BACKGROUND: The axillary pathologic complete response rate (pCR) and the effect of axillary pCR on disease-free survival (DFS) was determined in patients with HER2-positive breast cancer and biopsy-proven axillary lymph node metastases who were receiving concurrent trastuzumab and neoadjuvant chemotherapy. The use of neoadjuvant chemotherapy is reported to result in pCR in the breast and axilla in up to 25% of patients. Patients achieving a pCR have improved DFS and overall survival. To the authors' knowledge, the rate of eradication of biopsy-proven axillary lymph node metastases with trastuzumab-containing neoadjuvant chemotherapy regimens has not been previously reported. METHODS: Records were reviewed of 109 consecutive patients with HER2-positive breast cancer and axillary metastases confirmed by ultrasound-guided fine-needle aspiration biopsy who received trastuzumab-containing neoadjuvant chemotherapy followed by breast surgery with complete axillary lymph node dissection. Survival was evaluated by the Kaplan-Meier method. Clinicopathologic factors and DFS were compared between patients with and without axillary pCR. RESULTS: Eighty-one patients (74%) achieved a pCR in the axilla. Axillary pCR was not associated with age, estrogen receptor status, grade, tumor size, initial N classification, or median number of lymph nodes removed. More patients with an axillary pCR also achieved a pCR in the breast (78% vs 25%; P < .001). At a median follow-up of 29.1 months, DFS was significantly greater in the axillary pCR group (P = .02). CONCLUSIONS: Trastuzumab-containing neoadjuvant chemotherapy appears to be effective in eradicating axillary lymph node metastases in the majority of patients treated. Patients who achieve an axillary pCR are reported to have improved DFS. The success of pCR with concurrent trastuzumab and chemotherapy in eradicating lymph node metastases has implications for surgical management of the axilla in these patients.
BACKGROUND: The axillary pathologic complete response rate (pCR) and the effect of axillary pCR on disease-free survival (DFS) was determined in patients with HER2-positive breast cancer and biopsy-proven axillary lymph node metastases who were receiving concurrent trastuzumab and neoadjuvant chemotherapy. The use of neoadjuvant chemotherapy is reported to result in pCR in the breast and axilla in up to 25% of patients. Patients achieving a pCR have improved DFS and overall survival. To the authors' knowledge, the rate of eradication of biopsy-proven axillary lymph node metastases with trastuzumab-containing neoadjuvant chemotherapy regimens has not been previously reported. METHODS: Records were reviewed of 109 consecutive patients with HER2-positive breast cancer and axillary metastases confirmed by ultrasound-guided fine-needle aspiration biopsy who received trastuzumab-containing neoadjuvant chemotherapy followed by breast surgery with complete axillary lymph node dissection. Survival was evaluated by the Kaplan-Meier method. Clinicopathologic factors and DFS were compared between patients with and without axillary pCR. RESULTS: Eighty-one patients (74%) achieved a pCR in the axilla. Axillary pCR was not associated with age, estrogen receptor status, grade, tumor size, initial N classification, or median number of lymph nodes removed. More patients with an axillary pCR also achieved a pCR in the breast (78% vs 25%; P < .001). At a median follow-up of 29.1 months, DFS was significantly greater in the axillary pCR group (P = .02). CONCLUSIONS:Trastuzumab-containing neoadjuvant chemotherapy appears to be effective in eradicating axillary lymph node metastases in the majority of patients treated. Patients who achieve an axillary pCR are reported to have improved DFS. The success of pCR with concurrent trastuzumab and chemotherapy in eradicating lymph node metastases has implications for surgical management of the axilla in these patients.
