VIDEO: ‘Tremendous advances’ in surgery, radiation, systemic therapy for breast cancer

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So breast cancer treatment involves various modalities, surgery, radiation therapy, chemotherapy, hormonal therapy. And over the last few decades, there have been tremendous advances in all of these arenas.

As you all know, breast cancer surgery has evolved from just radical mastectomy to a modified mastectomy and majority of patients getting a lumpectomy. We also have data to show that we could omit sentinel lymph node biopsy in a subgroup of patients. Most of this is very recent data that was presented over the last few months, end of 2024. So various academic institutions are trying to omit sentinel lymph node biopsies in patients who are candidates so that we can prevent or reduce the incidence of lymphedema. In terms of radiation, type of fractionated radiation options, there are reduced intervals for radiation. And then in older women, we also have data that it may be safe to omit radiation in a subgroup of women. So these are all advances that have taken place in surgery and radiation.

When it comes to systemic therapy, we have had tremendous advances in the approval of new medications. We have immunotherapy now approved for patients with triple negative breast cancer. We have monoclonal antibodies such as sacituzumab, trastuzumab, deruxtecan, the approval of dupilumab deruxtecan as of last week. We have medications geared for patients with BRCA one and BRCA two mutations, specifically the PARP inhibitors that improve survival both in the adjuvant setting as well as in the metastatic setting via medications, targeted therapies such as CDK46 inhibitors. Then we have the HER two targeted therapies. So there's a plethora of medications that are available for the treatment of breast cancer.

We are also able to deescalate therapies, so with the approval of new medications, we are not treating all patients with all of these drugs. We are trying to identify patients who may be candidate for deescalation of therapy. So this is particularly relevant in patients with hormone receptor positive, HER2 negative breast cancer, where we use Oncotype DX to understand if patients would benefit from adjuvant chemotherapy. And if there is no benefit from adjuvant chemotherapy, chemotherapy is omitted. So vast majority of patients with this subtype of breast cancer is able to omit chemotherapy.

So there have been a lot of changes and I think there'll be more to come where we may be able to deescalate therapies or have better targeted therapies through improved long-term outcomes for our patients.