Drugs first.

Here’s an excellent review of the data on de-escalating therapies, including comprehensive nodal irradiation and even surgery, for breast cancers that achieve a pathologic complete response (pCR) to neoadjuvant chemo. Pointing to the recent upswing in radiation omission among women who do not fit into trials establishing it’s safety among elderly women with favorable breast cancers, these authors conclude with caution against broadly applying deescalation in the setting of pCR, particularly among minority patients who are both at higher risk of recurrence as well as poorly represented on trials. | Oluwadamilola, JAMA Oncol 2020

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