SABCS 2016: Axillary Lymph Node Dissection Might Be Avoidable for Certain Early-Stage Breast Cancer Patients Receiving Neoadjuvant Chemotherapy
A sentinel lymph node biopsy during surgery that showed no signs of cancer was associated with a low risk for breast cancer recurrence in the axillary lymph nodes for patients with large, operable breast tumors and no clinical signs of the cancer in the axillary lymph nodes prior to neoadjuvant chemotherapy, according to data from the GANEA 2 clinical trial presented at the 2016 San Antonio Breast Cancer Symposium, held December 6–10 (Abstract S2-07).
“Axillary lymph node dissection … is often performed to check whether a patient’s cancer has spread outside the breast after neoadjuvant chemotherapy,” said Jean-Marc Classe, MD, PhD, Head of Surgery at the Institut de Cancerologie de l’Ouest René Gauducheau in Nantes, France. “[Axillary lymph node dissection] has a high risk for serious complications and long-term sequelae. So we wanted to assess the feasibility and safety of the less invasive procedure of sentinel lymph node biopsy for patients treated with neoadjuvant chemotherapy for a large breast cancer,” he explained.
“We found that for patients with no proof of cancer in the axillary lymph nodes before neoadjuvant chemotherapy, [sentinel lymph node biopsy] during the surgery after neoadjuvant chemotherapy was safe because those who had a negative [sentinel lymph node biopsy] and did not have an [axillary lymph node dissection] had a very low risk of an axillary relapse at 3 years after surgery,” continued Dr. Classe, who is also Professor of Oncology at the Medical University in Nantes. “We had expected more axillary lymph node relapses than we observed, so this is very exciting and will hopefully mean that more patients are spared the potential complications of invasive [axillary lymph node dissection].”
GANEA 2 Details
Dr. Classe and colleagues enrolled in the trial 590 patients with large, operable breast tumors who had no cancer in the lymph nodes as determined by axillary sonography with fine needle cytology. All patients received neoadjuvant chemotherapy, and then underwent surgery and sentinel lymph node biopsy.
Cancer cells were detected in the sentinel lymph node biopsy samples from 139 patients. These patients all then underwent axillary lymph node dissection. No cancer cells were detected in the sentinel lymph node biopsy samples from 432 patients. Among these 432 patients, follow-up was available for 416. Median follow-up for these patients was 35.8 months.
At 3 years, disease-free survival in the patients who had no cancer in the sentinel lymph node biopsy sample and, therefore, did not receive axillary lymph node dissection was 94.8%. One patient had homolateral axillary lymph node relapse. The other nine relapses were metastatic (n = 3) or recurrences in the breasts (n = 6). The overall survival rate was 98.7%.
“The disease-free and overall survival results we observed for the patients who underwent only a [sentinel lymph node biopsy] after neoadjuvant chemotherapy are comparable with the historical survival rates for patients in this situation who have [axillary lymph node dissection] rather than [sentinel lymph node biopsy],” said Dr. Classe. “Therefore, an [axillary lymph node dissection] could be avoided by patients who have no signs of cancer in the axillary lymph nodes following a sonographic axillary assessment prior to neoadjuvant chemotherapy and [sentinel lymph node biopsy] during surgery after neoadjuvant chemotherapy.”
Dr. Classe noted that longer follow-up of the patients is needed to further confirm the safety of sentinel lymph node biopsy for these patients.
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