Adjuvant and neoadjuvant breast cancer treatments: A systematic review of their effects on mortality

The role of DDIT3 in modulating proliferation and tamoxifen resistance in luminal A subtype breast cancer through the DDIT3-IRF1 axis

BACKGROUND

This study investigates the role of DNA Damage Inducible Transcript 3 (DDIT3) in luminal A subtype breast cancer (LABC). DDIT3, a transcription factor linked to various stress responses, has been implicated in tumorigenesis, yet its specific contributions to LABC biology remain poorly understood.

METHODS

To elucidate these functions, we utilized bioinformatics analyses, including data from TCGA and Kaplan-Meier databases. Furthermore, we performed siRNA-mediated knockdown and overexpression experiments in MCF-7 and T47D cells to assess DDIT3's functional impact on cell proliferation, drug resistance, etc. RNA sequencing analysis identified differentially expressed genes (DEGs) associated with DDIT3 manipulation, and pinpointing the crucial downstream target with rescue experiment.

RESULTS

Compared to normal breast tissue, DDIT3 is lowly expressed in LABC, and LABC patients with low DDIT3 expression have a lower survival rate, indicating relatively poor prognosis. Furthermore, DDIT3 negatively regulates the proliferation of LABC cells, also negatively correlated with the sensitivity of TAM. RNA-seq result and rescue experiment identified the interferon regulatory factor 1 (IRF1) as a crucial downstream target of DDIT3 to regulating LABC cell proliferation and tamoxifen (TAM) resistance.

CONCLUSIONS

DDIT3 is negatively correlated with poor prognosis in LABC patients. And DDIT3 may negatively regulate the proliferation and TAM sensitivity in LABC cells through the DDIT3-IRF1 axis.

On-site delivery of bioactive nanospheres utilizing lanthanides as crosslinkers and metastasis-inhibiting agents for breast cancer therapy

Postoperative breast cancer patients face a critical 2-3-week window during which residual tumor cells are highly prone to metastasis, yet systemic therapies are often ineffective due to impaired vascularization and limited drug transport. To address this challenge, we developed an injectable nanosphere formulation based on hyaluronic acid (HyA) crosslinked with lanthanide ions-europium (Eu) or lanthanum (La) ions-that act dually as physical crosslinkers and therapeutic agents. This dual-function design ensures structural stability without chemical crosslinkers, while actively inhibiting cancer cell migration, invasion, and colonization. The small ionic size of lanthanides facilitates deep interstitial transport, overcoming diffusion barriers in poorly perfused tissues. Upon injection, the nanospheres swell to sub-micrometer dimensions, achieving prolonged retention at the tumor site and sustained ion release for up to 21 days. In vitro and in vivo studies revealed distinct anti-metastatic profiles: HyA-Eu nanospheres effectively suppressed migration and distant metastasis, whereas HyA-La nanospheres inhibited colony formation and primary tumor growth. These results demonstrate a novel lanthanide ion-mediated strategy for post-surgical cancer therapy, integrating local retention with controlled ion release to bridge the treatment gap during recovery.

Inhibitory effects of nimodipine, nitrendipine and felodipine on tamoxifen metabolism and molecular docking

Tamoxifen, a selective estrogen receptor modulator (SERM) used in breast cancer therapy, requires metabolic activation by CYP3A4 to exert its biological effects. This study evaluated the effects of calcium channel blockers nimodipine, nitrendipine and felodipine on tamoxifen metabolism by studying their interactions with tamoxifen in vitro and in vivo. Rat liver microsomes (RLM) and human liver microsomes (HLM) were used in this study to evaluate the inhibitory potential of nimodipine, nitrendipine and felodipine on tamoxifen metabolism in vitro. A total of 28 cardiovascular drugs, including calcium channel blockers, were screened in an RLM incubation system in vitro. In RLM, nimodipine, nitrendipine and felodipine had half-maximum inhibitory concentration (IC50) values of 5.55 µM, 11.86 µM and 7.71 µM, respectively. In HLM, the IC50 values were increased to 20.38 µM, 30.06 µM, and 44.45 µM for nimodipine, nitrendipine and felodipine, respectively. The kinetic assays indicated that nimodipine and felodipine inhibited the metabolism of tamoxifen in a competitive way, whereas nitrendipine showed non-competitive inhibition in RLM. However, felodipine exhibited non-competitive inhibition, and nimodipine and nitrendipine showed competitive inhibition in HLM. Pharmacokinetic studies in rats revealed that pretreatment with nimodipine and nitrendipine significantly increased the systemic exposure of tamoxifen, as demonstrated by increasing the area under the curve (AUC), the maximum concentration (Cmax) and decreasing the clearance (CLz/F). Finally, molecular docking studies supported these findings, showing potential interactions at the active site of CYP3A4. These results suggested the necessity for careful monitoring and possible dose adjustments of tamoxifen when co-administered with calcium channel blockers in clinic.

