IN A groundbreaking US clinical trial, researchers found that skipping breast surgery may be a viable option for select patients with invasive breast cancer who respond exceptionally well to neoadjuvant systemic therapy (NST).
The single-arm, phase 2 nonrandomised trial followed 50 women aged 40 and above, all diagnosed with ERBB2-positive or triple-negative breast cancer. Patients were enrolled from seven US centres and underwent image-guided vacuum-assisted biopsy (VAB) following NST. Those who showed no residual cancer on VAB received whole-breast radiotherapy—with no breast surgery.
After a median follow-up of 55.4 months, the results were striking: the ipsilateral breast tumour recurrence rate was 0%, and both disease-free and overall survival rates reached 100% in patients who avoided surgery.
Among participants, 62% achieved a pathologic complete response (pCR) in the breast as confirmed by biopsy, and patients who initially had nodal disease but met criteria for surgery avoidance also showed no recurrence after targeted axillary dissection.
Lead investigator Dr Henry M. Kuerer and his team suggest these findings may pave the way for broader de-escalation strategies in breast cancer care—potentially reducing surgical burden in carefully selected patients.
However, the researchers caution that larger, confirmatory trials are essential before this approach can be widely adopted. “Selective avoidance of breast surgery is not yet standard practice,” the authors conclude, “but our findings suggest it could be a safe option for some.”
This trial marks a pivotal step toward more personalised, less invasive treatment pathways in oncology—offering new hope for patients seeking effective care with fewer long-term side effects.
Aleksandra Zurowska, EMJ
Reference
Kuerer HM et al. Selective Elimination of Breast Surgery for Invasive Breast Cancer: A Nonrandomized Clinical Trial. JAMA Oncol. 2025;DOI: 10.1001/jamaoncol.2025.0207.
