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How Effective is Neoadjuvant Endocrine Therapy (NET) in Downstaging the Axilla and Achieving Breast-Conserving Surgery?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant endocrine therapy (NET) is effective in downstaging large hormone receptor-positive (HR+) breast cancers and increasing rates of breast-conserving surgery (BCS), but data regarding nodal pathologic complete response (pCR) are sparse. We reported nodal and breast downstaging rates with NET, and compared axillary response rates following NET and neoadjuvant chemotherapy (NAC).

Methods

Consecutive stage I–III breast cancer patients treated with NET and surgery from January 2009 to December 2019 were identified from a prospectively maintained database. Nodal pCR rates were compared between biopsy-proven node-positive patients treated with NET, and HR+/HER2- patients treated with NAC from November 2013 to July 2019.

Results

127 cancers treated with NET and 338 with NAC were included. NET recipients were older, more likely to have lobular and lower-grade tumors, and higher HR expression. With NET, the nodal pCR rate was 11% (4/38) of biopsy-proven cases, and the breast pCR rate was 1.6% (2/126). Nodal-dowstaging rates with NET and NAC were not significantly different (11% vs 18%; P = 0.37). Patients achieving nodal pCR with NET versus NAC were older (median age 70 vs 50, P = 0.004) and had greater progesterone receptor (PR) expression (85% vs 13%, P = 0.031), respectively. Of patients not candidates for BCS due to a large tumor relative to breast size, 36/47 (77%) became BCS-eligible with NET (median PR expression 55% vs 5% in those remaining ineligible, P < 0.05).

Conclusion

Although nodal pCR is more frequent than breast pCR, NET is more likely to de-escalate breast surgery than axillary surgery. However, with a nodal pCR rate of 11%, NET remains an option for downstaging node-positive patients without clear indications for NAC.

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Acknowledgment

The preparation of this study was supported in part by a NIH/NCI Cancer Center Support Grant (No. P30 CA008748) to Memorial Sloan Kettering Cancer Center.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Giacomo Montagna MD, Monica Morrow MD & Melissa L. Pilewskie MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Varadan Sevilimedu DrPH

  3. Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Monica Fornier MD & Komal Jhaveri MD

Authors
  1. Giacomo Montagna MD
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  2. Varadan Sevilimedu DrPH
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  3. Monica Fornier MD
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  4. Komal Jhaveri MD
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  5. Monica Morrow MD
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  6. Melissa L. Pilewskie MD
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Corresponding author

Correspondence to Melissa L. Pilewskie MD.

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Disclosures

Dr. Monica Morrow has received speaking honoraria from Genomic Health. Dr. Giacomo Montagna was supported by the Ticino Cancer League, the Hanne Liebermann Foundation, the Fondation Ancrage, and the HEMMI-Stiftung. Dr. Komal Jhaveri has a consulting or advisory role with Novartis, Pfizer, Genentech, Lilly Pharmaceuticals, Astra Zeneca, Bristol-Myers Squibb, ADC Therapeutics, Taiho Oncology, Jounce Therapeutics, and Abbvie, and research funding (to the institution) from Pfizer, Genentech, Novartis, Lilly Pharmaceuticals, Astra Zeneca, Immunomedics, Puma Biotechnology, Novita Pharmaceuticals, ADC Therapeutics, Zymeworks, Debio Pharmaceuticals, and Clovis Oncology. The remaining authors have no conflicts of interest.

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Accepted for an oral presentation in poster format at the 21st Annual Meeting of the American Society of Breast Surgeons, 2020 held virtually on the 23rd of May 2020.

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Montagna, G., Sevilimedu, V., Fornier, M. et al. How Effective is Neoadjuvant Endocrine Therapy (NET) in Downstaging the Axilla and Achieving Breast-Conserving Surgery?. Ann Surg Oncol 27, 4702–4710 (2020). https://doi.org/10.1245/s10434-020-08888-7

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