Ankur Mehta, Medical Oncologist at Dana-Farber Cancer Institute, shared a post on X about a paper by Tove Filtenborg Tvedskov published in The Lancet Oncology:
“Micrometastatic axillary disease after neoadjuvant treatment – The Lancet Oncology
Post NACT, ypN1mi.
Study asks if ALND reduces axillary recurrence at 3 years.
Current SOC- SLND, targeted axillary dissection (TAD) + Regional Nodal Irradiation (RNI) if ypN1mic
Key takeaways
- 3 y Axillary Recurrence (Primary endpoint) 2.0% (low)
- 1.7% with ALND vs 2.3% w/o ALND (P=0.92)
- overall safe to omit completion of ALND in most, NOT ALL!
- in TNBC. 8.7% risk of recurrence at 3 yr (without ALND) vs 2.4% (with ALND), P=0.018. HR 3.83
- omission of Nodal XRT in all HR 2.62.
Practice affirming – in Non TNBC, safe to omit ALND but favor RNI.
In TNBC clearly need for RNI, and caution in omitting completion of ALND.
- Large sample size(1585 pts), multicenter, diverse groups of histology, stages included.
- limitations-retrospective? possible bias if low-risk pts selected for omission of ALND. Short f/u especially HR+ve pts with potential late recurrences.”
Title: Micrometastatic axillary disease after neoadjuvant treatment
Author: Tove Filtenborg Tvedskov
You can read the Full Article in The Lancet Oncology.
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