Poster Spotlight Session 1: Less is More: Minimizing Surgical Treatment in Patients with Early Stage Breast Cancer
Tuesday, December 5 • 5:30 p.m. – 6:30 p.m. • Stars at Night Ballroom 3-4

Presentation: What to expect from the No axillary surgical treatment for lymph node-negative patients after ultra-sonography [NAUTILUS] trial (KBCSG-21): Clinicopathologic characteristics and axillary lymph node status of enrolled patients (NCT04303715)

Jai Min Ryu, MD, PhD
Samsung Medical Center, Sungkyunkwan University School of Medicine,
Seoul, Republic of Korea

What is your presentation about?
My presentation focuses on the clinicopathologic characteristics and axillary lymph node status of patients enrolled in the No Axillary Surgical Treatment for Lymph Node-Negative Patients after Ultrasonography (NAUTILUS) trial (KBCSG-21). This trial is a prospective multicenter phase 3 randomized controlled trial (1:1) conducted in 8 hospitals in South Korea. The objective is to evaluate the non-inferiority of omitting Sentinel Lymph Node Biopsy (SLNB) in cT1-2/N0 breast cancer patients who are planned for breast-conserving surgery and adjuvant radiotherapy.

What makes this topic important in 2023?
The Choosing Wisely campaign by the Society of Surgical Oncology recommends omitting SLNB in patients older than 70 years with cN0, ER(+)/HER2(-) breast cancer when the adjuvant treatment plan is clear. Similarly, the SOUND trial revealed that the 5-year disease-free survival is not significantly different in the axillary surgery omission group, with a mean age of 60 years and 87% HR(+)/HER2(-) status, among cT1N0 breast cancer patients.

However, many studies have limited evidence regarding SLNB omission in older women and/or cT1N0 cases. The patients enrolled in the NAUTILUS trial exhibited characteristics such as a younger mean age (55.3 years), 40.2% pre-menopausal status, and inclusion of 14.1% pT2-3 cases. We anticipate that the NAUTILUS trial will contribute to expanding the indications for SLNB omission in the future.

How did you get involved in this particular area of breast cancer research, care, or advocacy?
Korean breast cancer patients tend to be younger than those in Western countries, with a median age of 52 years. However, in several clinical trials conducted in Western countries, the subjects for the omission of SLNB were of older ages. We initiated the NAUTILUS trial with the goal of expanding the indications for omitting SLNB.