ASO Author Reflections: Neoadjuvant Systemic Therapy and Nodal Management in cT1-2 N0 Triple-Negative Breast Cancer

Excerpt

Neoadjuvant chemotherapy (NAC) for breast cancer has traditionally been used to downstage the primary breast tumor in an effort to facilitate breast-conserving surgery or to downstage the clinically positive axilla in hopes of sparing those who have a pathologic complete response the morbidity of an axillary lymph node dissection (ALND). More recent advances in systemic therapy have resulted in improved pathologic complete response rates and improved survival outcomes among patients with triple-negative breast cancer (TNBC) but require an NAC approach to assess disease response and dictate the role for additional adjuvant therapy.¹ Secondary to these systemic therapy paradigm shifts for TNBC, recent national data have revealed a shift towards a NAC approach for most patients with cT1c and cT2 clinically node-negative (cN0) TNBC.² The concern has been raised that using NAC for TNBC patients with cT1–T2 cN0 may increase the likelihood these patients may receive ALND if they are found to actually harbor clinically occult nodal metastasis and are found to be pathologically node-positive (pN+) after NAC. …