Pre-op chemo may spur metastasis in breast cancer patients

Chemotherapy administered prior to breast cancer tumor removal may facilitate the spread of malignant cancer cells to different sites, resulting in incurable metastasis, according to a new study published in Science Translational Medicine.

Pre-op chemo is used to shrink tumors in breast cancer patients so physicians can perform a lumpectomy, rather than a more invasive mastectomy, to remove the tumors. To assess pre-op chemo's possible influence on metastasis, researchers examined lab mice with mutations that spurred the random development of breast cancer and human breast cancer xenografts in the laboratory setting.

The team found chemo changed the tumor microenvironment — the areas on blood vessels where cancer cells can affix to immune cells before spreading to the rest of the body via the blood stream — in three ways, all of which aided in the metastasizing process. The chemo promoted a microenvironment with more immune cells that carry cancer cells to blood vessels. The treatment also created blood cells more permeable to cancer cells and more mobile cancer cells.

Julio Aguirre-Ghiso, PhD, a metastasis expert at the Mount Sinai School of Medicine in New York City who was not involved with the study, told STAT the findings were "fascinating, powerful and very important."

"It raises awareness that we might have to be smarter about how we use chemotherapy," Dr. Aguirre-Ghiso said.

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