Background: Randomized trials have shown that axillary clearance (AC) can safely be omitted in patients with sentinel lymph node-positive breast cancer. At the same time, de-escalation of chemotherapy in postmenopausal patients with ER+HER2− breast cancer may depend on detailed axillary nodal stage. The aim of this pre-specified secondary analysis of the SENOMAC trial was to investigate whether the choice of axillary staging affected the proportion of patients receiving adjuvant chemotherapy, and recurrence-free survival (RFS). Methods: Proportion receiving adjuvant chemotherapy was calculated according to AC or sentinel lymph node biopsy (SLNB) only, menopausal status, and region of inclusion, for 2168 patients with clinically node-negative ER+HER2− breast cancer and 1–2 sentinel lymph node macrometastases included in the SENOMAC trial. Findings: In premenopausal patients, 514 out of 615 patients (83.6%) received adjuvant chemotherapy with no significant difference between randomization arms. In postmenopausal patients, the proportion receiving chemotherapy varied considerably by region and country (36.0–82.4%). In Denmark, where 194 out of 539 postmenopausal patients (36.0%) received adjuvant chemotherapy, rates differed significantly between the AC and the SLNB only arm (41.3% vs 31.4%, p = 0.019). After a median follow-up of 44.88 months for Danish postmenopausal patients, no significant difference was seen in 5-year RFS, which was 91% (85.6%–96.6%) for the SLNB only and 90.9% (86.3%–95.6%) for the AC arm (p = 0.42). Interpretation: When omitting axillary clearance, and thus reducing the risk of long-term arm morbidity, potential under-treatment of postmenopausal patients with ER+HER2− breast cancer may require the development of new predictive and imaging tools. Funding: Swedish Research Council, Swedish Cancer Society, Nordic Cancer Union, Swedish Breast Cancer Association.
Axillary clearance and chemotherapy rates in ER+HER2− breast cancer: secondary analysis of the SENOMAC trial / Tvedskov, T. F.; Szulkin, R.; Alkner, S.; Andersson, Y.; Bergkvist, L.; Frisell, J.; Gentilini, O. D.; Kontos, M.; Kuhn, T.; Lundstedt, D.; Offersen, B. V.; Bagge, R. O.; Reimer, T.; Sund, M.; Ryden, L.; Christiansen, P.; De Boniface, J.; Norenstedt, S.; Sackey, H.; Celebioglu, F.; Patil, E. V.; Warnberg, F.; Wedin, M.; Falck, A. -K.; Erngrund, M.; Nyman, P.; Wallberg, M.; Ahsberg, K.; Wangblad, C.; Holsti, C.; Myrskog, L.; Starck, E.; Lindwall, K. A.; Wadsten, C.; Bjorkman, J.; Malterling, R. R.; Sigvardsson, J. L.; Svensjo, T.; Handler, J.; Hoyer, U.; Carstensen, L.; Filtenborg, T. T.; Soe, K. L.; Balling, E.; Hansen, L. B.; Kjaer, C.; Andersen, I. S.; Bonatz, G.; Kuhn, C.; Stachs, A.; Camara, O.; Hausmuller, S.; Polata, S.; Stefek, A.; Ollig, S.; Eichler, H.; Muller, T.; Franzen, A.; Ledwon, P.; Hammerle, C.; Schwickardi, G. F.; Lindner, C.; Schirrmeister, S.; Renner, S.; Perez, S.; Strittmatter, H. -J.; Hahn, A.; Keller, M.; Nixdorf, A.; Ohlinger, R.; Fischer, D.; Brucker, S.; Gatzweiler, A.; Melnichuk, L.; Seldte, J. -P.; Kontzoglou, K.; Askoxylakis, I.; Metaxas, G.; Faliakou, E.; Poulakaki, N.; Venizelos, V.; Kaklamanos, I.; Michalopoulos, N.; Gentilini, O.; Galimberti, V.; Fogazzi, G.; Cristofolini, P.; Garcia-Etienne, C.; Fucito, A.. - In: THE LANCET REGIONAL HEALTH. EUROPE. - ISSN 2666-7762. - 47:(2024). [10.1016/j.lanepe.2024.101083]
Axillary clearance and chemotherapy rates in ER+HER2− breast cancer: secondary analysis of the SENOMAC trial
Gentilini O. D.;Gentilini O.;
2024-01-01
Abstract
Background: Randomized trials have shown that axillary clearance (AC) can safely be omitted in patients with sentinel lymph node-positive breast cancer. At the same time, de-escalation of chemotherapy in postmenopausal patients with ER+HER2− breast cancer may depend on detailed axillary nodal stage. The aim of this pre-specified secondary analysis of the SENOMAC trial was to investigate whether the choice of axillary staging affected the proportion of patients receiving adjuvant chemotherapy, and recurrence-free survival (RFS). Methods: Proportion receiving adjuvant chemotherapy was calculated according to AC or sentinel lymph node biopsy (SLNB) only, menopausal status, and region of inclusion, for 2168 patients with clinically node-negative ER+HER2− breast cancer and 1–2 sentinel lymph node macrometastases included in the SENOMAC trial. Findings: In premenopausal patients, 514 out of 615 patients (83.6%) received adjuvant chemotherapy with no significant difference between randomization arms. In postmenopausal patients, the proportion receiving chemotherapy varied considerably by region and country (36.0–82.4%). In Denmark, where 194 out of 539 postmenopausal patients (36.0%) received adjuvant chemotherapy, rates differed significantly between the AC and the SLNB only arm (41.3% vs 31.4%, p = 0.019). After a median follow-up of 44.88 months for Danish postmenopausal patients, no significant difference was seen in 5-year RFS, which was 91% (85.6%–96.6%) for the SLNB only and 90.9% (86.3%–95.6%) for the AC arm (p = 0.42). Interpretation: When omitting axillary clearance, and thus reducing the risk of long-term arm morbidity, potential under-treatment of postmenopausal patients with ER+HER2− breast cancer may require the development of new predictive and imaging tools. Funding: Swedish Research Council, Swedish Cancer Society, Nordic Cancer Union, Swedish Breast Cancer Association.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
