Outcomes of non-metastatic triple negative breast cancers: Real-world data from a large Indian cohort

Manufacturing and Financial Evaluation of Peptide-Based Neoantigen Cancer Vaccines for Triple-Negative Breast Cancer in the United Kingdom: Opportunities and Challenges

This review evaluates the financial burden of current treatments for triple-negative breast cancer (TNBC) and projects potential financial scenarios to assess the feasibility of introducing a peptide-based neoantigen cancer vaccine (NCV) targeting the disease, using the UK as a healthcare system model. TNBC, the most aggressive breast cancer subtype, is associated with poor prognosis, worsened by the lack of personalised treatment options. Neoantigen cancer vaccine therapies present a personalised alternative with the potential to enhance T-cell responses independently of genetic factors, unlike approved immunotherapies for TNBC. Through a systematic literature review, the underlying science and manufacturing processes of NCVs are explored, the direct medical costs of existing TNBC treatments are enumerated, and two contrasting pricing scenarios for NCV clinical adoption are evaluated. The findings indicate that limited immunogenicity is the main scientific barrier to NCV clinical advancement, alongside production inefficiencies. Financial analysis shows that the UK spends approximately GBP 230 million annually on TNBC treatments, ranging from GBP 2200 to GBP 54,000 per patient. A best-case pricing model involving government-sponsored NCV therapy appears financially viable, while a worst-case, privately funded model exceeds the National Institute for Health and Care Excellence (NICE) cost thresholds. This study concludes that while NCVs show potential clinical benefits for TNBC, uncertainties about their standalone efficacy make their widespread adoption in the UK unlikely without further clinical research.

Occult Breast Cancer in High-Risk Gene-Positive Pakistani Women Undergoing Contralateral Prophylactic Mastectomy/Prophylactic Mastectomy: Implications for Sentinel Lymph Node Biopsy

Introduction

Sentinel lymph node biopsy (SLNB) of the axilla is standard in breast cancer (BC) management; however, its role in prophylactic/contralateral prophylactic mastectomy (CPM) is still questioned. To avoid future consequences on surgical morbidity and socioeconomic aspects in low and middle-income countries (LMICs), we intend to determine the prevalence of occult breast cancer (OBC) among CPM cases.

Objective

To determine the prevalence of OBC in patients undergoing prophylactic mastectomy (PM).

Design

This is a retrospective cohort study.

Materials and methods

This retrospective cohort study is conducted at a tertiary-care hospital from January 2017 to December 2022. All individuals with the positive genetic test for high-risk breast cancer (HRBC) genes who underwent PMs/CPM at our centre were included. We analysed data using SPSS version 23.0.

Results

Twenty-six mutation-positive females underwent PM/CPM (16.1%). Two (7.69%) of 26 had later post-PM recurrence. Only 8 (30.76%) patients had SLNB and all were negative. No OBC was seen in PM/CPM specimens, whereas 3 (11.5%) had atypical ductal hyperplasia (ADH). Two of the ADH had BI-RADS-1, whereas 1 was BI-RADS-4 (33.3%) on the preoperative assessment. Results also showed that with an increase in the tumour grade of the diseased breast, the BI-RADS score of the asymptomatic breast was subsequently increased (P = .029).

Conclusion

Our study shows negative OBCs in PM/CPM cases with persistently negative SLNB results; however, ADH is identified in 11.5% of specimens. Our results suggest that SLNB can be safely omitted in patients undergoing CPM, but, preoperatively, patient and disease factors should be considered.

The inherent fragility of collective proliferative control

Tissues achieve and maintain their sizes through active feedback, whereby cells collectively regulate proliferation and differentiation so as to facilitate homeostasis and the ability to respond to disturbances. One of the best understood feedback mechanisms-renewal control-achieves remarkable feats of robustness in determining and maintaining desired sizes. Yet in a variety of biologically relevant situations, we show that stochastic effects should cause rare but catastrophic failures of renewal control. We define the circumstances under which this occurs and raise the possibility such events account for important non-genetic steps in the development of cancer. We further suggest that the spontaneous stochastic reversal of these events could explain cases of cancer normalization or dormancy following treatment. Indeed, we show that the kinetics of post-treatment recurrence for many cancers are often better fit by a model of stochastic re-emergence due to loss of collective proliferative control, than by deterministic models of cancer relapse.

Receptor subtype and outcome of breast cancer - Single-center experience from North India

AIMS/OBJECTIVES

In resource-limited settings, data regarding the impact of molecular/receptor subtypes on breast cancer (BC) are sparse. In this single-center retrospective study from north India, we analyze the outcomes of various molecular subtypes of BC.

MATERIALS AND METHODS

Females with biopsy-proven BC who were treated at our State Cancer Institute from 2014-2018 were included. Data regarding clinicopathological parameters and follow-up details were evaluated. For data analysis, cancers were categorized into 4 subtypes: HR+HER2-, HR+HER2+, HR-HER2+, and HR-HER2-.

RESULTS

Among 944 patients included, HR+HER2- (49.1%) and HR+HER2+ (13.1%) were the most and least common subtypes, respectively. The receptor subtype significantly impacted overall survival (OS). HR+HER2- cancers had the best outcomes while HR-HER2- cancers fared worst (3-yr OS of 94.3% and 69.1%, respectively). On subgroup analysis, the molecular subtype continued to significantly impact OS in patients with tumor grades II and III, disease stages II and III, and age groups of <40 and 40-60 years, respectively (HR-HER2- cancers had the lowest cumulative survival in each subgroup). In patients with metastatic BC, all molecular subtypes except HR+HER2- had a dismal prognosis.

CONCLUSIONS

Overall and across various subgroups, patients with triple-negative BC had the poorest outcomes. Ensuring optimal treatment utilization including affordable access to personalized tailored therapy is the need of the hour to improve long-term outcomes in these patients.