Orli Friedman-Eldar1,2, Tolga Ozmen3,4, Salah James El Haddi5, Neha Goel4, Youley Tjendra6, Susan B Kesmodel4, Mecker G Moller4, Dido Franceschi4, Christina Layton4, Eli Avisar4. 1. Department of Surgical Oncology, Jackson Memorial Hospital, Miami, FL, USA. eldaror@gmail.com. 2. Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. eldaror@gmail.com. 3. Department of Surgical Oncology, Jackson Memorial Hospital, Miami, FL, USA. 4. Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. 5. Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA. 6. Division of Surgical Pathology, University of Miami Miller School of Medicine, Miami, FL, USA.
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.
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.
Authors: Jean-Francois Boileau; Brigitte Poirier; Mark Basik; Claire M B Holloway; Louis Gaboury; Lucas Sideris; Sarkis Meterissian; Angel Arnaout; Muriel Brackstone; David R McCready; Stephen E Karp; Isabelle Trop; Andre Lisbona; Frances C Wright; Rami J Younan; Louise Provencher; Erica Patocskai; Atilla Omeroglu; Andre Robidoux Journal: J Clin Oncol Date: 2014-12-01 Impact factor: 44.544
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: Carol Sweeney; Philip S Bernard; Rachel E Factor; Marilyn L Kwan; Laurel A Habel; Charles P Quesenberry; Kaylynn Shakespear; Erin K Weltzien; Inge J Stijleman; Carole A Davis; Mark T W Ebbert; Adrienne Castillo; Lawrence H Kushi; Bette J Caan Journal: Cancer Epidemiol Biomarkers Prev Date: 2014-02-12 Impact factor: 4.254
Authors: Judy C Boughey; Vera J Suman; Elizabeth A Mittendorf; Gretchen M Ahrendt; Lee G Wilke; Bret Taback; A Marilyn Leitch; Henry M Kuerer; Monet Bowling; Teresa S Flippo-Morton; David R Byrd; David W Ollila; Thomas B Julian; Sarah A McLaughlin; Linda McCall; W Fraser Symmans; Huong T Le-Petross; Bruce G Haffty; Thomas A Buchholz; Heidi Nelson; Kelly K Hunt Journal: JAMA Date: 2013-10-09 Impact factor: 56.272
Authors: Jose Vila; Elizabeth A Mittendorf; Gabriel Farante; Roland L Bassett; Paolo Veronesi; Viviana Galimberti; Nicolas Peradze; Michael C Stauder; Mariana Chavez-MacGregor; Jennifer F Litton; Lei Huo; Henry M Kuerer; Kelly K Hunt; Abigail S Caudle Journal: Ann Surg Oncol Date: 2016-05-23 Impact factor: 5.344
Authors: Cornelia Liedtke; Chafika Mazouni; Kenneth R Hess; Fabrice André; Attila Tordai; Jaime A Mejia; W Fraser Symmans; Ana M Gonzalez-Angulo; Bryan Hennessy; Marjorie Green; Massimo Cristofanilli; Gabriel N Hortobagyi; Lajos Pusztai Journal: J Clin Oncol Date: 2008-02-04 Impact factor: 44.544