Effects of CBT-based interventions on health outcomes in breast cancer patients: a systematic review and Meta-analysis

PURPOSE

The systematic review and meta-analysis aimed to comprehensively evaluate the impact of cognitive-behavioral therapy (CBT)-based interventions on health outcomes in patients with breast cancer. Additionally, it assessed the implementation and sustainability of these interventions in clinical and healthcare settings.

METHODS

A search of electronic databases including PubMed, Web of Science, Cochrane Library, CINAHL, CNKI, and Wanfang Data Knowledge Service Platform was conducted for relevant studies published between July 2014 and July 2024. Standardized Mean Differences (SMD) with 95% Confidence Intervals (CIs) were used to determine the effects of the interventions. The pooled effect size was calculated using a random-effects model. The RE-AIM Framework was used to evaluate the potential implementation and sustainability of the interventions in real-world settings.

RESULTS

This systematic review incorporated 14 randomized controlled trials and quasi-experimental studies. We found that various CBT-based interventions had positive effects on fear of cancer recurrence (SMD = - 0.64; 95% CI [- 1.02, - 0.26]; P = 0.0011), anxiety (SMD = - 0.38; 95% CI [- 0.65, - 0.10]; P = 0.0068), depression (SMD = - 0.49; 95% CI [- 0.80, - 0.19]; P = 0.0017), mindfulness skills (SMD = 0.80; 95% CI [0.48, 1.13]; P < 0.0001), fatigue (SMD = - 0.37; 95% CI [- 0.59, - 0.15]; P = 0.0011), quality of life (SMD = 0.54; 95% CI [0.14, 0.93]; P = 0.0080), sleep (SMD = - 0.16; 95% CI [- 0.32, - 0.01]; P = 0.0398), positive psychology (SMD = 2.19; 95% CI [0.38, 4.00]; P = 0.0178) and spiritual well-being (SMD = 0.89; 95% CI [0.56, 1.21]; P < 0.0001). However, there was no significant effect on perceived stress in patients with breast cancer (SMD = - 0.70; 95% CI [- 1.44, 0.04]; P = 0.0634).

CONCLUSIONS

CBT-based interventions are effective in improving the health outcomes of patients with breast cancer. Rigorously designed randomized controlled trials are needed to validate CBT-based interventions (such as personalized, long-term, and diversified intervention strategies) to optimize psychological health interventions and enhance health outcomes for these patients.

Evaluation and Comparison of Prognostic Multigene Tests in Early-Stage Breast Cancer: Which Is the Most Effective? A Literature Review Exploring Clinical Utility to Enhance Therapeutic Management in Luminal Patients

Breast cancer is the most common malignancy affecting women, marked by significant complexity and heterogeneity. This disease includes multiple subtypes, each with unique biological features and treatment responses. Despite significant advancements in detection and therapy, challenges remain, particularly in managing aggressive forms like triple-negative breast cancer and overcoming drug resistance. Breast cancer classification and subtype determination are typically performed by immunohistochemistry (IHC) method, which assesses four key markers (ER, PR, HER2, KI67); however, due to the recognized issues with this approach-especially regarding the evaluation of Ki67-there is a risk of misclassification. Patients who may be suitable for chemotherapy could miss possible advantages and only experience needless toxicity as a result of improper treatment decisions. Molecular profiling has improved breast cancer management, enabling the creation of multigene prognostic tests (MPTs) like Oncotype Dx, MammaPrint, Prosigna, Endopredict, and Breast Cancer Index which assess gene expression profiles to more accurately predict recurrence risks. These tools help personalize treatment, identifying patients who can avoid chemotherapy and/or extended endocrine therapy. While many MPTs are available, only Oncotype Dx and MammaPrint have prospective validation, with Prosigna providing additional prognostic insights by incorporating clinical variables. Molecular tests are especially usefull in the "gray zone," which includes tumors measuring between 1 and 3 cm with 0-3 positive lymph nodes and an intermediate proliferation index. However, their clinical utility has not been definitively established, and significant differences exist between them. This article provides an in-depth analysis of established genomic assays, including testing procedures, clinical validity, utility, diagnostic frameworks, and methodologies. Our comparison aims to improve early breast cancer management by guiding pathologists and oncologists in optimizing the use of genomic assays in clinical practice. By presenting this information, we aim to enhance understanding of the clinical utility and effectiveness of these assays, supporting the development of personalized treatment strategies for early breast cancer patients. Genomic assays offer important insights that can support treatment decisions in early-stage breast cancer, especially when used alongside other clinical evaluations, predictive tools, and management guidelines. While multiple gene expression profiling tests are available, they classify patients differently and are not interchangeable; therefore, their application should be at the clinician's discretion during the decision-making process. It is essential that these tests are not the sole factor in determining the best treatment plan: other clinical considerations and patient preferences should also play a significant role in guiding treatment decisions.

