Research by investigators at The Cancer Institute of New Jersey shows that a favorable response to neoadjuvant chemotherapy 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. The results are part of a poster presentation being given at the 14th Annual Meeting of the American Society of Breast Surgeons.

Prior to the surgical removal of breast cancer, 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. In cases where breast cancer has spread to the lymph nodes, the sentinel lymph nodes are affected first and give an accurate representation of whether or not cancer has spread to the axilla.

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 used 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, M.D., 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, M.D., Ph.D., Thomas Kearney, M.D., FACS, Aparna Kolli, M.D., and Laurie Kirstein, M.D., FACS, all of The Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School.