Breast Cancer Update, Issue 2, 2016 (Video Program) - Video 4Management of the axilla in patients with HER2-positive BC converted from clinically node-positive to node-negative after neoadjuvant therapy
2:20 minutes.
TRANSCRIPTION:
DR LOVE: How are you all at Stanford approaching patients who have palpable node-positive disease who then clinically become node-negative? Do you do a sentinel node and if it’s negative, you stop? Do you do an axillary dissection? What do you do? DR SLEDGE: I think you’d see some variance even among our surgeons at Stanford. My personal bias is that if you do a sentinel lymph node dissection and have a path CR, it’s likely that it means the same thing as a path CR in the breast, particularly if the patient, as many of our patients do, go on to get radiation therapy that includes the axilla. I can’t imagine that there’s likely to be a huge benefit for removing more nodes. DR LOVE: Yes. And actually, we did a poster for San Antonio of 61 investigators. We actually documented that in the surgical investigators — we had 30 surgical investigators — they pretty much all do postneoadjuvant sentinel node. Even in those who start out positive, it’s negative, they don’t do axillary dissection. But the other thing that’s interesting is, if it’s positive, they do an axillary dissection. It’s not like in the adjuvant situation. So I think that’s kind of the de facto algorithm that’s out there right now. DR SLEDGE: Indeed. And, of course, there’s a randomized trial looking at that question right now, so hopefully we’ll have more data in the not-too-distant future. DR LOVE: Although to me, it also gets into the question of, you mentioned the fact that, quote, there’s no advantage to neoadjuvant therapy, although in HER2-positive disease, we had a little bit of data from the NeoSphere study, not that highly powered, suggesting maybe a disease-free survival benefit with neoadjuvant therapy. But I also think it kind of supports the fact that by using neoadjuvant therapy, if you use an effective one in an effective situation, you can reduce the need for axillary node dissection. DR SLEDGE: Yes. And that would be a huge benefit. We see a lot less lymphedema than we saw 15 or 20 years ago, but we still see some. And if we could reduce the number of lymph nodes being pulled out of women’s armpits, that would certainly be the greatest advantage in terms of reducing lymphedema. |