Background

One of the key potential benefits of NAC is to sterilise the axilla of patients who present with axillary stage positive disease. In certain patients, this allows axillary conservation as opposed to an axillary clearance (ANC). This unit’s standard practice was to offer TAD to patients with node positive disease with favourable biology following NAC if a radiological response had been seen. This prospective study considers the impact of this approach to the management of these patients in a real-world setting.

Methods

Prospective data collection from a large breast screening institution of all patients undergoing NAC with axillary node positive disease (1-2 nodes or 3+ nodes) from May 2014 to January 2021. Axillary pCR is defined as no tumour cells seen in nodes.

Results

A total 99 patients, with node positive disease, were treated with NAC in this time-period. The overall axillary pCR rate in the population was 49.5%. In patients with 1-2 nodes, the pCR rate was 56.3% compared with 43.1% in a higher axillary burden; breakdown of these figures as stratified by hormone receptor status is illustrated in the table. TAD was performed successfully in 70.4% patients with 1-2 nodes without the need for an ANC. Of the 22 patients who had 3+ nodes at presentation with a pCR, 72.7% (16) underwent an ANC who may have avoided this if they had been considered for a TAD. Table: 69P

pCR rate stratified by axillary burden and hormone receptor status

Conclusions

Pathological response rates in this study are relatively consistent with those published in recent major trials. Evolution of the practice in this unit now includes offering patients presenting with 3+ nodes, favourable biology and a radiological response, a TAD rather than a potentially unnecessary ANC following appropriate counselling.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M. Verrill: Honoraria (self), Research grant/Funding (self): Roche; Honoraria (self), Research grant/Funding (self): Pfizer; Honoraria (self), Research grant/Funding (self): Novartis; Research grant/Funding (self): Amgen; Honoraria (self): Lilly; Honoraria (self): Exact Science. N. Cresti: Advisory/Consultancy, Research grant/Funding (institution): Roche. H. Cain: Advisory/Consultancy: Roche; Advisory/Consultancy: AZ; Advisory/Consultancy: Pfizer; Advisory/Consultancy: Exact Science. All other authors have declared no conflicts of interest.