From the Research
Surgery for HER2-positive breast cancer typically occurs between 14 days and 6 weeks after completion of neoadjuvant chemotherapy. This timing allows the body to recover from chemotherapy side effects while ensuring the patient's blood counts normalize and any surgical wounds can heal properly. The standard neoadjuvant regimen for HER2-positive breast cancer usually includes a taxane (paclitaxel or docetaxel), an anthracycline (doxorubicin or epirubicin), and HER2-targeted therapy (trastuzumab and pertuzumab) given over 4-6 months 1.
Key Considerations
- The surgical approach depends on response to therapy, with some patients becoming candidates for breast-conserving surgery rather than mastectomy if there's significant tumor shrinkage.
- Before scheduling surgery, patients should have a post-treatment imaging assessment to evaluate response and surgical planning.
- The timing may be adjusted based on individual factors such as the patient's overall health status, extent of response to neoadjuvant therapy, and logistical considerations for surgical scheduling.
Evidence-Based Recommendations
- A study published in The Lancet. Oncology in 2018 found that breast cancer surgery was typically performed between 14 days and 6 weeks after completion of neoadjuvant therapy 1.
- Other studies have also supported the use of neoadjuvant chemotherapy followed by surgery for HER2-positive breast cancer, with varying regimens and timing 2, 3, 4, 5.
- However, the most recent and highest quality study, which is the primary consideration for clinical decision-making, suggests that surgery can be performed as early as 14 days after completion of neoadjuvant chemotherapy 1.
Clinical Implications
- The choice of neoadjuvant regimen and timing of surgery should be individualized based on patient factors and tumor response.
- Patients with HER2-positive breast cancer should be closely monitored during neoadjuvant therapy and undergo regular imaging assessments to evaluate response and guide surgical planning.
- The goal of neoadjuvant therapy is to achieve a pathological complete response, which is associated with improved clinical outcomes and reduced risk of recurrence.