SABCS 2022 | The role of axillary dissection to determine nodal burden to inform systemic therapy recommendations

Walter P. Weber, MD, University Hospital Basel, Basel, Switzerland, shares the results of a pre-planned substudy of the Phase III TAXIS (NCT03513614) trial investigating axillary dissection to determine nodal burden to inform systemic therapy recommendations in patients with clinically node-positive breast cancer. Patients were randomized after tailored axillary surgery (TAS) to undergo axillary lymph node dissection or axillary radiotherapy without axillary lymph node dissection. There has been a recent comeback in axillary dissection as a staging procedure in patients with positive nodes to determine the exact tumor volume and applicability of systemic therapy protocols or molecular tests. The first 500 randomized patients of the Phase III TAXIS (NCT03513614) trial had axillary dissections. 60% of patients had four or more positive nodes in the dissection group. Within the radiation group with no dissection, patients were heavily under-staged. Although axillary lymph node dissection significantly increased the number of positive nodes removed in the adjuvant and neoadjuvant setting, there was no difference in rate or type of systemic therapy in the adjuvant and neoadjuvant setting. This interview took place at the San Antonio Breast Cancer Symposium (SABCS) 2022 in San Antonio, TX.

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