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Axillary Management After Neoadjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer

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

Abstract

Background

Data to guide axillary management after neoadjuvant endocrine therapy (NET) remain limited.

Methods

We analyzed type of axillary surgery [sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND)] and residual nodal disease burden after NET in two cohorts of patients with cT1-4N0-1M0 hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) breast cancer: Dana-Farber/Brigham and Women’s Cancer Center (DFBWCC) cohort (2015–2018) and the National Cancer Data Base (NCDB) cohort (2012–2016). Cox proportional hazard regression was used to determine adjusted 5-year overall survival (OS) by type of axillary surgery.

Results

Ninety-four (4.3%) of 2191 HR+/HER2− DFBWCC patients and 4363 (1.5%) of 283,344 NCDB patients were selected for NET. Of those who underwent axillary surgery, 30 (43.5%) in the DFBWCC cohort and 1583 (40.6%) in the NCDB cohort had ALND. Over 90% of cN0 patients in both cohorts had fewer than three positive nodes on final pathology [44 (95.7%) DFBWCC and 2945 (91.3%) NCDB]. In contrast, only 7 (30.4%) DFBWCC patients and 342 (50.7%) NCDB cN1 patients had fewer than three positive nodes. In the DFBWCC patients, there were no locoregional recurrences and four distant recurrences. In the NCDB, 5-year OS did not differ by type of axillary surgery regardless of residual nodal disease burden: 96.6% SLNB versus 97.9% ALND for 0 positive nodes; 84.4% versus 84.4% for one to two positive nodes, and 75.9% versus 77.3% for three or more positive nodes (all p > 0.10).

Conclusions

In cN0 patients selected for NET, > 90% have fewer than three positive nodes at surgery. The lack of a survival difference between SLNB and ALND suggests an opportunity to de-escalate treatment of the axilla in patients with limited residual nodal disease.

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Funding

Olga Kantor acknowledges the Pamela and Nick Gelsomini Breast Surgical Oncology Fellowship Fund for their support, and Elizabeth A. Mittendorf acknowledges the Rob and Karen Hale Distinguished Chair in Surgical Oncology for their support.

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Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Olga Kantor MD, MS, Anna Weiss MD, Alison Laws MD, Samantha Grossmith BA, Elizabeth A. Mittendorf MD, PhD & Tari A. King MD

  2. Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, 02215, USA

    Olga Kantor MD, MS, Melia Wakeman BS, Anna Weiss MD, Alison Laws MD, Samantha Grossmith BA, Elizabeth A. Mittendorf MD, PhD & Tari A. King MD

  3. McGill University Health Centre, Montreal, QC, Canada

    Stephanie Wong MD

Authors
  1. Olga Kantor MD, MS
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  2. Melia Wakeman BS
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  3. Anna Weiss MD
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  5. Alison Laws MD
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  7. Elizabeth A. Mittendorf MD, PhD
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Correspondence to Tari A. King MD.

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Disclosures

Elizabeth A. Mittendorf reports the following personal financial interests: research support for laboratory from GlaxoSmithKline; honoraria from Physician Education Resource; compensated service on Scientific Advisory Boards for Astra-Zeneca, Exact Sciences (formerly Genomic Health), Merck, Peregrine Pharmaceuticals, Roche/Genentech, Sellas Lifesciences, TapImmune Inc; and uncompensated service on steering committees for BMS, Lilly, Roche/Genentech. She also reports the following institutional financial interests: MD Anderson: clinical trial funding from AstraZeneca, EMD Serono, Galena Biopharma, Roche/Genentech; DFCI: clinical trial funding from Roche/Genentech (via an SU2C Grant); and the following non-financial interests and non-remunerated activities: Board of Directors: American Society of Clinical Oncology, Scientific Advisor: Susan G. Komen for the Cure Foundation. Tari A. King reports speaker’s fees and advisory board participation for Exact Sciences (formally Genomic Health).

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Kantor, O., Wakeman, M., Weiss, A. et al. Axillary Management After Neoadjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer. Ann Surg Oncol 28, 1358–1367 (2021). https://doi.org/10.1245/s10434-020-09073-6

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