A study on the impact of neoadjuvant therapy on molecular subtype conversion in breast cancer

PURPOSE

The aim of this study was to examine molecular subtype conversions in patients who received neoadjuvant therapy.

METHODS AND MATERIALS

A retrospective analysis was performed on 316 patients who underwent neoadjuvant therapy at Zhongnan Hospital of Wuhan University between March 2017 and October 2024. The study included data from patients with confirmed pathological residual disease at the primary site post-surgery, alongside complete receptor status and detailed information on the neoadjuvant treatment regimen administered before and after therapy. Univariate and multivariate logistic regression analyses were employed to identify factors influencing molecular subtype heterogeneity before and after neoadjuvant therapy.

RESULTS

Of the 316 patients who received neoadjuvant therapy and underwent repeated pathological biopsies, 84 (26.6%) achieved a pathological complete response (pCR). Among the remaining 232 patients with confirmed pathological residual disease after surgery, 85 (36.6%) exhibited conversion of molecular subtypes, with 45 cases (19.3%) leading to alterations in the treatment plan. In breast cancer patients undergoing neoadjuvant chemotherapy (NAC), particularly those with HR-positive tumors prior to NAC, those demonstrating favorable treatment responses on imaging, and those undergoing breast-conserving surgery, molecular subtype heterogeneity before and after NAC was more commonly observed.

CONCLUSION

Neoadjuvant therapy can induce molecular subtype heterogeneity in patients with invasive breast cancer. The identification of factors contributing to this heterogeneity may be associated with variations in biological markers of residual disease post-NAC, sampling discrepancies between core needle biopsy (CNB) and surgical specimens, or the selective mutagenic pressure exerted by chemotherapeutic agents.

Prophylactic Neurokinin-1 Receptor Antagonist Use Pre- and Post-Choosing Wisely Initiative Among Women With Invasive Breast Cancer

OBJECTIVE

To examine the impact of Choosing Wisely (CW) on prophylactic NK1-RA use among women with breast cancer.

STUDY SETTING AND DESIGN

This was a retrospective cohort study conducted using administrative claims data. The exposure variable was the start of chemotherapy relative to the implementation date for the CW antiemetic measure. The outcome was prophylactic NK1-RA use. Interrupted time series using segmented regression was used to assess the effect of CW on prophylactic NK1-RA use.

DATA SOURCES AND ANALYTIC SAMPLE

Optum's de-identified Clinformatics Data Mart Database (2010-2018) was used. This study included women aged ≥ 18 years with breast cancer with at least one newly initiated claim for low/minimal/moderate emetic risk chemotherapy (n = 25,549).

PRINCIPAL FINDINGS

The prophylactic use of NK1-RAs among patients with breast cancer receiving low/minimal/moderate emetic risk chemotherapy decreased from 11.1% pre-CW to 7.7% post-CW. Segmented regression analysis showed a significant increase of 0.11 per 100 patients per quarter in the use of prophylactic NK1-RAs prior to CW recommendation (95% CI = 0.10-0.12; p < 0.0001). However, immediately after the CW (occurred in Q4 2013), there was a significant decline in the prophylactic NK1-RA use by 1.03 per 100 patients in Q2 2014 (-0.93 to -1.13; p < 0.0001). For the time after intervention, there was a significant decline in NK1-RA use by 0.37 per 100 patients per quarter in the post-CW period compared to the pre-CW period (95% CI = -0.36 to -0.38; p < 0.0001).

