Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Neoadjuvant therapy and sentinel lymph node biopsy in HER2-positive breast cancer patients: results from the PEONY trial

Abstract

Objective

The aim of the study is to evaluate the optimal timing of sentinel lymph node biopsy (SLNB) in patients with clinical negative axillary lymph nodes (ALNs) before neoadjuvant therapy (NAT) and the feasibility of SLNB substituting for ALN dissection in patients with positive ALNs who convert to node negative, for HER2-positive disease.

Methods

Patients receiving SLNB with dual tracer mapping in the PEONY trial were analyzed.

Results

For 80 patients with clinical negative ALNs, the node negative rate by pathology after NAT was 83.8%. SLNB was performed after NAT in 71 patients. The identification rate of sentinel lymph nodes (SLNs) was 100%. For patients with positive ALNs before NAT, the axillary pathologic complete response rate in the dual HER2 blockade arm was significantly higher than that in the single blockade arm (p = 0.002). SLNB was performed in 71 patients. The identification rate was 100% and the false-negative rate was 17.2%. The false-negative rates were 33.3%, 14.3%, and 0 when 1, 2, and more than 2 SLNs were detected. There was no false-negative case when more than 1 SLN and the clipped nodes were removed simultaneously.

Conclusions

For clinical ALN negative patients, HER2-positive subtype is found to have high node negative rate by pathology and it is recommended to undergo SLNB after NAT. For patients with positive ALNs who convert to negative, the false-negative rate is high. Dual tracer mapping, more than 2 SLNs detected, more than 1 SLN identified plus the clips placed are the guarantees for lower false-negative rate.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Fisher B, Brown A, Mamounas E et al (1997) Effect of preoperative chemotherapy on local regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493. https://doi.org/10.1200/JCO.1997.15.7.2483

  2. 2.

    Shao Z, Pang D, Yang H et al (2019) Efficacy, safety, and tolerability of pertuzumab, trastuzumab, and docetaxel for patients with early or locally advanced ERBB2-positive breast cancer in Asia: the PEONY Phase 3 Randomized Clinical Trial. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2019.3692

  3. 3.

    Kumar A, Puri R, Gadgil PV et al (2012) Sentinel lymph node biopsy in primary breast cancer: window to management of the axilla. World J Surg 36:1453–1459. https://doi.org/10.1007/s00268-012-1635-8

  4. 4.

    Gentile LF, Plitas G, Zabor EC et al (2017) Tumor biology predicts pathologic complete response to neoadjuvant chemotherapy in patients presenting with locally advanced breast cancer. Ann Surg Oncol 24:3896–3902. https://doi.org/10.1245/s10434-017-6085-y

  5. 5.

    Boughey JC, McCall LM, Ballman KV et al (2014) Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg 260:608–614. https://doi.org/10.1097/SLA.0000000000000924

  6. 6.

    Gianni L, Pienkowshi T, Im YH et al (2012) Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol 13:25–32. https://doi.org/10.1016/S1470-2045(11)70336-9

  7. 7.

    Giuliano AE, Ballman KV, McCall L et al (2017) Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA 318:918–926. https://doi.org/10.1001/jama.2017.11470

  8. 8.

    Donker M, van Tienhoven G, Straver ME et al (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15:1303–1310. https://doi.org/10.1016/S1470-2045(14)70460-7

  9. 9.

    Grasishar WJ, Anderson BO, Balassanian R et al (2017) Breast Cancer, Version 3.2017 featured updates to the NCCN Guidelines. National Comprehensive Cancer Network. https://www.NCCN.org. Accessed 10 Nov 2017

  10. 10.

    Grasishar WJ, Anderson BO, Balassanian R et al (2020) Breast Cancer, Version 1.2020 featured updates to the NCCN Guidelines. National Comprehensive Cancer Network. https://www.NCCN.org. Accessed 15 Jan 2020

  11. 11.

    Curigliano G, Burstein H, Winer E et al (2017) De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer. Ann Oncol 28:1700–1712. https://doi.org/10.1093/annonc/mdy537

  12. 12.

    Burstein HJ, Curigliano G, Loibl S et al (2019) Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019. Ann Oncol 30:1541–1557. https://doi.org/10.1093/annonc/mdz235

  13. 13.

    von Minckwitz G, Huang C-S, Mano MS et al (2019) Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med 380:617–628. https://doi.org/10.1056/NEJMoa1814017

  14. 14.

    Shi ZQ, Qiu PF, Liu YB et al (2019) Neoadjuvant chemotherapy and axillary de-escalation management for patients with clinically node-negative breast cancer. Breast J 25:1154–1159. https://doi.org/10.1111/tbj.13422

  15. 15.

    Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553. https://doi.org/10.1056/NEJMoa012782

  16. 16.

    Krag DN, Anderson SJ, Julian TB et al (2010) Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 11:927–933. https://doi.org/10.1016/S1470-2045(10)70207-2

  17. 17.

    Mansel RE, Fallowfield L, Kissin M et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 98:599–609. https://doi.org/10.1093/jnci/djj158

  18. 18.

    Boughey JC, Suman VJ, Mittendorf EA et al (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) Clinical Trial. JAMA 310:1455–1461. https://doi.org/10.1001/jama.2013.278932

  19. 19.

    Kuehn T, Bauerfeind I, Fehm T et al (2013) Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENATINA): a prospective, multicentre cohort study. Lancet Oncol 14:609–618. https://doi.org/10.1016/S1470-2045(13)70166-9

  20. 20.

    Boileau JF, Poirier B, Basik M et al (2015) Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol 33:258–264. https://doi.org/10.1200/JCO.2014.55.7827

  21. 21.

    El Hage CH, Headon H, El Tokhy O et al (2016) Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients. Am J Surg 212:969–981. https://doi.org/10.1016/j.amjsurg.2016.07.018

  22. 22.

    Hunt KK, Yi M, Mittendorf EA et al (2009) Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients. Ann Surg 250:558–566. https://doi.org/10.1097/SLA.0b013e3181b8fd5e

  23. 23.

    Nason KS, Anderson BO, Byrd DR et al (2000) Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 89:2187–2194

  24. 24.

    Caudle AS, Yang WT, Krishnamurthy S et al (2016) Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol 34:1072–1078. https://doi.org/10.1200/JCO.2015.64.0094

Download references

Author information

Correspondence to Yong-Sheng Wang or Zhi-Min Shao.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional Research Committee and/or National Research Committee (National Medical Products Administrator 2015L01504, Fudan University Shanghai Cancer Center 150915–2, Shandong Cancer Hospital Affiliated to Shandong University 201512002) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sun, X., Wang, X., Zhang, Z. et al. Neoadjuvant therapy and sentinel lymph node biopsy in HER2-positive breast cancer patients: results from the PEONY trial. Breast Cancer Res Treat (2020). https://doi.org/10.1007/s10549-020-05559-9

Download citation

Keywords

  • Breast cancer
  • Neoadjuvant therapy
  • Sentinel lymph node biopsy
  • HER-2
  • Pathologic complete response