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Axillary Management after Neoadjuvant Endocrine Therapy (NET).

Laura Leonard1, Min Yi1, Emma Wingate1

  • 1Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

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|December 27, 2025
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Summary

Neoadjuvant endocrine therapy (NET) is safe for hormone receptor-positive breast cancer, showing a low 5-year local-regional recurrence rate. Axillary management strategies can be optimized post-NET, even with positive lymph nodes.

Keywords:
AxillaBreast cancerNeoadjuvant endocrine therapy (NET)

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Area of Science:

  • Oncology
  • Breast Cancer Research
  • Endocrine Therapy

Background:

  • Optimal axillary management strategies after neoadjuvant endocrine therapy (NET) for hormone receptor-positive (HR+), HER2-negative breast cancer lack sufficient data.
  • Hormone receptor-positive breast cancer treatment requires tailored approaches, especially after neoadjuvant therapies.

Purpose of the Study:

  • To evaluate axillary management strategies and oncologic outcomes in patients with HR+, HER2-negative breast cancer treated with NET.
  • To assess the safety and efficacy of NET in managing axillary disease in this patient population.

Main Methods:

  • Retrospective review of 230 patients with clinical stage I-III, HR+ breast cancer who received >90 days of NET.
  • Analysis of axillary procedures including sentinel lymph node dissection (SLND) and axillary lymph node dissection (ALND).
  • Evaluation of local-regional recurrence (LRR), distant recurrence, and overall survival (OS) rates.

Main Results:

  • A total of 230 patients were analyzed; 120 were clinically node-negative (cN0) and 110 were clinically node-positive (cN+).
  • The 5-year LRR rate was 2.2% for the entire cohort, with no significant difference between cN0 and cN+ groups (2.0% vs. 2.2%, p >0.05).
  • Distant recurrence was higher in cN+ patients (15.0% vs. 6.9%, p=0.03), and 5-year OS was 79.5% (cN0: 88.4% vs. cN+: 69.7%, p=0.004).

Conclusions:

  • Neoadjuvant endocrine therapy (NET) demonstrates oncologic safety for HR+ breast cancer, including cases with large tumors and positive lymph nodes.
  • The extremely low 5-year LRR rate supports NET as a viable strategy, even in node-positive patients.
  • Further research into tailored axillary management post-NET is warranted to optimize outcomes.