CONCLUSION

This study highlights a significant but modest decline in the use of prophylactic NK1-RAs. Educational efforts for the dissemination of CW recommendations are needed to facilitate appropriate prophylactic NK1-RAs use.

CXCR4/CXCL12 blockade therapy; a new horizon in TNBC therapy

The only subtype of breast cancer (BC) without specific therapy is triple-negative breast cancer (TNBC), which represents 15-20% of incidence cases of BC. TNBC encompasses transformed and nonmalignant cells, including cancer-associated fibroblasts (CAF), endothelial vasculature, and tumor-infiltrating cells. These nonmalignant cells, soluble factors (e.g., cytokines), and the extracellular matrix (ECM) form the tumor microenvironment (TME). The TME is made up of these nonmalignant cells, ECM, and soluble components, including cytokines. Direct cell-to-cell contact and soluble substances like cytokines (e.g., chemokines) may facilitate interaction between cancer cells and the surrounding TME. Through growth-promoting cytokines, TME not only enables the development of cancer but also confers therapy resistance. New treatment targets will probably be suggested by comprehending the processes behind tumor development and progression as well as the functions of chemokines in TNBC. In this light, several investigations have shown the pivotal function of the C-X-C motif chemokine ligand 12 (CXCL12 or SDF-1) axis and chemokine receptor type 4 (CXCR4) in the pathophysiology of TNBC. This review provides an overview of the CXCR4/CXCL12 axis' function in TNBC development, metastasis, angiogenesis, and treatment resistance. A synopsis of current literature on targeting the CXCR4/CXCL12 axis for treating and managing TNBC has also been provided.

Adjuvant systemic therapy in early breast cancer and results of a prospective observational multicenter BRIDE study: patients outcome and adherence to guidelines in cancer clinical practice

Introduction

Evaluation of every breast cancer (BC) patient by multidisciplinary team and application of guidelines are very important to ensure the best treatment and achieve the best outcome.

Methods

The multicenter prospective observational BRIDE study enrolled, from 01/2018 to 02/2021, 1633 BC patients from 19 Italian cancer centers. To evaluate the clinical and biopathological characteristics of BC patients with pathological stage I-II-III treated with surgery followed by adjuvant systemic therapy, type of therapies delivered, outcome and adherence to guidelines, an analysis of 1123 patients out of 1633 patients enrolled in BRIDE study was conducted.

Results

The 1123 patients with stage I-II-III BC had a median age of 61.2 years (Q1-Q3: 50.6-71.7); 70.2% were postmenopausal, 92.1% had ECOG PS 0, 68.4% pT1 disease, 70.7% pN0, 91.7% pathological stage I-II; 68.9% underwent conservative breast surgery and 79.8% sentinel lymph node biopsy alone. According to phenotypic subgroup, 80.6% of patients had a HER2-negative/HR-positive, 10.4% HER2-positive/HR-positive, 6.4% triple negative and 2.6% HER2-positive/HR-negative BC. In clinical practice, the phenotypic tumoral subgroup influenced oncologists in the choice of the type of adjuvant systemic therapy (p<0.0001) according to ESMO and AIOM Guidelines. Adjuvant radiotherapy was administered to 85.5% patients undergoing breast-conserving surgery. At the median follow up of 41.4 months (Q1: 35.3 months - Q3: 57.9 months), the DFS at 48 months was 92.8%, with different rates in the phenotypic subgroups. The adherence to AIOM Guidelines in clinical practice was ≥ 70% for the four evaluated quality indicators of treatment process.

Discussion

In patients with pathological stage I-II-III BC, the phenotypic subgroup influenced the oncologists' decision on the choice of type of adjuvant systemic therapy, as also indicated by international and national guidelines. In our patients, the DFS rate at 24 and 48 months after surgery was 95.4% and 92.8% respectively. The adherence to the AIOM Guidelines in clinical practice was high but having both quality indicators (shared at international and national level) to evaluate the quality of care in BC and standardized threshold levels to evaluate adherence to guidelines is very important today because this type of evaluation will increase in the coming years.

