Almost 300 delegates attended the Inaugural Australasian Breast Congress held at the Surfers Paradise Marriott Resort on 10-11 October 2014.
This was a co-badged meeting between BreastSurgANZ (Breast Surgeons of Australia and New Zealand) and the Australasian Society for Breast Disease (ASBD). Keynote speakers for the program were Prof Hiram (Chip) Cody III, Attending Surgeon at Memorial Sloan-Kettering Cancer Center, New York, Miss Anne Tansley, Specialist Consultant Breast Surgeon at the Royal Liverpool University Hospital, UK and Mr Richard Sutton, Director of the Breast Unit at the Royal United hospital in Bath, UK.
Highlights of the meeting included a 2 day preconference Oncoplastic Surgery Cadaveric Workshop at the Holy Spirit Northside Private Hospital, Chermside attended by 24 delegates. Level 1 & 2 oncoplastic techniques were taught through theory sessions, live model mark ups and hands on cadaver dissection.
The main program focussed on loco-regional disease management with sessions on managing the axilla, radiotherapy and reconstruction, neo-adjuvant therapy and a lively MDM panel discussion.
It was noted that in Australia only 3% of patients on the National Breast Quality Audit (BQA) actually get neoadjuvant chemotherapy therapy (NAC), a figure that should be much higher ideally. The MSK experience is around 10-15% and higher in other US centres. High rates of complete pathological remission (pCR) can be achieved with NAC, particularly in triple negative and Her2 positive patients. Multiple randomised trials have been associated with a modest increase in breast conservation rates and comparable survival to that of adjuvant chemotherapy. NAC benefits also include early assessment of the addition of new agents to therapy, potential bio-marker discovery and identification of non-responders allowing treatment adjustment. Even in ER positive, Her2 negative patients where pCR is less likely, a 20-30 % tumour shrinkage rate can mean improved breast conservation outcomes.
Managing the axilla around NAC is an area of debate. Chip Cody noted a trend in the US toward SLN biopsy after NAC rather than before given that 40% of node positive patients achieve pCR. A slightly lower success rate of SLN biopsy (91%) and 10% false negative rate in these patients was deemed acceptable. Two studies have addressed the clinically node positive patient having NAC, ACOSOG 1071 and the SENTINA trial. They demonstrated that with attention to technique, including dual agent mapping, removal of at least 2 SLN and SLN biopsy once after NAC rather than before and after, provided acceptable rates of false negative SLN biopsy.
Pathologic assessment of tumour response after NAC was addressed by pathologist Gelarah Fashid, from South Australia noting some of the pitfalls in this situation. Although there are a number of treatment response classification systems, the Residual Cancer Burden system assesses residual disease in the breast and nodes following NAC and is what is used by some in Australia. For more information see the RCB calculator at www.mdanderson.org/breastcancer_RCB. Dr Catherine Shannon, Mater Hospital Brisbane and A/Prof Nirmala Pathmanathan, Westmead Breast Cancer Institute, Sydney spoke on tumour biology and responsiveness, both in general and related to NAC. Reliability and reproducibility of Ki67 can be variable, with proper fixation techniques essential. Around 40% of ER / PR results and 10% of Her2 values have been shown to change with NAC in some studies. Four ongoing studies of neodajuvant therapy are recruiting in Australia with two more to open. The ELIMINATE trial will assess the addition of Letrozole to NAC in ER positive, Her2 negative patients. PENELOPE is a phase III trial looking at the addition of the CDK4/6 kinase inhibitor Palbociclib, to standard anti-hormonal therapy in non-pCR responders after NAC with ER positive/Her2 normal disease.
The next ASBD Scientific Meeting will be held at the Brisbane Exhibition and Convention Centre 17-19 September 2015. For further details go to www.asbd.org.au. BreastSurgANZ are planning a further Oncoplastic workshop next year and further details on this will soon be available at www.breastsurganz.com.
Dr Daniel de Viana is a breast and endocrine surgeon and President of the Australasian Society for Breast Disease.