TY - JOUR
T1 - Gauging the efficacy of neoadjuvant endocrine therapy in breast cancer patients with known axillary disease
AU - Hammond, Jacob B.
AU - Parnall, Taylor H.
AU - Scott, Derek W.
AU - Kosiorek, Heidi E.
AU - Pockaj, Barbara A.
AU - Ernst, Brenda J.
AU - Northfelt, Donald W.
AU - McCullough, Ann E.
AU - Ocal, Idris Tolgay
AU - Cronin, Patricia A.
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2020/9/1
Y1 - 2020/9/1
N2 - 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.
AB - 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.
KW - breast cancer
KW - efficacy
KW - endocrine therapy
KW - neoadjuvant
KW - node positive
KW - outcomes
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U2 - 10.1002/jso.26047
DO - 10.1002/jso.26047
M3 - Article
C2 - 32506815
AN - SCOPUS:85085973147
SN - 0022-4790
VL - 122
SP - 619
EP - 622
JO - Journal of Surgical Oncology
JF - Journal of Surgical Oncology
IS - 4
ER -