Favorable Lymph Node Response to Pre-Surgery Chemotherapy May Prompt Shift in Surgical Approach for Breast Cancer Patients
New Brunswick, N.J. – Research by investigators at The Cancer Institute of New Jersey shows that a favorable response to chemotherapy given prior to definitive surgery (neoadjuvant) in patients whose breast cancer has spread to the lymph nodes may warrant a new surgical approach. The researchers say such a shift could spare these patients the complications often associated with the standard procedure, which is a full axillary dissection (removal of all of the lymph nodes in the arm-pit). The results are part of a poster presentation being given at the 14th Annual Meeting of the American Society of Breast Surgeons being held in Chicago through Sunday.
Prior to the surgical removal of breast cancer (the entire breast or just the tumor), an examination of axillary lymph nodes is performed to see if the cancer has spread beyond the initial tumor site. This evaluation helps clinicians accurately “stage” the cancer and identify appropriate management and treatment options. The first few lymph nodes to which the breast drains are called the sentinel lymph node. In cases where breast cancer has spread to the lymph nodes, these nodes are affected first and give an accurate representation of whether or not cancer has spread to the axilla. The evaluation of these nodes is called a sentinel node biopsy. If the sentinel node has tumor cells, more lymph nodes are removed, which is called an axillary dissection. A number of complications can be associated with axillary node dissection, including swelling of the arm, nerve damage and a longer recovery time.
Patients who present with cancerous lymph nodes and receive neoadjuvant chemotherapy typically undergo a complete axillary node dissection, regardless of their response to the chemotherapy, which in some cases can result in no evidence of cancer in the lymph nodes. Investigators at The Cancer Institute of New Jersey examined whether patients could be spared axillary node dissection based on a favorable response of the lymph nodes to neoadjuvant chemotherapy.
The study utilized data from a retrospective review of patients who were treated at The Cancer Institute of New Jersey between 2008 to 2013 who had invasive breast cancer and were administered neoadjuvant chemotherapy. Patient and tumor characteristics were examined including node status prior to neoadjuvant chemotherapy, as determined by clinical exam, imaging or biopsy. Following surgery, node status was confirmed by either sentinel node biopsy or axillary node dissection. Patients also were analyzed based on hormone receptor status and divided into four sub-groups: luminal A, luminal B, Her2 and basal-like.
Overall, 50 patients were found to have cancerous axillary nodes prior to receiving neoadjuvant chemotherapy. Out of this group, 46 percent had a complete response to the chemotherapy, meaning that by the time patients were scheduled for surgery, their previously positive lymph nodes were found to be negative. And while no statistical significance was found between the different hormone receptor sub-types relating to a favorable chemotherapy response, investigators did note a trend of more responders in the Her2 group with 75 percent. The other groups – luminal A, luminal B and basal-like – had response rates of 41 percent, 37.5 percent and 42 percent respectively.
Anna Katz, MD, breast surgery fellow at The Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School, is the lead author on the research. “These data suggest that a significant number of patients who present with positive axillary nodes might avoid the complications associated with a complete axillary dissection if the sentinel node biopsy was utilized instead to identify those who have a complete response to pre-surgical chemotherapy,” said Dr. Katz.
Katz and colleagues note that since the review included a small number of patients from only one institution, future studies with larger numbers of patients in this population are needed.
Other investigators include Shridar Ganesan, MD, PhD, Thomas Kearney, MD, FACS, Aparna Kolli, MD, and Laurie Kirstein, MD, FACS, all of The Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School.
About The Cancer Institute of New Jersey
The Cancer Institute of New Jersey (www.cinj.org) is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center dedicated to improving the detection, treatment and care of patients with cancer, and serving as an education resource for cancer prevention. Physician-scientists at The Cancer Institute of New Jersey engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. To make a tax-deductible gift to support The Cancer Institute of New Jersey, call 732-235-8614 or visit www.cinjfoundation.org. Follow us on Facebook at www.facebook.com/TheCINJ. The Cancer Institute of New Jersey is a Center of Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.
The Cancer Institute of New Jersey Network is comprised of hospitals throughout the state and provides the highest quality cancer care and rapid dissemination of important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. System Partner: Meridian Health (Jersey Shore University Medical Center, Ocean Medical Center, Riverview Medical Center, Southern Ocean Medical Center, and Bayshore Community Hospital). Major Clinical Research Affiliate Hospitals: Carol G. Simon Cancer Center at Morristown Medical Center, Carol G. Simon Cancer Center at Overlook Medical Center, and Cooper University Hospital. Affiliate Hospitals: CentraState Healthcare System, JFK Medical Center, Robert Wood Johnson University Hospital Hamilton (CINJ Hamilton), Shore Medical Center, Somerset Medical Center, The University Hospital/UMDNJ-New Jersey Medical School*, and University Medical Center of Princeton at Plainsboro. *Academic Affiliate