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Review
. 2023 Jul 14:61:102085.
doi: 10.1016/j.eclinm.2023.102085. eCollection 2023 Jul.

The Lucerne Toolbox 2 to optimise axillary management for early breast cancer: a multidisciplinary expert consensus

Orit Kaidar-Person  1   2   3 , André Pfob  4   5 , Oreste Davide Gentilini  6 , Bettina Borisch  7 , Ana Bosch  8   9 , Maria João Cardoso  10 , Giuseppe Curigliano  11   12 , Jana De Boniface  13   14 , Carsten Denkert  15 , Nik Hauser  16 , Jörg Heil  4   17 , Michael Knauer  18 , Thorsten Kühn  19 , Han-Byoel Lee  20   21 , Sibylle Loibl  22   23 , Meinrad Mannhart  24 , Icro Meattini  25   26 , Giacomo Montagna  27 , Katja Pinker  28 , Fiorita Poulakaki  29 , Isabel T Rubio  30 , Patrizia Sager  31 , Petra Steyerova  32 , Christoph Tausch  33 , Trine Tramm  34 , Marie-Jeanne Vrancken Peeters  35 , Lynda Wyld  36 , Jong Han Yu  37 , Walter Paul Weber  38   39 , Philip Poortmans  40   41 , Peter Dubsky  42   43
Affiliations
Review

The Lucerne Toolbox 2 to optimise axillary management for early breast cancer: a multidisciplinary expert consensus

Orit Kaidar-Person et al. EClinicalMedicine. .

Abstract

Clinical axillary lymph node management in early breast cancer has evolved from being merely an aspect of surgical management and now includes the entire multidisciplinary team. The second edition of the "Lucerne Toolbox", a multidisciplinary consortium of European cancer societies and patient representatives, addresses the challenges of clinical axillary lymph node management, from diagnosis to local therapy of the axilla. Five working packages were developed, following the patients' journey and addressing specific clinical scenarios. Panellists voted on 72 statements, reaching consensus (agreement of 75% or more) in 52.8%, majority (51%-74% agreement) in 43.1%, and no decision in 4.2%. Based on the votes, targeted imaging and standardized pathology of lymph nodes should be a prerequisite to planning local and systemic therapy, axillary lymph node dissection can be replaced by sentinel lymph node biopsy ( ± targeted approaches) in a majority of scenarios; and positive patient outcomes should be driven by both low recurrence risks and low rates of lymphoedema.

Keywords: Axillary management; Breast cancer; Consensus; Patient journey.

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Conflict of interest statement

Ana Bosch: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly, Roche, Novartis; Support for attending meetings and/or travel from Roche; Participation on a Data Safety Monitoring Board or Advisory; Giuseppe Curigliano: Consulting fees from BMS, Roche, Pfizer, Novartis, Lilly, Astra Zeneca, Daichii Sankyo, Merck, Seagen, Ellipsis, Gilead; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly, Pfizer, Relay; Support for attending meetings and/or travel from Daichii Sankyo; Jana De Boniface: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astra Zeneca; Carsten Denkert: Grants from Myriad, Roche, BMBF, European Commission, GBG Foundation; consulting fees from MSD Oncology, Daiichi Sankyo, Molecular Health, AstraZeneca, Roche, Lilly; Peter Dubsky: Honoraria for presentations and Advisory from Roche and Astra Zeneca to Hirslanden Klinik St. Anna; Michael Knauer: Grants or contracts Agendia BV; Consulting fees from Myriad, Exact Sciences; Thorsten Kühn: Consulting fees from Merit Medical, Endomag, Hologic, Sirius Medical; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GILEAD, MSD, Pfizer, Exact Sciences; Support for attending meetings and/or travel from Gilead, MSD; Sibylle Loibl: Grants or contracts from Abbvie, AZ, BMS/Celgene, DAichi Synkyo, Gilead, Molecular Health, Novartis, Pfizer, Roche; Royalties or licenses for Ki 67 Analyser, VM SCOPE; Consulting fees from AZ, Amgen, Abbvie, BMS, Celgene, Daichi Sankyo Eirgenix, Gilead, Lilly, Merck, MSD, Novartis, Olema, Pfizer, Pierre Fabre, Relay Therapeutics, Incyte, Roche, Sanofi, Seagen; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AZ, Gilead, Roche, Seagen, MSD, Pierre Fabre, MEDSCAPE; Patents planned, issued or pending EP14153692.0; EP21152186.9; EP15702464.7; EP15702464.7; Participation on a Data; Safety Monitoring Board or Advisory Board from Daichi Sankyo; Receipt of equipment, materials, drugs, medical writing, gifts or other services Daichiy Sankyo, Gilead, Novartis, AstraZeneca, Roche, Seagen; Icro Meattini: Consulting fees from Novartis, Pfizer, Eli Lilly, Seagen, Gilead; Katja Pinker: Consulting fees from Genentech, Inc., Merantix Healthcare, AURA Health Technologies GmbH; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: European Society of Breast Imaging (active), Bayer (active), Siemens Healthineers (ended), DKD 2019 (ended), Olea Medical (ended), Roche (ended); Trine Tramm: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Pfizer, Roche; Support for attending meetings and/or travel from Roche and Novartis; Jong Han Yu: Consulting fees from Gencurix; Walter Paul Weber: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from MSD; all other others have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Main toolbox recommendations for axillary management.
Fig. 2
Fig. 2
Treatment algorithms for axillary radiation therapy and surgery. a) Upfront surgery setting. b) Primary systemic treatment setting. Abbreviations: axRT, Axillary radiation therapy; ALND, Axillary lymph node dissection; ECE, Extracapsular extension; IM, Internal mammary; LVI, Lymphovascular invasion; RT, Radiation therapy; SLNB, Sentinel lymph node biopsy; Tx, Treatment.
Fig. 3
Fig. 3
Radiation planning CT after axillary lymph node dissection. The arrow shows the clips at the upper border of axillary dissection. No surgical changes are noted behind the pectoral minor muscle, suggesting only partial axillary dissection of level 1 without level 2.
Supplemental Fig. S1
Supplemental Fig. S1
See this image and copyright information in PMC

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