0057 The impact of the ratio of positive nodes to removed nodes on recurrence and overall survival in node positive breast cancer patients

e12520 Background: Oncotype Dx (ODX) is a commercial diagnostic test primarily used to predict the likely benefit from chemotherapy in ER+, HER2-, and node negative breast cancer. The prognostic value (recurrence risk) has also been demonstrated to apply to early stage lymph node positive (LN+) disease in a number of retrospective and prospective studies. The ongoing RxPONDER trial aims to clarify the predictive value of RS in LN+ population. In light of the initial results, we analyzed the practice patterns and outcomes for HR+/Her2 -/node positive breast cancer patients receiving ODX testing in the years from 2010-2017 with RS 14-25 in a retrospective observational study of the NCDB. Methods: Women with HR+/Her2 -/node positive breast cancer receiving ODX testing from 2010-2017 were identified in the NCDB using TAILORx and RxPONDER patients’ inclusion criteria: ages 18-75, 6-50mm invasive tumors, N1, M0, ER+/HER2 -. The impact of ODX results in the high-intermediate range (14-25) and other clinico-pathologic variables on the receipt of chemotherapy were compared. Additionally, we examined the impact of chemotherapy on overall survival (OS). Frequencies, Kaplain-Meier analysis, and changepoint analysis using the Contal and O’Quigley method were utilized. Results: There were 109,652 T1-2 and N1 patients of whom 32,506 (29.6%) received ODX testing. 13,461 (41.4%%) women had scores in the high-intermediate (14-25) range. The majority tended to have only 1 LN involved (1LN: 77.2%, 2LNs: 17.5%, 3LNs: 5.3%), had a mean age of 57.8y, were Caucasian (86.4%), and were preferentially tested at academic or comprehensive community cancer programs (79.2%). 6,610 (49.3%) patients were recommended chemotherapy, the median ODX score for all women who were recommended chemotherapy was 20 compared to 17 for those whom chemotherapy was not recommended. 5,068 (76.7%) women had documentation of receiving chemotherapy which correlated with improved OS regardless of age. Conclusions: In the group of women with HR+/Her2 -/node positive breast cancer, clinicians appear to utilize ODX testing in less than one-third of patients, possibly finding RS to be most useful in guiding adjuvant therapy recommendations when only 1LN is involved. Both the recommendation and receipt of chemotherapy correlated linearly with increasing RS, as expected based on the current NCCN guideline recommendations. We identified an OS benefit when chemotherapy was administered, regardless of patient age. Long-term follow-up in the RxPONDER trial will likely continue to clarify the predictive value of RS < 25 in the ER+/HER2-/node positive breast cancer population.

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Abstract P2-10-23: Lymphovascular Invasion (LVI) and Overall Survival in Node-negative and Node-positive Breast Cancer Patients: A Meta-analysis.

10.1158/0008-5472.sabcs12-p2-10-23 ◽

2012 ◽

Author(s):

S Sahebjam ◽

I Diaz-Padilla ◽

A Ocana ◽

B Seruga ◽

E Amir

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Lymphovascular Invasion ◽

Meta Analysis ◽

Breast Cancer Patients ◽

Node Negative ◽

Node Positive ◽

Positive Breast Cancer

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Prognostic Significance of Apex Axillary Invasion for Locoregional Recurrence and Effect of Postmastectomy Radiotherapy on Overall Survival in Node-Positive Breast Cancer Patients

World Journal of Surgery ◽

10.1007/s00268-003-7215-1 ◽

2004 ◽

Vol 28 (3) ◽

pp. 236-241 ◽

Cited By ~ 2

Author(s):

Bekir Kuru ◽

Mithat Camlibel ◽

Soykan Dinc ◽

Mehmet A. Gulcelik ◽

Haluk Alagol

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Locoregional Recurrence ◽

Prognostic Significance ◽

Breast Cancer Patients ◽

Postmastectomy Radiotherapy ◽

Node Positive ◽

Positive Breast Cancer

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The Clinical Relevance of Target Lymph Node Biopsy after Primary Systemic Therapy in Initially Node-Positive Breast Cancer Patients

