Elizabeth A. Mittendorf, MD PhD
Rob and Karen Hale Distinguished Chair in Surgical Oncology
Brigham and Womens Hospital/Harvard Medical School
Boston, Massachusetts, United States
Disclosure: Exact Sciences/Genomic Health (Individual(s) Involved: Self): Advisor or Review Panel member, Research Support; Genentech/Roche (Individual(s) Involved: Self): Advisor or Review Panel member; Merck (Individual(s) Involved: Self): Advisor or Review Panel member
Introduction: The KEYNOTE-522 trial showed improved pathologic complete response and event free-survival in early-stage TNBC patients receiving preoperative pembrolizumab (pembro) with chemotherapy. Due to potential toxicities with immunotherapy (IO), clinicians are thoughtfully considering how to incorporate pembro into multi-disciplinary treatment planning. Considering that nodal positivity identifies patients at higher risk of recurrence from early breast cancer, there is a general consensus that the addition of IO to neoadjuvant chemotherapy (NACT) should be recommended in most patients with node-positive TNBC. This study was undertaken to determine nodal positivity rates in TNBC patients presenting with cT1-2N0 disease.
Methods:
Patients with cT1-2N0 TNBC undergoing upfront surgery were identified from the National Cancer Database (2010-2017) and our Dana-Farber/Brigham and Women’s Cancer Center (DFBWCC) database (Jan 2016- Feb 2021). Pathologic nodal status by clinical T category and clinical tumor size was determined.
Results: Among 45,954 NCDB patients undergoing upfront surgery, 6,363 (13.8%) were pathologically node positive; 5.0% for cT1a/b, 11.6% for cT1c and 19.7% for cT2 tumors. Nodal positivity rates increased with increasing tumor size (table). Among 343 DFBWCC patients undergoing upfront surgery, 50 (14.6%) were pathologically node positive; 9.4% for cT1a/b, 14.9% for cT1c and 20.8% for cT2 tumors.
Conclusions: The nodal positivity rate among cT1-2N0 TNBC patients exceeds 10% for cT1c and larger tumors. Pre-treatment axillary US and biopsy can identify these patients and should be considered in patients presenting with TNBC tumors >1cm to inform preoperative IO considerations.