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Gaillard T, Piketty J, Feron JG, Girard N, Pauly L, Gauroy E, Darrigues L, Grandal B, Pierga JY, Hamy-Petit AS, Reyal F, Laas E. Rethinking surgical revisions: impact of the MonarchE trial on axillary dissection in hormone-positive HER2-negative early breast cancer patients potentially eligible for abemaciclib. Br J Cancer 2024; 130:1141-1148. [PMID: 38280968 PMCID: PMC10991415 DOI: 10.1038/s41416-024-02580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION The MonarchE trial explored the use of abemaciclib, a CDK4/6 inhibitor, as an adjuvant treatment in high-risk early-stage luminal-like breast cancer. The study's inclusion criteria, especially the N2 status, may require revisiting surgical interventions, including invasive axillary lymph node dissection (ALND)-a procedure that current guidelines generally do not recommend. METHODS We conducted a single-centre, retrospective, observational cohort study on non-metastatic breast cancer patients managed from 2002 to 2011, at the Institut Curie. Data collection involved clinical and histological characteristics plus treatment follow-up. RESULTS Out of 8715 treated patients, 721 met the inclusion criteria. Overall, 12% (87) were classified as N2 ( ≥ 4 positive lymph nodes), thus eligible for abemaciclib per "node criterion." Tumour size, positive sentinel lymph nodes, and lobular histology showed a significant correlation with N2 status. Approximately 1000 ALNDs would be required to identify 120 N2 cases and prevent four recurrences. CONCLUSION The MonarchE trial may significantly affect surgical practices due to the need for invasive procedures to identify high-risk patients for adjuvant abemaciclib treatment. The prospect of unnecessary morbidity demands less invasive N2 status determination methods. Surgical decisions must consider patient health and potential treatment benefits.
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Affiliation(s)
- Thomas Gaillard
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France.
| | - Jeanne Piketty
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Jean-Guillaume Feron
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Noemie Girard
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Lea Pauly
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Elodie Gauroy
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Lauren Darrigues
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Beatriz Grandal
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Jean-Yves Pierga
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Anne-Sophie Hamy-Petit
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Fabien Reyal
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Enora Laas
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris Cité, Paris, France
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