Axillary Management after Neoadjuvant Endocrine Therapy (NET).

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.