Neoadjuvant chemotherapy in patients with breast cancer: Does response in the breast predict axillary node response?

Morgan, Catrin; Stringfellow, Thomas; Rolph, Rachel; Kovács, Tibor; Kothari, Ashutosh; Pinder, Sarah; Hamed, Hisham; Sever, Ali

doi:10.1016/j.ejso.2019.11.498

Cited by 12 publications

(14 citation statements)

References 25 publications

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“…This seems logical, although some studies have shown a differential response to treatment between the breast and axilla. Morgan and colleagues 29 found in a retrospective series that 12 (14%) of 83 patients with stage 1-2 breast cancer treated with neoadjuvant chemotherapy had a differential response in the breast and axilla; this is far higher than the rate in our series. Based on these results, we propose the algorithm depicted in Figure 2 going forward and encourage further study to bolster its use.…”

Section: Recherche E94contrasting

confidence: 74%

Predictors of axillary node response in node-positive patients undergoing neoadjuvant chemotherapy for breast cancer

Ladak

Chua

Lesniak

et al. 2022

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Background:The ability to accurately predict which patients will achieve a pathologic complete response (pCR) after neoadjuvant chemotherapy could help identify those who could safely be spared the potential morbidity of axillary lymph node dissection. We performed a retrospective analysis of a cohort of clinically node-positive patients managed with neoadjuvant chemotherapy with the goal of identifying predictors of axillary pCR.Methods: Eligible patients were aged 18 years or older, had clinical T1-T4, N1-N3, M0 breast cancer and received neoadjuvant chemotherapy followed by surgical axillary lymph node staging between 2001 and 2017 at Misericordia Hospital, Edmonton, Alberta. Patient data, including tumour characteristics, details of neoadjuvant chemotherapy, imaging results before and after neoadjuvant chemotherapy, and final pathologic analysis, were collected from the appropriate provincial electronic data repositories. We summarized the data using descriptive statistics. We characterized associations between clinical/tumour characteristics and pCR using univariate and multivariate regression analysis.Results: Of the 323 patients included in the study, 130 (40.2%) achieved axillary pCR. Absence of residual disease in the breast was associated with axillary pCR (odds ratio 6.74, 95% confidence interval 2.89-15.67). HER2-positive, triple-negative and ER-positive/PR-negative/HER2-negative tumours were significantly associated with a pCR on univariate analysis; the association trended toward significance on multivari ate analysis.

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Section: Recherche E94contrasting

confidence: 74%

Predictors of axillary node response in node-positive patients undergoing neoadjuvant chemotherapy for breast cancer

Ladak

Chua

Lesniak

et al. 2022

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“…Morgan et al [23] showed similar results in their study which included 83 patients with pathological axillary lymph nodes who received NACT. Twenty-one patients had pCR in the breast.…”

Section: Discussionsupporting

confidence: 52%

The implications of a pathological complete response of the primary tumour after neoadjuvant chemotherapy for breast cancer on axillary surgery

Youssef

Manie

2021

J Egypt Natl Canc Inst

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Background Management of the node-positive axilla after neoadjuvant chemotherapy is controversial. The aim of this study is to predict the group of patients who may require a less invasive approach for axillary management. One possible group are patients with pathological complete response of the primary after chemotherapy. Results A unicentral retrospective cohort study including all breast cancer patients with axillary node metastases at presentation who received neoadjuvant chemotherapy resulting in pathological complete response. Pathological complete response in the axillary lymph nodes was recorded. A correlation between the response in the primary tumour and the lymph nodes was assessed. A subgroup analysis was conducted for different biological groups. Complete response was seen in the axillary nodes in 80.5% of patients. Patients with lobular cancer were less likely to show a similar response in the axilla as the primary tumour (p = 0.077). A higher incidence of axillary response was observed in HER2-positive tumours (p = 0.082). All patients with grade 3 tumours achieved complete response in the axilla (p = 0.094). Patients with negative or weak positive hormone receptor status had a significantly higher rate of complete response in the axilla compared to strongly positive hormone receptor status (OR, 7.8; 95% CI, 1.7–34.5; p = 0.007). Conclusion A less invasive axillary surgery may be safely recommended in selected group of node-positive patients after neoadjuvant chemotherapy when the primary tumour shows complete response. This group may include HER2-positive, ER-negative and grade 3 tumours. Less response is expected in ER-positive and lobular carcinoma even with complete response in the primary.

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“…A recent retrospective study concluded that breast rCR and pCR were poor predictors of axillary response [15]; however, this may also depend on the specific breast cancer subtype [16,17]. To the best of our knowledge, no previous studies have specifically investigated the role of early lymph node progression during NACT for breast cancer or any other cancer.…”

Section: Discussionmentioning

confidence: 99%

Early progression of breast cancer during neoadjuvant chemotherapy may predict poorer prognoses

et al. 2020

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Background: In Finland, breast cancers treated with neoadjuvant chemotherapy (NACT) are usually locally advanced and/or have an inflammatory phenotype. We evaluated early NACT responses in breast tumours and lymph nodes and their correlation with survival. Material and methods: We collected a retrospective dataset of 145 patients with very high-risk but non-metastasised breast cancers that were treated with NACT in a Finnish University Hospital between September 2013 and January 2019. The patients underwent magnetic resonance imaging (MRI) scans before beginning NACT and after every second NACT cycle thereafter. Results: The total pathological complete response rate was only 10.7% and breast cancer-specific survival (BCSS) at 24 months was 93.0%. The 2-year breast cancer-specific survival (BCSS) rate was 93.0%, but this varied from 86.5% for the triple-negative subtype to 100.0% for the luminal Alike subtype. Enlargement of the malignant axillary lymph nodes during the first two NACT cycles was associated with poor BCSS rates in HER2-negative patients (p ¼ .00003 in the univariate analysis; hazard ratio ¼ 26.3; 95% confidence interval ¼ 2.66-259.6; p ¼ .005 in the multivariate analysis). Furthermore, progression in the combined diameters of the breast tumours and axillary lymph nodes during the period between a patient's pre-treatment MRI and her MRI after two NACT cycles was also correlated with worse BCSS rates in both univariate and multivariate analyses. Conclusions: An early MRI assessment after two NACT cycles, specifically of the tumour's axillary lymph nodes, has the potential to predict short-term BCSS in patients with locally advanced HER2negative breast cancers.

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Neoadjuvant chemotherapy in patients with breast cancer: Does response in the breast predict axillary node response?

Cited by 12 publications

References 25 publications

Predictors of axillary node response in node-positive patients undergoing neoadjuvant chemotherapy for breast cancer

Predictors of axillary node response in node-positive patients undergoing neoadjuvant chemotherapy for breast cancer

The implications of a pathological complete response of the primary tumour after neoadjuvant chemotherapy for breast cancer on axillary surgery

Early progression of breast cancer during neoadjuvant chemotherapy may predict poorer prognoses

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