Treatment Modalities for Aromatase Inhibitor-Associated Musculoskeletal Syndrome (AIMSS): A Scoping Review of Prospective Treatment Studies

Aromatase inhibitors (AI's) are effective adjuvant treatments for postmenopausal patients with hormone receptor-positive breast cancer. However, AIs are often associated with diffuse joint and muscle pain, referred to as aromatase inhibitor-associated musculoskeletal syndrome (AIMSS), the symptoms of which are associated with negative impacts and reduced adherence to AI therapy. As more interventions for AIMSS continue to be investigated, a scoping review is needed to survey and summarize the types of interventions and outcomes assessed in studies conducted to date, which may help identify areas needing attention or additional focus in future research. Online databases were searched (from inception to January 8, 2025) to identify 74 reports from prospective studies of interventions for AIMSS pain, stiffness, or interference with functioning. Such interventions were classified as pharmacological (14 reports), complementary/alternative (43 reports), or rehabilitative (17 reports). Included papers required the presence of AIMSS symptoms at enrollment. Several interventions were deemed promising for reducing AIMSS symptoms based on positive results from individual reports, including duloxetine (3 reports from 2 studies), vitamin B12 (2 reports), vitamin D (2 reports), calcitonin (1 report), prednisolone (1 report), glucosamine and chondroitin (1 report), various mind-body (14 reports from 12 studies) and traditional medicine interventions (3 reports), and switching to another AI (1 report). Many positive findings were from uncontrolled studies or were from single studies that await replication in independent cohorts, and no studies focused on structured psychological interventions. The durations for all reviewed studies were brief relative to the expected 5-10-year course of AI therapy. Intervention effects on a wide range of outcomes were studied, including pain or stiffness (70 reports), functioning/disability (34 reports), quality of life (37 reports), mental health symptoms (25 reports), pain self-efficacy (4 reports), and AI persistence (3 reports). However, intervention effects on other important endpoints such as cancer recurrence, survival, healthcare utilization/costs, and caregiver experiences are unclear. The knowledge gaps and limitations identified in this scoping review constitute areas in urgent need of further research and attention.

High Ki-67 expression is associated with increased risk of distant recurrence in Oncotype Dx low risk breast cancer

PURPOSE

To assess whether high Ki-67 protein expression level could independently predict the distant recurrence in early-stage breast cancer with low Oncotype Dx scores (≤ 25).

METHODS

This single-center retrospective cohort study included 278 patients with hormone receptor positive (HR+) human epidermal growth factor receptor 2 negative (HER2-), T1-2N0M0, low Oncotype Dx recurrence score (RS) (≤ 25) breast cancer. We identified 2 groups: "high Ki-67″ ≥ 15% (n = 130, 47%) and "low Ki-67″ < 15% (n = 148, 53%). Clinical characteristics, treatment and survival were abstracted from chart review. Fisher's exact test was used to assess differences between Ki-67 groups. Cox-regression models were used to assess differences in survival.

RESULTS

After a median follow up of 7 years, 13 (4.7%) patients experienced distant metastasis. Recurrence rate was significantly higher in the "high Ki-67″ group 9.2% (12/130) versus the "low Ki-67″ group 0.7% (1/148) (P = .001). Distant metastasis-free survival (dMFS) was significantly shorter in the "high Ki-67″ group (HR 12.90, 95% CI, 12.53-13.27, P = .008). Tumor size ≥ 2 cm was associated with shorter dMFS (HR, 12.90; 95% CI, 12.53-13.27; P < .001). In a multivariable analysis, tumor size ≥ 2 cm and "High Ki-67″ were independent prognosis factors for dMFS.

CONCLUSION

Ki-67 expression level may help to identify a subset of low risk Oncotype Dx patients who could benefit from adjuvant chemotherapy.

circSTIL mediates pirarubicin inhibiting the malignant phenotype of triple-negative breast cancer and acts as a biomarker in plasma exosomes

In clinical practice, pirarubicin (THP) is a widely used triple-negative breast cancer (TNBC) agent. It has been found that circular RNAs (circRNAs) are involved in cancer treatment and progression. However, the biological function of circRNAs in TNBC and the relationship between THP and circRNAs remain poorly studied. circSTIL (hsa_circ_0000069) was screened and validated by bioinformatics analysis, demonstrating that it was highly expressed in TNBC cell lines and plasma exosomes, and correlated with a poor prognosis of patients. The expression level of circSTIL in patients' plasma exosomes has potential diagnostic value in distinguishing TNBC from non-TNBC. In vitro studies confirmed that overexpression of circSTIL promotes the proliferation, migration, and invasion of MDA-MB-231 cells whereas silicification of circSTIL shows the reverse effect. Also, circSTIL mediates THP inhibiting the malignant phenotype of MDA-MB-231 cells. The above results suggested that circSTIL is a possible biomarker for the diagnosis, treatment, and prognosis of TNBC.

