Tailored axillary surgery - A novel concept for clinically node positive breast cancer

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Axillary lymph node dissection (ALND) remains standard for node-positive breast cancer.
• Neoadjuvant systemic treatment (NST) can achieve nodal pathologic complete response (pCR), potentially avoiding ALND, but pCR rates vary by tumor biology.
• Luminal tumors, though common, have lower pCR rates, necessitating alternative strategies.

Purpose of the Study:

• To investigate the safety and efficacy of omitting ALND in clinically node-positive breast cancer patients.
• To evaluate tailored axillary surgery (TAS) followed by radiotherapy as an alternative to ALND.
• To assess disease-free survival, morbidity, and quality of life in patients undergoing TAS versus standard ALND.

Main Methods:

• The TAXIS trial is a non-inferiority study randomizing 1500 patients.
• Patients are either treated with NST or undergo upfront surgery.
• All patients receive tailored axillary surgery (TAS) including removal of biopsied, clipped, sentinel, and suspicious nodes, followed by axillary radiotherapy.

Main Results:

• Feasibility of TAS was confirmed in a preliminary TAXIS substudy.
• Patient accrual is ongoing, with 663 of 1500 patients randomized as of the report.
• The trial aims to determine if TAS can be safely substituted for ALND, particularly in challenging cases.

Conclusions:

• The TAXIS trial is pioneering surgical de-escalation for clinically node-positive breast cancer, including those with residual disease post-NST or in the upfront setting.
• Investigating TAS followed by radiotherapy addresses the need for less morbid axillary staging in a high-risk population.
• Projected completion in 2025, the trial's findings will be crucial for refining breast cancer treatment guidelines.