Refining chemo-first option
Project to analyse treatment ahead of breast cancer ops
Anewly-funded Auckland pilot programme will investigate how to better deliver chemotherapy before surgery for some breast cancer patients. Traditionally, neoadjuvant therapy (NAT), where chemotherapy is completed before surgery, has been reserved for those patients whose breast cancer is either an inflammatory subtype or inoperable.
But it’s become increasingly common for patients with operable breast cancer to undergo chemotherapy first, particularly when it’s likely the same chemotherapy would have been recommended for them after surgery anyway.
The approach can help shrink tumours to facilitate surgery and allows a real-time assessment of the sensitivity of the cancer to treatment.
The medical oncologist leading the programme, Dr Sheridan Wilson, said the number receiving NAT was a small proportion — no more than one in 10 of breast cancer cases who received chemotherapy.
But our health system hadn’t yet set out a definitive pathway for patients treated with NAT.
Wilson said there was nothing experimental or controversial about the chemo-first approach — but it required careful up-front coordination and a high level of collaboration between the clinicians involved in the patient’s care.
“We have not yet sat down to figure out the best arrangement and time course for using this approach in the New Zealand setting.”
A main aim of the pilot, being supported with a grant from the New Zealand Breast Cancer Foundation, was to create new guidelines to set out a path for future patients.
“Compared with giving chemotherapy after surgery, neoadjuvant therapy is not associated with a difference in survival but it can potentially improve operability and enable breast-conserving surgery.
“And if it puts us in a stronger position to do extra research activities, that’s also a win for breast cancer patients of the future.”
Many drugs were now being tested in the NAT space, as it offered a shorter time to establish efficacy.
Other research projects to receive a total $370,000 worth of grants from the foundation include studies to track the spread of breast cancer with a simple magnetic tracer; to prevent spread with a new sugar-based drug; to develop a new model to locate tumours; and to direct a promising bowel cancer vaccine toward breast cancer.