Recent advancements in breast cancer treatment are reshaping clinical practices, particularly in optimizing surgical decisions post-neoadjuvant therapy and introducing advanced therapeutics for treatment-resistant cases.
Neoadjuvant therapy is increasingly utilized to potentially reduce tumor burden before surgical interventions, yet predicting residual axillary disease remains a critical challenge. A recent study identified baseline cN+ status, HR+/HER2− subtype and larger primary tumor size as independent predictors of significant residual nodal involvement after neoadjuvant regimens. Incorporating these predictors into preoperative assessments allows oncologists to tailor the extent of axillary dissection, minimizing invasive procedures without compromising oncologic outcomes.
Equally transformative are innovations in postoperative radiotherapy. A 10-year follow-up reported at ESTRO 2025 demonstrated that a one-week radiotherapy regimen post-surgery matches the efficacy and safety of the conventional three-week course in early-stage breast cancer. Shortened schedules can decrease patient burden, enhance access to treatment and streamline oncology protocols without sacrificing disease control.
Treatment-resistant cases such as metastatic triple-negative breast cancer demand novel therapeutic strategies. In a multicenter observational cohort from Turkey, the antibody-drug conjugate Sacituzumab Govitecan showed significant efficacy and a manageable safety profile in heavily pretreated metastatic triple-negative and HR+/HER2− breast cancer patients. This targeted approach exemplifies the shift toward personalized cancer treatment, offering an option when standard regimens fail.
Emerging cell therapy innovations may further expand options for resistant solid tumors. Next-generation “armored” CAR T cells, designed to resist immunosuppressive microenvironments, have demonstrated promising activity in lymphoma. Translating this technology to breast cancer could address inherent resistance barriers and broaden the scope of immunotherapy advancements.
Maintaining an adaptive approach that integrates precise risk stratification after neoadjuvant therapy, streamlined radiotherapy protocols and advanced systemic agents will refine both surgical planning and overall management in breast oncology.
Key Takeaways
- Baseline cN+, HR+/HER2− subtype and larger tumor size predict high-burden residual axillary disease following neoadjuvant therapy.
- A one-week postoperative radiotherapy course delivers comparable outcomes to a three-week regimen in early-stage breast cancer.
- Sacituzumab Govitecan provides an effective antibody-drug conjugate option for heavily pretreated metastatic triple-negative and HR+/HER2− cancers.
- Next-generation armored CAR T cells underscore the potential of cell therapy innovation beyond hematologic malignancies.