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Axillary Response to Neoadjuvant Therapy in Node-Positive, Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Patients: Predictors and Oncologic Outcomes

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

Abstract

Background

One potential benefit of neoadjuvant therapy (NAT) in node-positive, estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2−) patients is axillary downstaging to avoid axillary dissection.

Objective

The aim of this study was to evaluate axillary response to NAT with chemotherapy (NCT) or endocrine therapy (NET) and identify potential predictors of response.

Methods

A prospectively collected database was queried for node-positive, ER+, HER2− breast cancer patients treated with NAT and surgery from January 2011 to September 2020. Axillary response was categorized into pathologic complete response (pCR) versus no pCR, and was correlated to demographic and clinicopathologic parameters in a logistic regression model.

Results

A cohort of 176 eligible patients was identified and 178 breast cancers were included in the study. The overall axillary pCR rate was 12.3% (22/178). NCT and NET achieved response rates of 13.9% (19/137) and 7.3% (3/41), respectively (p = 0.232). A significantly higher axillary pCR rate was identified in patients with clinical stage II at diagnosis (12/60, 20%) compared with stage III (10/118, 8.4%; p = 0.03). NET patients with ypN0 were younger and were treated for a longer period of time (>6 months). Completion axillary dissection was omitted in the majority (73.7%) of NCT patients achieving axillary pCR.

Conclusions

For patients with node-positive, ER+, HER2− breast cancer, a lower burden of disease at the time of diagnosis (stage II) is associated with a significantly higher axillary pCR, enabling those patients to be spared axillary dissection. Further studies are necessary to define the role of genomic profiling in predicting axillary response.

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The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Surgical Oncology, Jackson Memorial Hospital, Miami, FL, USA

    Orli Friedman-Eldar MD & Tolga Ozmen MD

  2. Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Orli Friedman-Eldar MD, Tolga Ozmen MD, Neha Goel MD, FACS, Susan B. Kesmodel MD, FACS, Mecker G. Moller MD, FACS, Dido Franceschi MD, FACS, Christina Layton DO & Eli Avisar MD, FACS

  3. Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA

    Salah James El Haddi MD

  4. Division of Surgical Pathology, University of Miami Miller School of Medicine, Miami, FL, USA

    Youley Tjendra MD

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Correspondence to Orli Friedman-Eldar MD.

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Orli Friedman-Eldar, Tolga Ozmen, Salah James El Haddi, Neha Goel, Youley Tjendra, Susan B. Kesmodel, Mecker G. Moller, Dido Franceschi, Christina Layton, and Eli Avisar declare that they have no conflicts of interest.

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Friedman-Eldar, O., Ozmen, T., El Haddi, S.J. et al. Axillary Response to Neoadjuvant Therapy in Node-Positive, Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Patients: Predictors and Oncologic Outcomes. Ann Surg Oncol 29, 4092–4101 (2022). https://doi.org/10.1245/s10434-022-11473-9

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