women's Cancer Center Figure 1 continued on back cover Figure 2

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