System and Technology of Breast Intervention Robot: A Review

BACKGROUND

At present, breast cancer has become the cancer with the highest incidence rate in the world. Breast intervention robot is an important biopsy or targeted therapy method for breast diseases.

METHOD

According to the robot's work requirements, the structure, actuation method, auxiliary device, and puncture planning method for the breast intervention robot are summarised. Based on the research status of intervention breast robots, the limitations of current research are discussed and the future development trends are proposed.

RESULTS

The structure, actuation method, auxiliary device, and puncture planning method of breast robots have been widely studied. They significantly impact robotic intervention accuracy, stability, efficiency, and patient satisfaction.

CONCLUSIONS

The development of breast intervention robots faces many challenges. With the continuous progress of science and technology, these challenges are expected to be addressed through multidisciplinary research. Breast intervention robots have adequate potential for treating and diagnosing breast diseases.

SNS‑032 combined with decitabine induces caspase‑3/gasdermin E‑dependent pyroptosis in breast cancer cells

SNS-032 is a synthetic compound that specifically inhibits cyclin-dependent kinases 2, 7 and 9. Its primary anticancer activity involves cell cycle arrest, which prevents tumor cell growth. However, there are limited reports on whether SNS-032 induces pyroptosis, a novel inflammation-mediated programmed cell death pathway in breast cancer (BC). The present study demonstrated that SNS-032 treatment decreased cell viability by inducing pyroptosis in BC cells. Typical morphological indications of pyroptosis were observed, including cell swelling and destruction of cell membrane integrity, leading the release of adenosine 5'-triphosphate and lactate dehydrogenase. Furthermore, the expression of caspase-3, the N terminus of gasdermin E (GSDME) and B-cell lymphoma-2 (BCL-2)-associated X protein increased, whereas expression of BCL-2 decreased. In addition, Z-DEVD-FMK, a specific caspase-3 inhibitor, markedly alleviated pyroptosis triggered by SNS-032. These findings suggested that SNS-032 induced caspase-3/GSDME-dependent pyroptosis. Furthermore, the present study demonstrated that decitabine (DAC), a DNA methyltransferase inhibitor, upregulated the expression of GSDME protein and enhanced SNS-032-induced caspase-3/GSDME-dependent pyroptosis in BC cells. In conclusion, these results suggest that caspase-3/GSDME-induced pyroptosis can be facilitated by SNS-032 treatment in BC cells, and DAC has the potential to enhance SNS-032-induced pyroptosis by increasing GSDME expression. This mechanistic insight indicates that SNS-032 is a promising therapeutic agent for BC treatment.

Targeted editing of CCL5 with CRISPR-Cas9 nanoparticles enhances breast cancer immunotherapy

Breast cancer remains one of the leading causes of cancer-related mortality among women worldwide. Immunotherapy, a promising therapeutic approach, often faces challenges due to the immunosuppressive tumor microenvironment. This study explores the innovative use of CRISPR-Cas9 technology in conjunction with FCPCV nanoparticles to target and edit the C-C Motif Chemokine Ligand 5 (CCL5) gene, aiming to improve the efficacy of breast cancer immunotherapy. Single-cell RNA sequencing (scRNA-seq) and TCGA-BRCA data identified CCL5 as a key immune-related gene in breast cancer. Using CRISPR-Cas9, sgRNA targeting CCL5 was designed and delivered to breast cancer cells and humanized mouse models via FCPCV nanoparticles. In vitro experiments demonstrated that FCPCV nanoparticles effectively silenced CCL5, enhanced CD8+ T cell activity, and increased the production of cytokines such as IFN-γ, TNF-α, and GZMB. In vivo studies revealed significant tumor suppression, improved immune microenvironment, and increased CD8+/CD4+ ratios in treated mice, without notable toxic side effects. These findings highlight the potential of CRISPR-Cas9 nanoparticle-mediated gene editing as a novel strategy for enhancing breast cancer immunotherapy, providing a new direction for personalized and effective cancer treatment.

