Gauging the efficacy of neoadjuvant endocrine therapy in breast cancer patients with known axillary disease

Jacob B. Hammond, Taylor H. Parnall, Derek W. Scott, Heidi E. Kosiorek, Barbara A. Pockaj, Brenda J. Ernst, Donald W. Northfelt, Ann E. McCullough, Idris Tolgay Ocal, Patricia A. Cronin

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives: Neoadjuvant endocrine therapy (NET) for ER+ breast cancer can downstage primary tumors. We evaluated NET efficacy in node-positive patients. Methods: Node-positive patients undergoing NET for ER+ breast cancer from 2012 to 2019 were reviewed. Primary endpoints included rates of axillary lymphadenectomy (ALND), pathologic complete response (pCR), and final nodal staging. Results: Thirty-nine patients were included. Before NET, all were clinically node-positive (cN1 = 36, 94%; cN2 = 2, 5%; cN3 = 1, 3%; Stage II = 23, 59%, Stage III = 16, 41%). After NET, nine (23%) had clinically persistent axillary disease necessitating ALND. The remaining 30 (77%) underwent sentinel lymph node biopsy (SLNB). Of these, 25 (83%) were SLNB+ on frozen section, undergoing immediate ALND. Five patients were negative on frozen section: one had a confirmed axillary pCR, and four had residual nodal disease on permanent pathology. One underwent delayed ALND, and for the remaining three patients, decision was made to forgo ALND. Final overall axillary staging was: N0 (pCR) = 1, 3%, pN1mic = 1, 3%, pN1 = 20, 51%, pN2 = 12, 30%, pN3 = 5, 13%; Stage II = 16, 41%, Stage III = 23, 59%. Conclusions: While NET is reported to downstage primary tumors, downstaging of the axilla was unsuccessful in the majority of patients.

Original languageEnglish (US)
Pages (from-to)619-622
Number of pages4
JournalJournal of Surgical Oncology
Volume122
Issue number4
DOIs
StatePublished - Sep 1 2020

Keywords

  • breast cancer
  • efficacy
  • endocrine therapy
  • neoadjuvant
  • node positive
  • outcomes

ASJC Scopus subject areas

  • Surgery
  • Oncology

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