Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Axillary clearance and chemotherapy rates in ER+HER2− breast cancer : secondary analysis of the SENOMAC trial

Tvedskov, Tove Filtenborg ; Szulkin, Robert ; Alkner, Sara LU ; Andersson, Yvette ; Bergkvist, Leif ; Frisell, Jan ; Gentilini, Oreste Davide ; Kontos, Michalis ; Kühn, Thorsten and Lundstedt, Dan , et al. (2024) In The Lancet Regional Health - Europe 47.
Abstract

Background: Randomized trials have shown that axillary clearance (AC) can safely be omitted in patients with sentinel lymph node-positive breast cancer. At the same time, de-escalation of chemotherapy in postmenopausal patients with ER+HER2− breast cancer may depend on detailed axillary nodal stage. The aim of this pre-specified secondary analysis of the SENOMAC trial was to investigate whether the choice of axillary staging affected the proportion of patients receiving adjuvant chemotherapy, and recurrence-free survival (RFS). Methods: Proportion receiving adjuvant chemotherapy was calculated according to AC or sentinel lymph node biopsy (SLNB) only, menopausal status, and region of inclusion, for 2168 patients with clinically... (More)

Background: Randomized trials have shown that axillary clearance (AC) can safely be omitted in patients with sentinel lymph node-positive breast cancer. At the same time, de-escalation of chemotherapy in postmenopausal patients with ER+HER2− breast cancer may depend on detailed axillary nodal stage. The aim of this pre-specified secondary analysis of the SENOMAC trial was to investigate whether the choice of axillary staging affected the proportion of patients receiving adjuvant chemotherapy, and recurrence-free survival (RFS). Methods: Proportion receiving adjuvant chemotherapy was calculated according to AC or sentinel lymph node biopsy (SLNB) only, menopausal status, and region of inclusion, for 2168 patients with clinically node-negative ER+HER2− breast cancer and 1–2 sentinel lymph node macrometastases included in the SENOMAC trial. Findings: In premenopausal patients, 514 out of 615 patients (83.6%) received adjuvant chemotherapy with no significant difference between randomization arms. In postmenopausal patients, the proportion receiving chemotherapy varied considerably by region and country (36.0–82.4%). In Denmark, where 194 out of 539 postmenopausal patients (36.0%) received adjuvant chemotherapy, rates differed significantly between the AC and the SLNB only arm (41.3% vs 31.4%, p = 0.019). After a median follow-up of 44.88 months for Danish postmenopausal patients, no significant difference was seen in 5-year RFS, which was 91% (85.6%–96.6%) for the SLNB only and 90.9% (86.3%–95.6%) for the AC arm (p = 0.42). Interpretation: When omitting axillary clearance, and thus reducing the risk of long-term arm morbidity, potential under-treatment of postmenopausal patients with ER+HER2− breast cancer may require the development of new predictive and imaging tools. Funding: Swedish Research Council, Swedish Cancer Society, Nordic Cancer Union, Swedish Breast Cancer Association.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
contributor
Christiansen, Peer ; LU and LU
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adjuvant treatment, Axillary staging, Breast cancer
in
The Lancet Regional Health - Europe
volume
47
article number
101083
publisher
Elsevier
external identifiers
  • pmid:39386258
  • scopus:85204775740
ISSN
2666-7762
DOI
10.1016/j.lanepe.2024.101083
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2024 The Author(s)
id
2dbd8a0f-d923-4bd7-a344-0f1d449f3ba2
date added to LUP
2024-10-17 09:16:54
date last changed
2025-07-11 08:50:13
@article{2dbd8a0f-d923-4bd7-a344-0f1d449f3ba2,
  abstract     = {{<p>Background: Randomized trials have shown that axillary clearance (AC) can safely be omitted in patients with sentinel lymph node-positive breast cancer. At the same time, de-escalation of chemotherapy in postmenopausal patients with ER+HER2− breast cancer may depend on detailed axillary nodal stage. The aim of this pre-specified secondary analysis of the SENOMAC trial was to investigate whether the choice of axillary staging affected the proportion of patients receiving adjuvant chemotherapy, and recurrence-free survival (RFS). Methods: Proportion receiving adjuvant chemotherapy was calculated according to AC or sentinel lymph node biopsy (SLNB) only, menopausal status, and region of inclusion, for 2168 patients with clinically node-negative ER+HER2− breast cancer and 1–2 sentinel lymph node macrometastases included in the SENOMAC trial. Findings: In premenopausal patients, 514 out of 615 patients (83.6%) received adjuvant chemotherapy with no significant difference between randomization arms. In postmenopausal patients, the proportion receiving chemotherapy varied considerably by region and country (36.0–82.4%). In Denmark, where 194 out of 539 postmenopausal patients (36.0%) received adjuvant chemotherapy, rates differed significantly between the AC and the SLNB only arm (41.3% vs 31.4%, p = 0.019). After a median follow-up of 44.88 months for Danish postmenopausal patients, no significant difference was seen in 5-year RFS, which was 91% (85.6%–96.6%) for the SLNB only and 90.9% (86.3%–95.6%) for the AC arm (p = 0.42). Interpretation: When omitting axillary clearance, and thus reducing the risk of long-term arm morbidity, potential under-treatment of postmenopausal patients with ER+HER2− breast cancer may require the development of new predictive and imaging tools. Funding: Swedish Research Council, Swedish Cancer Society, Nordic Cancer Union, Swedish Breast Cancer Association.</p>}},
  author       = {{Tvedskov, Tove Filtenborg and Szulkin, Robert and Alkner, Sara and Andersson, Yvette and Bergkvist, Leif and Frisell, Jan and Gentilini, Oreste Davide and Kontos, Michalis and Kühn, Thorsten and Lundstedt, Dan and Offersen, Birgitte Vrou and Bagge, Roger Olofsson and Reimer, Toralf and Sund, Malin and Rydén, Lisa and de Boniface, Jana}},
  issn         = {{2666-7762}},
  keywords     = {{Adjuvant treatment; Axillary staging; Breast cancer}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{The Lancet Regional Health - Europe}},
  title        = {{Axillary clearance and chemotherapy rates in ER+HER2− breast cancer : secondary analysis of the SENOMAC trial}},
  url          = {{http://dx.doi.org/10.1016/j.lanepe.2024.101083}},
  doi          = {{10.1016/j.lanepe.2024.101083}},
  volume       = {{47}},
  year         = {{2024}},
}