Editor’s Note: The 20th Shanghai International Breast Cancer Symposium (SIBCS), organized by the Shanghai Anti-Cancer Association and the Breast Cancer Professional Committee of the China Anti-Cancer Association, was held in Shanghai from November 13–15, 2025. The meeting convened leading international and Chinese scholars as well as many rising young investigators. Oncology Frontier invited Professor Yiding Chen of the Second Affiliated Hospital of Zhejiang University School of Medicine for an in-depth interview. Professor Chen reviewed milestone changes in breast surgical oncology over the past twenty years, discussed the emerging role of trastuzumab deruxtecan (T-DXd) in early-stage HER2-positive breast cancer, and examined ways to strengthen translational research and clinical integration to accelerate precision treatment adoption.
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Oncology Frontier: SIBCS has reached its twentieth edition, and you have participated many times, witnessing the continuous enrichment of diagnostic and therapeutic options for breast cancer. From a surgeon’s perspective, what do you consider the most significant, milestone changes in breast surgical treatment over the past two decades, and how have these changes affected patients’ outcomes and quality of life?
Professor Yiding Chen:
Surgical diagnosis and treatment for breast cancer have indeed changed dramatically over the past twenty years, and the overall treatment paradigm has been profoundly transformed—both locally and systemically. As a breast surgeon, I am especially attuned to the landmark advances in surgical practice.
First, axillary lymph node management has changed substantially. Twenty years ago we commonly performed radical mastectomy with routine axillary dissection. With the validation of the sentinel lymph node concept, sentinel lymph node biopsy has become mainstream. For clinically node-negative patients and for patients who convert from node-positive to node-negative status after neoadjuvant therapy, sentinel node biopsy is now a viable option, significantly altering axillary surgical strategies.
Second, breast-conserving surgery has become far more prevalent. This change is particularly meaningful to surgeons because much of our work centers on balancing oncologic safety with breast preservation. Two decades ago, breast conservation rates were very low—even in large centers they were only about 5–10%. According to a recent nationwide survey presented by Professor Wu Jiong, China’s breast-conserving rate has risen from roughly 5–10% to about 15–20% overall, with some centers reaching nearly 50%. Regional variation remains, but the trend is unmistakable.
Third, breast reconstruction has gained much wider acceptance. Both oncoplastic repair after lumpectomy and reconstruction after mastectomy are increasingly emphasized. Current clinical guidelines and operative manuals—compiled under the leadership of experts including Director Wu Jiong—have standardized and normalized reconstruction approaches. These advances represent major steps forward for surgical care.
I would also highlight the dramatic evolution in the use of neoadjuvant and adjuvant systemic therapies. Two decades ago, the standard approach for most nonmetastatic patients was primary surgery followed by adjuvant treatment. Today, for node-negative HER2-positive or triple-negative tumors larger than 2 cm, we commonly consider neoadjuvant therapy. Achieving pathologic complete response (pCR) after neoadjuvant therapy strongly correlates with improved prognosis. As a result, our initial patient workup now routinely includes core biopsy and immunohistochemistry to determine molecular subtype and to guide multidisciplinary discussion about whether neoadjuvant therapy is indicated, what surgical approach to take, and postoperative adjuvant strategies.
Overall, from a surgical perspective, these areas—axillary management, breast conservation, reconstructive surgery, and the integration of neoadjuvant systemic therapy—represent the most significant, practice-changing advances over the past twenty years.
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Oncology Frontier: At the recently concluded ESMO Congress, ADC data attracted much attention. New findings from DB-05 and DB-11 further highlighted T-DXd’s potential in early HER2-positive disease in both neoadjuvant and adjuvant settings. How do you view the role of T-DXd in early HER2-positive breast cancer, and what opportunities and challenges lie ahead for early-stage patients?