Tumor-stroma type and tumor-stroma ratio predict neoadjuvant chemotherapy response in breast cancer

OBJECTIVE

Breast cancer is the most common cancer type among women. One of the most important parameters in the prognosis of patients is the response to neoadjuvant chemotherapy. The most important parameter for neoadjuvant chemotherapy success is appropriate patient selection. We investigated the effect of tumor-stroma type and tumor-stroma ratio on neoadjuvant chemotherapy response, using the Residual Cancer Burden scoring systems.

METHODS

Patients diagnosed with breast carcinoma in core needle biopsy materials between 2010 and 2023 and whose neoadjuvant treatments and surgeries were performed in our institution were scanned from the database. A total of 158 patients who met the study criteria were included in the study.

RESULTS

Tumor-stroma ratio and collagen-dominant tumor-stroma type were associated with neoadjuvant chemotherapy resistance, and tumor-stroma ratio was found to be an independent risk factor in treatment response. The probability of response to neoadjuvant chemotherapy treatment was higher in luminal molecular subtype breast cancer patients with low tumor stroma.

CONCLUSION

An effective risk analysis for neoadjuvant chemotherapy treatment is not always possible with current clinicopathological parameters. Tumor-stroma ratio and tumor-stroma type seem useful in predicting neoadjuvant chemotherapy response as a reproducible practical marker and do not require additional cost and time.

Molecular Subtypes and Mechanisms of Breast Cancer: Precision Medicine Approaches for Targeted Therapies

Breast cancer remains one of the most prevalent diseases worldwide, primarily affecting women. Its heterogeneous nature poses a significant challenge in the development of effective and targeted treatments. Molecular characterization has enabled breast cancer to be classified into four main subtypes: luminal A, luminal B, HER2-positive, and triple-negative breast cancer, based on hormone receptor expression and HER2 status. A deeper understanding of these molecular markers and their associated signaling pathways, such as MAPK and PI3K/AKT, is essential for improving prognosis and optimizing treatment strategies. Currently, several therapeutic agents are utilized in neoadjuvant and adjuvant therapies, often in combination with surgical interventions. However, emerging evidence highlights the growing challenge of drug resistance, which significantly limits the efficacy of existing treatments. Addressing this issue may require innovative approaches, including combination therapies and precision medicine strategies, tailored to the molecular profile of each patient. Therefore, a comprehensive understanding of the pathophysiologic mechanisms driving breast cancer progression and resistance is crucial for the development of advanced targeted therapies with greater precision and efficacy. This review aims to explore recent advancements in molecular research related to breast cancer subtypes and provide a critical analysis of current therapeutic approaches within the framework of precision medicine.

ATP6AP1 promotes cell proliferation and tamoxifen resistance in luminal breast cancer by inducing autophagy

Autophagy is a highly conserved cellular process essential for maintaining cellular homeostasis and influencing cancer development. Lysosomal acidification and autophagosome-lysosome fusion are two important steps of autophagy degradation that are tightly regulated. Although many key proteins that regulate these two events have been identified, the effector proteins that co-regulate both steps remain to be explored. ATP6AP1, an accessory subunit of V-ATPase, plays a critical role in the assembly and regulation of V-ATPase. However, the function of ATP6AP1 in autophagy remains unknown, and the role of ATP6AP1 in cancer is still poorly understood. In this study, we found that ATP6AP1 is overexpressed in luminal breast cancer tissues and promotes the proliferation and tamoxifen resistance of luminal breast cancer cells both in vitro and in vivo. We also observed that high ATP6AP1 expression correlates with poor overall patient survival. Our research further revealed that ATP6AP1 enhances tamoxifen resistance by activating autophagy. Mechanistically, ATP6AP1 promotes autophagy by regulating both lysosomal acidification and autophagosome-lysosome fusion. Remarkably, ATP6AP1 induces lysosomal acidification through the regulation of V-ATPase assembly and facilitates autophagosome-lysosome fusion by enhancing the interaction between Rab7 and the HOPS complex. Together, our studies identify ATP6AP1 as a crucial regulator of autophagy, potentially serving as a valuable prognostic marker or therapeutic target in human luminal breast cancer.

