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Factors Associated with Nodal Pathologic Complete Response Among Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: Results of CALGB 40601 (HER2+) and 40603 (Triple-Negative) (Alliance).

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Weiss, A; Campbell, J; Ballman, KV; Sikov, WM; Carey, LA; Hwang, ES; Poppe, MM; Partridge, AH; Ollila, DW; Golshan, M
Published in: Ann Surg Oncol
October 2021

BACKGROUND: De-escalation of axillary surgery after neoadjuvant chemotherapy (NAC) requires careful patient selection. We seek to determine predictors of nodal pathologic complete response (ypN0) among patients treated on CALGB 40601 or 40603, which tested NAC regimens in HER2+ and triple-negative breast cancer (TNBC), respectively. PATIENTS AND METHODS: A total of 760 patients with stage II-III HER2+ or TNBC were analyzed. Those who had axillary surgery before NAC (N = 122), or who had missing pretreatment clinical nodal status (cN) (N = 58) or ypN status (N = 41) were excluded. The proportion of patients with ypN0 disease was estimated for those with and without breast pathologic complete response (pCR) according to pretreatment nodal status. RESULTS: In 539 patients, the overall ypN0 rate was 76.3% (411/539) to 93.2% (245/263) in patients with breast pCR and 60.1% (166/276) with residual breast disease (RD) (P < 0.0001). For patients who were cN0 pretreatment, the ypN0 rate was 88.8% (214/241), 96.3% (104/108) with breast pCR, and 82.7% (110/133) with RD. For patients who were cN1, 66.2% (157/237) converted to ypN0, 91.7% (111/121) with breast pCR and 39.7% (46/116) with RD. For patients who were cN2/3, 65.6% (40/61) converted to ypN0, 88.2% (30/34) with breast pCR and 37.0% (10/27) with RD. On multivariable analysis, only pretreatment clinical nodal status and breast pCR/RD were associated with ypN0 status (both P < 0.0001). CONCLUSIONS: Breast pCR and pretreatment nodal status are predictive of ypN0 axillary nodal involvement, with < 5% residual nodal disease among cN0 patients who experience breast pCR. These findings support the incorporation of axillary surgery de-escalation strategies into NAC trials.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2021

Volume

28

Issue

11

Start / End Page

5960 / 5971

Location

United States

Related Subject Headings

  • Triple Negative Breast Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm, Residual
  • Neoadjuvant Therapy
  • Humans
  • Female
  • Breast Neoplasms
  • Axilla
  • Antineoplastic Combined Chemotherapy Protocols
  • 3211 Oncology and carcinogenesis
 

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Weiss, A., Campbell, J., Ballman, K. V., Sikov, W. M., Carey, L. A., Hwang, E. S., … Golshan, M. (2021). Factors Associated with Nodal Pathologic Complete Response Among Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: Results of CALGB 40601 (HER2+) and 40603 (Triple-Negative) (Alliance). In Ann Surg Oncol (Vol. 28, pp. 5960–5971). United States. https://doi.org/10.1245/s10434-021-09897-w
Weiss, Anna, Jordan Campbell, Karla V. Ballman, William M. Sikov, Lisa A. Carey, E Shelley Hwang, Matthew M. Poppe, Ann H. Partridge, David W. Ollila, and Mehra Golshan. “Factors Associated with Nodal Pathologic Complete Response Among Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: Results of CALGB 40601 (HER2+) and 40603 (Triple-Negative) (Alliance).” In Ann Surg Oncol, 28:5960–71, 2021. https://doi.org/10.1245/s10434-021-09897-w.
Weiss A, Campbell J, Ballman KV, Sikov WM, Carey LA, Hwang ES, Poppe MM, Partridge AH, Ollila DW, Golshan M. Factors Associated with Nodal Pathologic Complete Response Among Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: Results of CALGB 40601 (HER2+) and 40603 (Triple-Negative) (Alliance). Ann Surg Oncol. 2021. p. 5960–5971.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2021

Volume

28

Issue

11

Start / End Page

5960 / 5971

Location

United States

Related Subject Headings

  • Triple Negative Breast Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm, Residual
  • Neoadjuvant Therapy
  • Humans
  • Female
  • Breast Neoplasms
  • Axilla
  • Antineoplastic Combined Chemotherapy Protocols
  • 3211 Oncology and carcinogenesis