Neoadjuvant chemotherapy and timing of sentinel lymph node biopsy in different molecular subtypes of breast cancer with clinically negative axilla

Zhao, Bin; Liu, Jingjing; Chen, Peng; Liu, Yanbing; Zhao, Tong; Wang, Chunjian; Zhang, Zhaopeng; Sun, Xiao; Qiu, Pengfei; Cong, Bin; Song, Xianrang; Wang, Yongsheng

doi:10.1007/s12282-018-00934-3

Cited by 20 publications

(27 citation statements)

References 11 publications

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“…In our survey, molecular profiling influenced the decision of SLNB instead of ALND in breast cancer patients getting an axillary complete pathological response after NAC in approximately one‐third (26.3%) of the responders. A recent study showed that patients with TN and HER2+ breast tumors and clinically node‐positive disease achieve higher rates of pathologic complete response (PCR) after NAC when compared to hormone receptor‐positive/HER2 negative subtypes 19 …”

Section: Discussionmentioning

confidence: 99%

“…The risk for missing nodal metastasis in these subtypes is lower than in hormone‐positive tumors and concerns about FNR or even avoiding axillary surgery might be considered for hormone‐positive subtypes 20,21 . Patients diagnosed with TN and HER2 positive tumor and clinically negative‐node disease also benefit more from a de‐escalation of axillary surgery after chemotherapy demonstrating lower rates of positive SLNs 19,22 . New studies focusing on the influence of tumor molecular profiling in axilla management after NAC in Brazilian practice might better explain the knowledge of breast surgeons on the subject, and in which cases they are indicating SLNB.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed that patients with TN and HER2+ breast tumors and clinically node-positive disease achieve higher rates of pathologic complete response (PCR) after NAC when compared to hormone receptor-positive/HER2 negative subtypes. 19 Breast PCR is highly correlated with axillary PCR after NAC in HER2+ and TN disease. The risk for missing nodal metastasis in these subtypes is lower than in hormone-positive tumors and concerns about FNR or even avoiding axillary surgery might be considered for hormone-positive subtypes.…”

Section: Avoiding Axillary Dissection With Positive Slnb After Nacmentioning

confidence: 98%

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Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey among Brazilian breast surgeons

Frasson

Resende²,

Lichtenfels

et al. 2020

Journal of Surgical Oncology

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Background: Currently, there are broadly differing patterns in the management of the axilla after neoadjuvant chemotherapy (NAC) and no consensus with clinically strong evidence on the subject. A survey was performed to assess the current axillary management after NAC among Brazilian breast cancer surgeons. Methods: The Brazilian Society of Mastology members were invited by email to complete an anonymous online survey and a total of 426 responses were collected. How to cite this article: Frasson AL, Resende HM, Lichtenfels M, et al. Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey among Brazilian breast surgeons.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Avoiding Axillary Dissection With Positive Slnb After Nacmentioning

confidence: 98%

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Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey among Brazilian breast surgeons

Frasson

Resende²,

Lichtenfels

et al. 2020

Journal of Surgical Oncology

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“…Editorial Bi, Liu, Chen, Song & Wang of ALND in the hormone receptor positive/HER-2 negative (HR+/HER2-) subtype (hazard ratio [HR]: 3.35; p < 0.001), whereas NAC versus upfront mastectomy remained significantly associated with lower odds of ALND in the HER2+ and TN subtypes (HR: 0.19, p < 0.001; HR: 0.25, p = 0.007, respectively) [13]. And in our study, we thought that combined with the results of AMAROS and ASCOG Z0011 trial, the rate of avoiding ALND when performing SLNB after NAC was associated with the axillary pCR (apCR) rate after NAC.…”

mentioning

confidence: 99%

“…And in our study, we thought that combined with the results of AMAROS and ASCOG Z0011 trial, the rate of avoiding ALND when performing SLNB after NAC was associated with the axillary pCR (apCR) rate after NAC. Our recent study showed that in patients with cN 0 disease, the rate of pathological lymph node positive (ypN + ) after NAC was 19.4% (13/67), and it was 28.1, 13.3 and 10.0%, respectively, among HR+/HER2-, HER2+ and TN patients [13]. The rates of ypN 0 after NAC in patients with HER2+ and TN were 90.0% (18/20) and 86.7% (13/15), respectively, which were significantly higher than HR+/HER2-patients (71.8%, 23/32).…”

