Axillary Management After Neoadjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer

Kantor, Olga; Wakeman, Melia; Weiss, Anna; Wong, Stéphanie; Laws, Alison; Grossmith, Samantha; Mittendorf, Elizabeth A.; King, Tari A.

doi:10.1245/s10434-020-09073-6

Cited by 35 publications

(23 citation statements)

References 25 publications

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“…In a series of 3406 PS(E)T-treated patients, matched in a propensity score analysis for clinical characteristics of age, race, clinical tumor and nodal stage, histology, grade, type of surgery, and presence of lymphovascular invasion with same number of patients undergoing upfront surgery, 5-year OS between patients from both cohorts was similar for all analyzed nodal stages. Another analysis from the same group demonstrated that in the NCDB cohort of PS(E)T patients there was no difference in 5-year estimated OS by type of axillary surgery (SLNB vs ALND) in any residual nodal disease burden subgroup (ypN0; 1-2 positive nodes; ≥3 positive nodes) [84]. It needs to be remembered, however, that due to pattern of relapse of luminal tumors characterized by late recurrences, 5-year OS may be not the optimal end point.…”

Section: Axillary De-escalation After Primary (Neoadjuvant) Endocrine Therapy (Ps(e)t)mentioning

confidence: 97%

De-escalation of axillary irradiation for early breast cancer – Has the time come?

Senkus

Cardoso

Kaidar‐Person

et al. 2021

Cancer Treatment Reviews

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Introduction of sentinel lymph node biopsy, initially in clinically node-negative and subsequently in patients presenting with involved axilla and downstaged by primary systemic therapy, allowed for significant decrease in morbidity compared to axillary lymph node dissection. Concurrently, regional nodal irradiation was demonstrated to improve outcomes in most node-positive patients. Additionally, over the last decades, introduction of more effective systemic therapies has resulted in improvements not only at distant sites, but also in locoregional control, creating space for de-escalation of locoregional treatments. We discuss the data on de-escalation in axillary surgery and irradiation, both in patients undergoing upfront surgery and primary systemic therapy, with special emphasis on the feasibility of omission of nodal irradiation in patients undergoing primary systemic therapy. In view of the accumulating evidence, omission of axillary irradiation may be considered in clinically node-positive patients converting after primary systemic therapy to pathologically negative nodes on sentinel lymph node biopsy (preferably also with in-breast pCR), presenting with lower initial nodal stage, older age and were treated with breast-conserving surgery followed by whole breast irradiation. Omission of regional nodal irradiation in patients with aggressive tumor phenotypes achieving a pCR is under investigation. In patients undergoing preoperative endocrine therapy the adoption of axillary management strategies utilized in case of upfront surgery seems more suitable than those used in post chemotherapy-based primary systemic therapy setting.

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Section: Axillary De-escalation After Primary (Neoadjuvant) Endocrine Therapy (Ps(e)t)mentioning

confidence: 97%

De-escalation of axillary irradiation for early breast cancer – Has the time come?

Senkus

Cardoso

Kaidar‐Person

et al. 2021

Cancer Treatment Reviews

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“…As previously stated, good responses in the axilla after NET are rarely expected, so this might create more difficulties when carrying out a SLNB. Paradoxically, most surgeons seem to apply the same criteria to NET as they do to NCT [ 37 ]; however, the context of NCT and, above all, of the high-risk tumors treated in this way, does not seem applicable to NET, since any low-burden disease left in the axilla after NET may not significantly impact the prognosis, as pointed out by Kantor et al [ 37 , 38 ] These authors concluded that axillary management strategies employed with upfront-surgery patients may also be used with NET patients, which would mean that Z0011 criteria for avoiding AD may be safely applied.…”

Section: Clinical Implications Of Netmentioning

confidence: 99%

The Present and Future of Neoadjuvant Endocrine Therapy for Breast Cancer Treatment

Martí

Sánchez-Méndez

2021

Cancers

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Endocrine therapy (ET) has established itself as an efficacious treatment for estrogen receptor-positive (ER+) breast cancers, with a reduction in recurrence rates and increased survival rates. The pre-surgical approach with chemotherapy (NCT) has become a common form of management for large, locally advanced, or high-risk tumors. However, a good response to NCT is not usually expected in ER+ tumors. Good results with primary ET, mainly in elderly women, have encouraged studies in other stages of life, and nowadays neoadjuvant endocrine treatment (NET) has become a useful approach to many ER+ breast cancers. The aim of this review is to provide an update on the current state of art regarding the present and the future role of NET.

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“…According to the panel, if the sentinel lymph node (SN) is negative at the time of surgery, axillary dissection (AD) is not recommended, even in previously positive axilla. If the SN is positive, however, then course of action should be discussed on a case-by-case basis, especially after NET 48 .…”

Section: Managing Axilla After Neoadjuvant Systemic Therapymentioning

confidence: 99%

“…The data in this scenario is limited. A study using the NCDB and Dana-Farber/Brigham and Women's Cancer Center database evaluated tumor burden after NET and the type of axillary surgery performed (SNB or AD): more than 90% of patients who had cN0 axilla at initial presentation, in both cohorts, they had <3 positive lymph nodes in the final pathology, with no difference in overall survival regardless of the type of axillary surgery 48 . In another study, using the NCDB, for stages 2 and 3, SNB use after NET was similar to that for upfront surgery and, among those with pN1 disease, the NET patients were less likely to undergo AD 56 .…”

Section: Managing Axilla After Neoadjuvant Systemic Therapymentioning

confidence: 99%

Impact of COVID-19 in early breast cancer management: a summary of the current evidence

Fp¹,

Abdala²,

Weissmann³

et al. 2021

Preprint

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Purpose: An Expert Panel on Breast Cancer and COVID-19 was convened to address the impact of the COVID-19 pandemic for early breast cancer management. Methods: In order to ensure the most clinically relevant information was addressed, essential information was drawn from several of the latest national and international guidelines and another technical document. The Expert Panel met in five virtual closed sessions from November 2020 to May 2021 to consult on the relevant data from evidence-based results. The data gathered were discussed on an online platform (Within3 ®). Results: This paper reports the Expert Panel’s highlights of these meetings’ discussions. In addition, it provides practical recommendations covering topics regarding diagnosis, treatment, and management of breast cancer patients in clinical settings routinely encountered by HCPs amid the COVID-19 pandemic. Conclusions: It was provided guidance on several topics regarding eBC management amid the COVID-19 pandemics to inform safer care practices.

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Axillary Management After Neoadjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer

Cited by 35 publications

References 25 publications

De-escalation of axillary irradiation for early breast cancer – Has the time come?

De-escalation of axillary irradiation for early breast cancer – Has the time come?

The Present and Future of Neoadjuvant Endocrine Therapy for Breast Cancer Treatment

Impact of COVID-19 in early breast cancer management: a summary of the current evidence

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