ASO Author Reflections: Using Tumor Genomics to Predict Axillary Response to Chemotherapy in Breast Cancer

Excerpt

Recent clinical trials have established that patients with limited node-positive breast cancer who achieve complete pathologic response (pCR) to neoadjuvant chemotherapy may omit formal axillary node dissection.1 For appropriately selected cases, use of sentinel lymph node biopsy/targeted axillary dissection following chemotherapy may identify patients who can safely avoid more invasive axillary surgery. Although advancements in surgical technique allow for potentially less morbid surgical procedures, the ability to reliably identify patients suitable for conservative axillary management following chemotherapy remains a difficult endeavor. The assessment of tumor genomics using Oncotype DX^® RS has proven valuable in customizing decisions around adjuvant chemotherapy. However, the role of genomic assays in predicting nodal response to neoadjuvant chemotherapy remains uncertain.2 We postulated that the use of Oncotype DX^® RS in the neoadjuvant setting might provide a more precise approach to patient selection for axillary management. Therefore, we explored the predictive capability of the multigene assay to determine axillary pCR after neoadjuvant chemotherapy. …