Neoadjuvant Chemotherapy in HER2 Positive Breast Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Neoadjuvant chemotherapy does not prolong survival compared to adjuvant chemotherapy:
    • However, it does result in decreased disease burden, and can be beneficial at time of surgery:
      • e.g., providing increased opportunity to perform breast-conserving surgery and reducing need for axillary lymph node dissection
  • A meta-analysis of 14 prospective randomized trials of neoadjuvant vs. adjuvant chemotherapy in 5,500 patients with breast cancer:
    • Demonstrated that NAC was associated with an absolute decrease in the mastectomy rate of 16.6% (95% CI 15.1–18.1%):
      • Patients with ER– and HER2 positive breast cancers:
        • Are more likely to experience complete pathologic response than those with ER+ cancers
  • Patients with a clinically positive axilla after neoadjuvant chemotherapy:
    • Should undergo axillary dissection at the time of breast surgery
  • Patients with no residual adenopathy on clinical exam may be considered for sentinel lymph node biopsy (SLNB):
    • Accuracy of SLNB after NAC can be improved with:
      • Localization of previously-clipped nodes
      • Use of dual tracer
      • Increasing the number of sentinel nodes retrieved:
        • SLNB after NAC has a false-negative rate of less than 10% only when ≥ 3 sentinel nodes were identified
  • References
    • Mieog, JS, van der Hage JA, van de Velde CJ. Neoadjuvant chemotherapy for operable breast cancer. Br J Surg. 2007;94(1):1189-1200.
    • van der Hage JA, van de Velde CJH, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol. 2001;19(22):4224-4237.
    • Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997;15(7):2483-2493.
    • Rouzier R, Perou CM, Symmans WF, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 2005;11(16):5678-5685.
    • Boughey JC, Ballman KV, Le-Petross HT, et al. Identification and resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0-T4, N1-N2) who receive neoadjuvant chemotherapy: results from ACOSOG Z1071 (Alliance). Ann Surg.2016;263(4):802-807.
    • Boileau, JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2015;33(3):258-264.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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