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confidence: 99%

The Time of Sentinel Lymph Node Biopsy and Neoadjuvant Chemotherapy in Clinical Negative Axilla Breast Cancer: Before or After?

et al. 2019

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Response to Treatment, Racial and Ethnic Disparity, and Survival in Patients With Breast Cancer Undergoing Neoadjuvant Chemotherapy in the US

et al. 2023

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ImportanceWith the increasing delivery of neoadjuvant chemotherapy (NACT) for patients with breast cancer in the US, it is important to know whether there is differential response to NACT by race and ethnicity and the potential long-term outcomes.ObjectiveTo examine whether there were any racial and ethnic differences in pathologic complete response (pCR) rate following NACT and, if so, whether they varied by molecular subtype and were associated with survival.Design, Setting, and ParticipantsA retrospective cohort study was conducted including patients with stage I to III breast cancer diagnosed between January 2010 and December 2017 who underwent surgery and received NACT; median follow-up was 5.8 years, and data analysis was conducted from August 2021 to January 2023. Data were obtained from the National Cancer Data Base, a nationwide, facility-based, oncology data set that captures approximately 70% of all newly diagnosed cases of breast cancer in the US.Main Outcomes and MeasuresPathologic complete response, defined as ypT0/Tis ypN0, was modeled using logistic regression. Racial and ethnic differences in survival were analyzed using a Weibull accelerated failure time model. Mediation analysis was conducted to measure whether racial and ethnic differences in the pCR rate affect survival.ResultsThe study included 107 207 patients (106 587 [99.4%] women), with a mean (SD) age of 53.4 (12.1) years. A total of 5009 patients were Asian or Pacific Islander, 18 417 were non-Hispanic Black, 9724 were Hispanic, and 74 057 were non-Hispanic White. There were significant racial and ethnic differences in pCR rates, but the differences were subtype-specific. In hormone receptor–negative (HR−)/erb-b2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)–positive (ERBB2+) subtype, Asian and Pacific Islander patients achieved the highest pCR rate (56.8%), followed by Hispanic (55.2%) and non-Hispanic White (52.3%) patients with the lowest pCR rate seen in Black patients (44.8%). In triple-negative breast cancer, Black patients had a lower pCR rate (27.3%) than other racial and ethnic groups (all &gt;30%). In HR+/ERBB2− subtype, Black patients had a higher pCR rate (11.3%) than other racial/ethnic groups (all ≤10%). In mediation analysis, racial and ethnic differences in achieving pCR after NACT could explain approximately 20% to 53% of the subtype-specific survival differences across racial and ethnic groups.Conclusions and RelevanceIn this cohort study of patients with breast cancer receiving NACT, Black patients had a lower pCR rate for triple-negative and HR−/ERBB2+ breast cancer but a higher pCR rate for HR+/ERBB2− diseases, whereas Asian and Pacific Islander patients had a higher pCR rate for HR−/ERBB2+ diseases. Tumor grade and ERBB2 copy number could account for some of these within-subtype disparities, but further studies are warranted. Inability to achieve a pCR can mediate in part, but not entirely, the worse survival outcomes experienced by Black patients.

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Neoadjuvant chemotherapy and timing of sentinel lymph node biopsy in different molecular subtypes of breast cancer with clinically negative axilla

Cited by 20 publications

References 11 publications

Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey among Brazilian breast surgeons

Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey among Brazilian breast surgeons

The Time of Sentinel Lymph Node Biopsy and Neoadjuvant Chemotherapy in Clinical Negative Axilla Breast Cancer: Before or After?

Response to Treatment, Racial and Ethnic Disparity, and Survival in Patients With Breast Cancer Undergoing Neoadjuvant Chemotherapy in the US

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