ArticleCancer2024
Should patients with hormone receptor-positive, HER2-negative breast cancer and one or two positive sentinel nodes undergo axillary dissection to determine candidacy for adjuvant abemaciclib?
Article in Cancer, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 14 citations in OpenAlex.
- Evaluating total tumor load (TTL) to predict metastasis in four or more axillary lymph nodes in HR +/HER2- breast cancer patients: the TULIP4N + study.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Article
- Role of Sentinel Node Surgery in Identifying Candidates for Adjuvant CDK4/6 Inhibitors: Implications of Choosing Wisely and ASCO Omission Criteria.Annals of surgical oncology · 2026Article
- ASO Author Reflections: Does the Axilla Still Matter? Rethinking Nodal Staging in the Era of CDK4/6 Inhibition.Annals of surgical oncology · 2026Article
- Axillary surgery in the cyclin-dependent kinase 4/6 inhibitors era: no time to move backward.Translational breast cancer research : a journal focusing on translational research in breast cancer · 2026Review
- ASO Author Reflections: All Positive, Not All Necessary: Reconsidering Axillary Lymph Node Dissection When Every Sentinel Node is Positive.Annals of surgical oncology · 2025Article
- Management and Outcomes in Patients with Breast Cancer with 1-of-1 and 2-of-2 Positive Sentinel Nodes.Annals of surgical oncology · 2025Article
- Reevaluating ALND omission and its impact on abemaciclib eligibility and treatment decisions.Breast cancer (Tokyo, Japan) · 2025Article
- Axillary dissection should not be performed in breast cancer patients with limited nodal disease to determine abemaciclib candidacy.Gland surgery · 2025Article
- How to choose optimal adjuvant therapies for high-risk hormone receptor-positive, HER2-negative breast cancer after chemotherapy?Acta oncologica (Stockholm, Sweden) · 2025Review
- Predicting pathologic ≥N2 disease in women with breast cancer.NPJ breast cancer · 2025Article
- The impact of axillary lymph-node dissection omission on adjuvant abemaciclib eligibility in HR-positive, HER2-negative breast cancer with positive sentinel lymph nodes.Breast cancer (Tokyo, Japan) · 2025Article
- Risking arm lymphedema in more than a hundred patients to benefit one patient-is it worth it?Gland surgery · 2025Article
- Review
- Article
- Axillary Surgery for Breast Cancer in 2024.Cancers · 2024Review
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThe monarchE trial demonstrated improved outcomes with the use of adjuvant abemaciclib in patients with high-risk hormone receptor-positive, HER2-negative (HR+/HER2-) breast cancer defined as ≥4 positive lymph nodes (+LNs) or one to three +LNs with one or more additional high-risk features (HRFs). The proportion of patients with one or two positive sentinel lymph nodes (+SLNs) without HRFs who had ≥4 +LNs at the time of completion axillary lymph node dissection (cALND), and who therefore qualified for receipt of abemaciclib, was investigated.
methodsFemales with pathologically node-positive nonmetastatic HR+/HER2- breast cancer stratified by the number of +SLNs and +LNs and the presence of one or more HRFs were identified from the National Cancer Database (2018-2019). The proportion of patients meeting the criteria for abemaciclib both before and after ALND was assessed.
resultsOf the 22,048 patients identified, 1578 patients underwent upfront surgery, had one or two +SLNs without HRFs, and went on to cALND. Only 213 (13%) of these patients had ≥4 +LNs; thus, cALND performed solely to determine abemaciclib candidacy would have constituted surgical overtreatment in 1365 patients (87%). When stratified by the number of +SLNs, only 10% of those with one +SLN and 24% of those with two +SLNs had ≥4 +LNs after cALND, which meets the criteria for abemaciclib.
conclusionsPatients with one +SLN without HRFs are unlikely to have ≥4 +LNs and should not be subjected to the morbidity of ALND in order to inform candidacy for abemaciclib. An individualized multidisciplinary discussion should be undertaken about the risk:benefit ratio of ALND and abemaciclib for those with two +SLNs.
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