Miguel Bronchud, Co-Founder and Advisory Board at Regenerative Medicine Solutions, shared a post on LinkedIn:
“What to do with axillary lymph nodes in breast cancer following successful or partially successful neo adjuvant treatment?
The feasibility and safety of axillary surgery de-escalation in patients with breast cancer who are at high risk of arm morbidity after ALND is an important clinical question.
For patients with breast cancer who undergo surgery as the first step in their treatment, randomised clinical trials have demonstrated no benefit of axillary lymph node dissection (ALND) in patients with micrometastases and macrometastases in 1 or 2 sentinel lymph nodes. In the neoadjuvant chemotherapy setting, omission of ALND in patients with nodal complete pathological response or residual isolated tumour cells after neoadjuvant chemotherapy does not affect oncological outcomes, but whether this is the case for patients with residual micrometastases and macrometastases is unknown.
Title: Oncological outcomes with and without axillary lymph node dissection in patients with residual micrometastases after neoadjuvant chemotherapy (OPBC-07/microNAC): an international, retrospective cohort study
Authors: Giacomo Montagna, Michael Alvarado, Sara Myers, Mary M Mrdutt, Susie X Sun, Varadan Sevilimedu, Andrea V Barrio, Astrid Botty van den Bruele, Judy C Boughey, Marissa K Boyle, Angelena Crown, Susan B Kesmodel, Tari A King, Henry M Kuerer, Elmore C Leisha, Tracy-Ann Moo, Anna Weiss, Austin D Williams, Priyanka Parmar, Brian Diskin, Callie Hlavin, Emilia J Diego, Natália Polidorio, Khaled Abdelwahab, Maggie Banys-Paluchowski, Christian Kurzeder, Martin Heidinger, Maite Goldschmidt, Alexandra Schulz, Jörg Heil, Güldeniz Karadeniz Cakmak, Nina Pislar, Margit Riis, Ipshita Prakash, Valentina Ovalle, M Umit Ugurlu, Gianluca Franceschini, Emelyanov Alexander Sergeevich, Javier Morales, Han-Byoel Lee, Viviana Galimberti, Sung Gwe Ahn, Jai Min Ryu, Mahmut Muslumanoglu, Neslihan Cabıoğlu, Tae-Kyung Robyn Yoo, Marie-Jeanne Vrancken Peeters, Massimo Ferrucci, Monica Morrow, Walter P Weber
Read the Full Article on The Lancet Oncology
While waiting for the results from prospective trials- Like : Weber, W ∙ Heidinger, M ∙ Hayoz, S ∙ et al.
Impact of imaging-guided localization on performance of tailored axillary surgery in patients with clinically node-positive breast cancer: prospective cohort study within TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101) Ann Surg Oncol. 2023; 31:344-355
Results might affect change in clinical practice, the authors of the OPBC-07/microNAC study just published in The Lancet attempt to provide some answers.
In The Lancet Oncology, Giacomo Montagna and colleagues report the results of the large international retrospective OPBC-07/microNAC study, comparing the oncological outcomes and 3-year axillary recurrence rate for 1585 patients with breast cancer and residual micrometastases at axillary staging after neoadjuvant chemotherapy with and without completion axillary lymph node dissection (ALND)
Title: Micrometastatic axillary disease after neoadjuvant treatment
Author: Tove Filtenborg Tvedskov
Read the Full Article on The Lancet Oncology
OPBC-07/microNAC was a retrospective cohort study, using data obtained from the institutional databases of 84 cancer centres in 30 countries.
Patients aged 18 years or older with clinical T1–4, N0–3 breast cancer at diagnosis treated with neoadjuvant chemotherapy followed by surgery between Jan 1, 2013, and May 31, 2023, who were found to have residual micrometastases (metastasis measuring >0·2 mm or >200 cells, not exceeding 2·0 mm in size) on frozen section or on final paraffin sections as determined by sentinel lymph node biopsy, targeted axillary dissection (sentinel lymph node biopsy with single or dual-tracer mapping plus image-guided localisation of the initially biopsy-proven and clipped node), or the marking axillary lymph nodes with radioactive iodine seeds (MARI) procedure were eligible for inclusion
Take home message is beware of triple negative breast cancer with residual axillary lymph nodes and micro metastatic tumors-Overall, these results do not support ALND for all patients with ypN1mi on sentinel lymph node biopsy treated with nodal radiotherapy but tumour biology should be taken into account.”
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