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Background <p>Studies regarding therapeutic response of invasive lobular carcinoma (ILC) to neoadjuvant systemic therapy (NST) suggest that ILC is less favorable and the prognostic impact of a pathologic complete response (pCR) is unclear.</p> Patients and Methods <p>This study included 853 (NAC; <i>n</i> = 715 and NET; <i>n</i> = 138) non-metastatic classic ILC cases that received NST followed by surgery. Propensity-score matched analysis (PSMA) was performed to compare clinicopathologic groups. Survival outcomes were compared for patients with and without a pCR.</p> Results <p>Most had large primary tumors with nodal metastases (89.5% cT2–T4, 64% cN+) and luminal subtype tumors (87.6%). Patients receiving NAC were more likely to be clinically node-positive (69.1% versus 34.3%; <i>p</i> = 0.0005), have grade 3 disease (18.7% versus 8.7%; <i>p</i> = 0.0082), and undergo mastectomy (84.2% versus 69.6%; <i>p</i> &lt; 0.001) and ALND (84.9% versus 57.3%; <i>p</i> &lt; 0.0001) compared with NET. Overall, breast and axillary nodal pCR rates were 4.9% and 9.3%, respectively. Among 155 patients who had SLNB, there was 1 axillary nodal recurrence (0.6%). The 10-year distant recurrence-free survival (DRFS) for patients with a breast pCR was 61% versus 46% for those without (<i>p</i> = 0.267). Patients with a nodal pCR demonstrated higher 10-year DRFS (49% versus 33%; <i>p</i> = 0.026) and OS compared with those without (65% versus 48%; <i>p</i> = 0.068). No survival outcome difference was seen for patients treated with NAC versus NET on PSMA.</p> Conclusions <p>Nodal pCR was associated with survival outcomes in ILC and systemic therapy decision-making should be reconsidered. SLNB after NST appears to be safe and effective in ILC.</p>

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Clinical Impact and Outcomes of Neoadjuvant Systemic Therapy for Invasive Lobular Carcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月3日

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  • Genevieve A. Fasano,
  • Jason Mouabbi,
  • Helen M. Johnson,
  • Heather Y. Lin,
  • Kerollos Nashat Wanis,
  • Susie X. Sun,
  • Anthony Lucci,
  • Vicente Valero,
  • Melissa Mitchell,
  • Yu Shen,
  • Kelly K. Hunt,
  • Henry Kuerer

摘要

Background

Studies regarding therapeutic response of invasive lobular carcinoma (ILC) to neoadjuvant systemic therapy (NST) suggest that ILC is less favorable and the prognostic impact of a pathologic complete response (pCR) is unclear.

Patients and Methods

This study included 853 (NAC; n = 715 and NET; n = 138) non-metastatic classic ILC cases that received NST followed by surgery. Propensity-score matched analysis (PSMA) was performed to compare clinicopathologic groups. Survival outcomes were compared for patients with and without a pCR.

Results

Most had large primary tumors with nodal metastases (89.5% cT2–T4, 64% cN+) and luminal subtype tumors (87.6%). Patients receiving NAC were more likely to be clinically node-positive (69.1% versus 34.3%; p = 0.0005), have grade 3 disease (18.7% versus 8.7%; p = 0.0082), and undergo mastectomy (84.2% versus 69.6%; p < 0.001) and ALND (84.9% versus 57.3%; p < 0.0001) compared with NET. Overall, breast and axillary nodal pCR rates were 4.9% and 9.3%, respectively. Among 155 patients who had SLNB, there was 1 axillary nodal recurrence (0.6%). The 10-year distant recurrence-free survival (DRFS) for patients with a breast pCR was 61% versus 46% for those without (p = 0.267). Patients with a nodal pCR demonstrated higher 10-year DRFS (49% versus 33%; p = 0.026) and OS compared with those without (65% versus 48%; p = 0.068). No survival outcome difference was seen for patients treated with NAC versus NET on PSMA.

Conclusions

Nodal pCR was associated with survival outcomes in ILC and systemic therapy decision-making should be reconsidered. SLNB after NST appears to be safe and effective in ILC.