Stage 1b breast cancer
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Stage 1B Breast Cancer: Current Research and Treatment Approaches
Quality of Early-Stage Breast Cancer Care
Recent studies have highlighted the importance of adjuvant treatments in improving health and longevity for early-stage breast cancer patients. A comprehensive assessment of 723 women with early-stage breast cancer at four hospitals in the Mount Sinai-NYU Health System revealed that 59% underwent breast-conserving surgery, with 81% of these patients receiving radiation therapy. However, there was significant variability in treatment rates across hospitals, with 18% to 33% of women not receiving beneficial local or systemic adjuvant treatments. This variability underscores the need for standardized, multidisciplinary approaches to ensure consistent and effective care across different institutions.
Neoadjuvant Chemotherapy and Pembrolizumab for High-Risk Early-Stage TNBC
The phase 1b KEYNOTE-173 study explored the combination of pembrolizumab and chemotherapy as a neoadjuvant treatment for high-risk, early-stage triple-negative breast cancer (TNBC). The study found that this combination had manageable toxicity and promising antitumor activity, with a pathological complete response (pCR) rate of 60%. Higher pre-treatment PD-L1 expression and stromal tumor-infiltrating lymphocyte levels were significantly associated with higher pCR rates, suggesting these biomarkers could help predict treatment response.
De-escalation of Breast Radiation (DEBRA) Following Breast-Conserving Surgery
The NRG-BR007 phase III trial is investigating whether breast-conserving surgery (BCS) alone is non-inferior to BCS plus radiation therapy (RT) in preventing ipsilateral breast recurrence (IBR) in women with stage 1, hormone receptor-positive (HR+), HER2-negative breast cancer with a low Oncotype DX Recurrence Score (RS ≤ 18). This study aims to reduce overtreatment and associated toxicities by potentially omitting RT in low-risk patients. Preliminary results suggest that BCS alone, followed by endocrine therapy, may be sufficient for certain low-risk patients, thus sparing them from the side effects of radiation .
Conclusion
The treatment landscape for stage 1B breast cancer is evolving, with a focus on personalized and less invasive approaches. While adjuvant treatments remain crucial, ongoing research is exploring the potential for de-escalation in low-risk patients to minimize treatment-related toxicity without compromising efficacy. Multidisciplinary care and the use of predictive biomarkers are essential in optimizing treatment strategies and improving patient outcomes.
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