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Purpose of Review <p>Axillary management in clinically node-positive (cN1), hormone receptor-positive (HR+)/HER2-negative (HER2-) breast cancer poses a complex clinical dilemma, and the optimal approach to the axilla is uncertain. This review summarizes current evidence, highlights emerging data, and discusses future directions. </p> Recent Findings <p>Unlike triple-negative or HER2-positive subtypes, the HR+/HER2- subset rarely achieves pathologic complete response with neoadjuvant chemotherapy, rendering this strategy suboptimal for axillary de-escalation. Genomic profiling is now a crucial determinant in systemic therapy decision making, particularly among postmenopausal cN1 HR+/HER2- patients. Evolving surgical approaches such as selective use of SLNB and targeted axillary dissection offer promising avenues for tailored locoregional management. </p> Summary <p>Selective use of upfront surgery among cN1 HR+/HER2- patients with limited nodal burden can minimize morbidity for eligible patients without compromising oncologic outcomes. Further research is necessary, particularly with continually improving systemic therapies, for risk-stratification and individualization of axillary management in cN1 HR+/HER2- breast cancer.</p>

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Axillary Management of Node-Positive HR+/HER2- Breast Cancer

  • 期刊论文

  • 发表日期：

    2026年5月2日

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  • Anita Mamtani

摘要

Purpose of Review

Axillary management in clinically node-positive (cN1), hormone receptor-positive (HR+)/HER2-negative (HER2-) breast cancer poses a complex clinical dilemma, and the optimal approach to the axilla is uncertain. This review summarizes current evidence, highlights emerging data, and discusses future directions.

Recent Findings

Unlike triple-negative or HER2-positive subtypes, the HR+/HER2- subset rarely achieves pathologic complete response with neoadjuvant chemotherapy, rendering this strategy suboptimal for axillary de-escalation. Genomic profiling is now a crucial determinant in systemic therapy decision making, particularly among postmenopausal cN1 HR+/HER2- patients. Evolving surgical approaches such as selective use of SLNB and targeted axillary dissection offer promising avenues for tailored locoregional management.

Summary

Selective use of upfront surgery among cN1 HR+/HER2- patients with limited nodal burden can minimize morbidity for eligible patients without compromising oncologic outcomes. Further research is necessary, particularly with continually improving systemic therapies, for risk-stratification and individualization of axillary management in cN1 HR+/HER2- breast cancer.