Authors: Savitri Krishnamurthy; Nour Sneige; Deepak G Bedi; Beth S Edieken; Bruno D Fornage; Henry M Kuerer; S Eva Singletary; Kelly K Hunt Journal: Cancer Date: 2002-09-01 Impact factor: 6.860
Authors: Aman U Buzdar; Nuhad K Ibrahim; Deborah Francis; Daniel J Booser; Eva S Thomas; Richard L Theriault; Lajos Pusztai; Marjorie C Green; Banu K Arun; Sharon H Giordano; Massimo Cristofanilli; Debra K Frye; Terry L Smith; Kelly K Hunt; Sonja E Singletary; Aysegul A Sahin; Michael S Ewer; Thomas A Buchholz; Donald Berry; Gabriel N Hortobagyi Journal: J Clin Oncol Date: 2005-02-28 Impact factor: 44.544
Authors: H M Kuerer; A A Sahin; K K Hunt; L A Newman; T M Breslin; F C Ames; M I Ross; A U Buzdar; G N Hortobagyi; S E Singletary Journal: Ann Surg Date: 1999-07 Impact factor: 12.969
Authors: G Vlastos; B D Fornage; N Q Mirza; D Bedi; J T Lenert; D J Winchester; S M Tolley; F C Ames; M I Ross; B W Feig; K K Hunt; A U Buzdar; S E Singletary Journal: Am J Surg Date: 2000-06 Impact factor: 2.565
Authors: F Peintinger; A U Buzdar; H M Kuerer; J A Mejia; C Hatzis; A M Gonzalez-Angulo; L Pusztai; F J Esteva; S S Dawood; M C Green; G N Hortobagyi; W F Symmans Journal: Ann Oncol Date: 2008-07-29 Impact factor: 32.976
Authors: B Fisher; J Bryant; N Wolmark; E Mamounas; A Brown; E R Fisher; D L Wickerham; M Begovic; A DeCillis; A Robidoux; R G Margolese; A B Cruz; J L Hoehn; A W Lees; N V Dimitrov; H D Bear Journal: J Clin Oncol Date: 1998-08 Impact factor: 44.544
Authors: Kandice E Kilbride; M Catherine Lee; Alexis V Nees; Vincent M Cimmino; Kathleen M Diehl; Michael S Sabel; Daniel F Hayes; Anne F Schott; Celina G Kleer; Alfred E Chang; Lisa A Newman Journal: Ann Surg Oncol Date: 2008-09-11 Impact factor: 5.344
Authors: Erika A Newman; Michael S Sabel; Alexis V Nees; Anne Schott; Kathleen M Diehl; Vincent M Cimmino; Alfred E Chang; Celina Kleer; Daniel F Hayes; Lisa A Newman Journal: Ann Surg Oncol Date: 2007-05-19 Impact factor: 5.344
Authors: Wolfram Malter; Christian Eichler; Bettina Hanstein; Peter Mallmann; Johannes Holtschmidt Journal: In Vivo Date: 2020 May-Jun Impact factor: 2.155
Authors: Marieke E M van der Noordaa; Ileana Ioan; Emiel J Rutgers; Erik van Werkhoven; Claudette E Loo; Rosie Voorthuis; Jelle Wesseling; Japke van Urk; Terry Wiersma; Vincent Dezentje; Marie-Jeanne T F D Vrancken Peeters; Frederieke H van Duijnhoven Journal: Ann Surg Oncol Date: 2021-05-12 Impact factor: 5.344
Authors: S David Nathanson; David Krag; Henry M Kuerer; Lisa A Newman; Markus Brown; Dontscho Kerjaschki; Ethel R Pereira; Timothy P Padera Journal: Clin Exp Metastasis Date: 2018-05-23 Impact factor: 5.150
Authors: Laura S Dominici; Monica Morrow; Elizabeth Mittendorf; Jennifer Bellon; Tari A King Journal: Curr Probl Surg Date: 2016-11-29 Impact factor: 1.909
Authors: Audree B Tadros; Wei T Yang; Savitri Krishnamurthy; Gaiane M Rauch; Benjamin D Smith; Vicente Valero; Dalliah M Black; Anthony Lucci; Abigail S Caudle; Sarah M DeSnyder; Mediget Teshome; Carlos H Barcenas; Makesha Miggins; Beatriz E Adrada; Tanya Moseley; Rosa F Hwang; Kelly K Hunt; Henry M Kuerer Journal: JAMA Surg Date: 2017-07-01 Impact factor: 14.766
Authors: Savitri Krishnamurthy; Therese Bevers; Henry M Kuerer; Benjamin Smith; Wei Tse Yang Journal: AJR Am J Roentgenol Date: 2016-12-08 Impact factor: 3.959
Authors: Abigail S Caudle; Henry M Kuerer; Savitri Krishnamurthy; Kyungmin Shin; Brian P Hobbs; Junsheng Ma; Elizabeth A Mittendorf; Ashley C Washington; Sarah M DeSnyder; Dalliah M Black; Kelly K Hunt; Wei T Yang Journal: Cancer Date: 2018-10-25 Impact factor: 6.860