ASO Author Reflections: Tailoring Axillary Surgery After Neoadjuvant Endocrine Therapy for Breast Cancer

Excerpt

Although neoadjuvant chemotherapy (NAC) is an excellent approach to downstaging of breast cancer for triple-negative or human epidermal growth factor receptor 2 (HER2)-positive subtypes, a complete response is uncommon in hormone receptor-positive HER2-negative (HR+HER2–) breast cancer. An alternate approach, neoadjuvant endocrine therapy (NET), is gaining popularity, especially as more is learned about which HR+HER2– tumors may not benefit from adding adjuvant chemotherapy to endocrine therapy. Data from clinical trials suggest that NET is similar to NAC in terms of downstaging the tumor in the breast and achieving breast conservation.1 However, axillary downstaging is rare. After NAC, the standard of care for residual nodal disease is axillary lymph node dissection (ALND). Although this strategy often is extrapolated to patients after NET, little data exist to guide axillary management for these patients. …