John Fralick, Cancer Care and Epidemiology, Queen's University
15 January 2009
Krainick-Strobel et al. provide detail of their single-arm trial of preoperative letrozole in stage T2 – T4b, N0 breast cancer patients. The authors observed that over 50% of the study population became eligible for breast conserving surgery within four months of neoadjuvant letrozole and that letrozole had a favourable safety and tolerability profile. They indicate that no patients showed evidence of metastatic disease at the final assessment.
The authors indicate, however, that ‘no or a very few’ patients did end up having ‘affected’ lymph nodes by the time of their final clinical assessment. It would be helpful to have clear documentation of the number of patients who were found to have positive nodes in table 7. Also, it is not clear from the article what clinical disease response was assigned to these patients who had affected nodes. Were these patients included in the progressive disease group? Were these nodes dissected at surgery, and if so, were they found to be negative for malignant disease? My concern is that if patients with affected nodal disease were not included in the progressive disease group, your estimates of clinical response are likely overestimated.
Nodal status
15 January 2009
Krainick-Strobel et al. provide detail of their single-arm trial of preoperative letrozole in stage T2 – T4b, N0 breast cancer patients. The authors observed that over 50% of the study population became eligible for breast conserving surgery within four months of neoadjuvant letrozole and that letrozole had a favourable safety and tolerability profile. They indicate that no patients showed evidence of metastatic disease at the final assessment.
The authors indicate, however, that ‘no or a very few’ patients did end up having ‘affected’ lymph nodes by the time of their final clinical assessment. It would be helpful to have clear documentation of the number of patients who were found to have positive nodes in table 7. Also, it is not clear from the article what clinical disease response was assigned to these patients who had affected nodes. Were these patients included in the progressive disease group? Were these nodes dissected at surgery, and if so, were they found to be negative for malignant disease? My concern is that if patients with affected nodal disease were not included in the progressive disease group, your estimates of clinical response are likely overestimated.
Competing interests
None