Professor Yiding Chen:
T-DXd was first used in heavily pretreated metastatic disease and has since advanced into earlier lines with striking efficacy. It is now being explored in early-stage disease, both for adjuvant escalation and as part of neoadjuvant regimens.
At ESMO, the DB-11 study reported that in previously untreated, high-risk HER2-positive early breast cancer, the pCR rates were 67.3% for the T-DXd-THP arm versus 56.3% for the ddAC-THP arm (difference 11.2%; 95% CI 4.0–18.3; P = 0.003). The trial’s T-DXd monotherapy arm was halted early because pCR rates there were not ideal, but the overall findings offer new strategies to optimize treatment for HER2-positive patients.
For example, inspired by the PHERGain design, we may be able to identify subsets of HER2-positive patients who could safely omit conventional chemotherapy. Similarly, in hormone receptor–positive, HER2-positive patients, combining CDK4/6 inhibitors with endocrine therapy has produced comparable efficacy in some contexts. DB-11 indicates that ADCs like T-DXd deserve a central place in neoadjuvant strategies. Many investigator-initiated trials (IITs) are now underway to refine patient selection to maximize ADC benefit, and I anticipate these studies will meaningfully inform early-stage practice.
Additionally, DB-05 showed that among patients who did not achieve pCR after neoadjuvant therapy, T-DXd provided superior efficacy to T-DM1—an encouraging development. Previously, the KATHERINE trial established T-DM1 as an effective adjuvant escalation for non-pCR HER2-positive patients, and we once thought that approach had reached a ceiling. The new data suggest that ADCs still have room to improve outcomes in this adjuvant escalation setting. We look forward to better options for patients who remain non-pCR after neoadjuvant treatment.
Our current clinical objective is to cure HER2-positive patients. For tumors >2 cm or node-positive disease, neoadjuvant therapy—followed by tailored adjuvant escalation when pCR is not achieved—represents a practical pathway toward that goal. At the same time, we must pursue earlier and more precise predictive tools. For example, basket-style studies led by Zhiming Shao’s team aim to select patients best suited to ADCs, chemotherapy, or small-molecule TKIs. Such precision stratification should increase cure rates among early HER2-positive patients.
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Oncology Frontier: As a participant in many clinical trials, how do you think we can more effectively accelerate the translation of research into clinical practice—so that scientific discoveries reach patients faster and provide more effective treatment options?
Professor Yiding Chen:
In clinical trials today, we typically include multiple secondary endpoints and perform stratified analyses—often based on molecular markers or multigene assays that may have predictive value.
From a translational perspective, basic research identifies potential targets and agents through mechanistic discovery. This year, two drugs targeting the PAM pathway—alpelisib and capivasertib—stand out as successful examples of translational breakthroughs. Historically, precision therapy relied heavily on immunohistochemistry and similar conventional tools. Now, with targeted agents for PIK3CA, AKT1, and PTEN alterations, we have actionable options for molecular subsets of patients. Translating these findings into clinical benefit is challenging but vitally important, given the long-standing heterogeneity of breast cancer.
In clinical research, we are actively pursuing biomarker discovery to advance precision care. No single therapy fits every patient, so in our trials we increasingly incorporate tumor biomarkers and multi-omics profiling to predict response earlier and to personalize therapy. The goal is to stratify patients precisely and to assign individualized drug combinations based on specific molecular vulnerabilities. For example, in HER2-positive disease the options may include chemotherapy plus targeted therapy, ADC monotherapy, ADC combined with a small-molecule TKI, combinations of large and small molecules with chemotherapy, or endocrine therapy combined with targeted agents. Identifying biomarkers to choose among these options is central to translational work.
If we can refine patient subgroups using robust biomarkers and then match them to precise treatments, we will achieve the true promise of precision oncology. That is the ultimate aim and the direction in which breast cancer research must continue advancing.
Professor Yiding Chen Chief Physician, Director of Breast Surgery, Doctoral Supervisor Second Affiliated Hospital, Zhejiang University School of Medicine