Cancers ◽

10.3390/cancers13112620 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2620

Author(s):

Steffi Hartmann ◽

Angrit Stachs ◽

Gesche Schultek ◽

Bernd Gerber ◽

Toralf Reimer

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Systemic Therapy ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Primary Systemic Therapy ◽

Node Positive ◽

The Impact ◽

Positive Breast Cancer

Purpose: To assess the impact of the removal of the target lymph node (TLN) on therapy after the completion of primary systemic therapy (PST) in initially node-positive breast cancer patients. Methods: Pooled data analysis of participants of the prospective CLIP- and TATTOO-study at the University of Rostock was performed. Results: A total of 75 patients were included; 63 of them (84.0%) converted to clinically node-negative after PST. Both TLN and sentinel lymph node (SLN) were identified in 41 patients (51.2%). In five out of 63 patients (7.9%), the TLN was metastatic after PST and the SLN was either tumor-free or not detected. Axillary lymph node dissection (ALND) was conducted in all five patients. In one patient, systemic therapy recommendation was influenced by the TLN; adjuvant radiotherapy was influenced by the TLN in zero patients. For patients with fewer than three removed SLNs, the FNR was 28.6% for the SLN biopsy alone and 7.1% for targeted axillary dissection (TAD). Conclusions: Removal of the TLN in addition to the SLN after PST has only minimal impact on the type of adjuvant systemic therapy and radiotherapy. However, the extent of axillary surgery was relevantly affected and FNR was improved by TAD.

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Sequential Adjuvant Epirubicin-Based and Docetaxel Chemotherapy for Node-Positive Breast Cancer Patients: The FNCLCC PACS 01 Trial

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.3916 ◽

2006 ◽

Vol 24 (36) ◽

pp. 5664-5671 ◽

Cited By ~ 392

Author(s):

Henri Roché ◽

Pierre Fumoleau ◽

Marc Spielmann ◽

Jean-Luc Canon ◽

Thierry Delozier ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Relative Risk ◽

Cancer Patients ◽

Disease Free Survival ◽

Breast Cancer Patients ◽

Risk Of Death ◽

Node Positive ◽

Disease Free ◽

Positive Breast Cancer

Purpose The PACS 01 trial compared six cycles of fluorouracil, epirubicin, and cyclophosphamide (FEC) with a sequential regimen of three cycles of FEC followed by three cycles of docetaxel (FEC-D) as adjuvant treatment for women with node-positive early breast cancer. Patients and Methods Between June 1997 and March 2000, 1,999 patients with operable node-positive breast cancer were randomly assigned to either FEC every 21 days for six cycles, or three cycles of FEC followed by three cycles of docetaxel, both given every 21 days. Hormone-receptor–positive patients received tamoxifen for 5 years after chemotherapy. The primary end point was 5-year disease-free survival (DFS). Results Median follow-up was 60 months. Five-year DFS rates were 73.2% with FEC and 78.4% with FEC-D (unadjusted P = .011; adjusted P = .012). Multivariate analysis adjusted for prognostic factors showed an 18% reduction in the relative risk of relapse with FEC-D. Five-year overall survival rates were 86.7% with FEC and 90.7% with FEC-D, demonstrating a 27% reduction in the relative risk of death (unadjusted P = .014; adjusted P = .017). The incidence of grade 3 to 4 neutropenia, the need for hematopoietic growth factor, and incidence of nausea/vomiting were higher with FEC. Docetaxel was associated with more febrile neutropenia in the fourth cycle, stomatitis, edema, and nail disorders. Though rare overall, there were fewer cardiac events after FEC-D (P = .03), attributable mainly to the lower anthracycline cumulative dose. Conclusion Sequential adjuvant chemotherapy with FEC followed by docetaxel significantly improves disease-free and overall survival in node-positive breast cancer patients and has a favorable safety profile.

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