FOXD1 activates KIFC1 to modulate aerobic glycolysis and reinforce cisplatin resistance of breast cancer

BACKGROUND

Breast cancer (BC) is the most prevalent invasive malignant tumor. Cisplatin (DDP) is a prototype of platinum-based chemotherapy drugs, its resistance severely hinders its clinical application. This project intended to figure out the exact mechanism of KIFC1 in the DDP resistance of BC.

METHODS

The levels of KIFC1 and FOXD1 in BC as well as their binding sites were investigated by bioinformatics analysis. The signaling pathways regulated by FOXD1 were analyzed. Chromatin immunoprecipitation (ChIP) and dual-luciferase reporter assays verified the binding relationship between the two. Through quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western blot (WB), we assessed the expression of FOXD1, KIFC1, and glycolysis-related genes. CCK-8 assay was applied in the determination of cell viability to assess the efficacy of DDP resistance. Extracellular acidification rate (ECAR), glucose consumption, lactate synthesis, Adenosine triphosphate (ATP) content, and oxygen consumption rate (OCR) were measured to evaluate glycolysis.

RESULTS

FOXD1 and KIFC1 were significantly upregulated in BC, with KIFC1 being significantly enriched in the glycolysis pathway. Overexpression of KIFC1 significantly enhanced the DDP resistance of BC cells, while promoting aerobic glycolysis. Mechanistically, FOXD1 was bound to the promoter of KIFC1 to activate its transcription. Its overexpression counteracted the inhibitory effect of KIFC1 knockdown on the DDP resistance of BC cells.

CONCLUSION

FOXD1 activates the glycolysis pathway by upregulating KIFC1, thereby facilitating BC cells' DDP resistance. Therefore, the FOXD1/KIFC1 axis linked the glycolysis pathway to DDP resistance and may be a promising new target for reinforcing DDP resistance in BC.

Nomogram Development for Assessing Oncotype DX Recurrence Scores in Breast Cancer: A Chinese Population Study

BACKGROUND

Breast cancer (BC) is the most prevalent cancer among women worldwide, with increasing incidence rates, particularly in China. Given the high costs of Oncotype DX (ODX) testing, which predicts recurrence scores (RSs) on the basis of gene expression, developing a nomogram utilizing clinicopathological variables may provide an accessible alternative for risk stratification.

METHODS

We conducted a retrospective analysis of 703 estrogen receptor (ER)-positive, HER2-negative T1-3N0M0 BC patients who underwent ODX testing at Qilu Hospital. A nomogram was developed using multivariate logistic regression to predict low and high RSs in the group. Model performance was validated by receiver operating characteristic curve, calibration curve, and decision curve analysis.

RESULTS

Multivariate analysis revealed that older age, lower histologic grade, a higher ER expression level, a higher proportion of cells expressing progesterone receptor, and a lower proportion of cells expressing Ki-67 were significantly associated with a patient being in the low-risk subgroup. A nomogram was then developed using these variables to predict the RS, with an area under the curve (AUC) of 0.811 (95% confidence interval [CI] = 0.772-0.850) in the development group and 0.794 (95% CI = 0.737-0.851) in the validation group. Calibration and decision curve analyses further confirmed the nomogram's clinical utility. Moreover, a comparison between the TAILORx-nomogram and our nomogram was conducted, which proved that our nomogram has better predictive accuracy and reliability in Chinese BC patients.

CONCLUSION

We present the first nomogram for predicting the RS in Chinese patients with BC on the basis of clinicopathological factors. This model could aid in identifying patients who may not need ODX testing and serve as a cost-effective alternative for those unable to access ODX, thereby optimizing treatment decisions and enhancing patient management in resource-limited settings.

Mast cell activation induced by tamoxifen citrate via MRGPRX2 plays a potential adverse role in breast cancer treatment

Breast cancer is the most common malignant tumor endangering women's life and health. Tamoxifen citrate (TAM) is the first-line drug of adjuvant endocrine therapy for estrogen receptor-positive (ER+) breast cancer patients. Some sporadic cases have described rare adverse reactions of TAM with potentially life-threatening dermatological manifestations, which were associated with skin allergy. Mas related G protein-coupled receptor X2 (MRGPRX2) on human mast cells is the key target for skin allergy. We aimed to investigate the mechanism of TAM-induced allergic reactions and their potential effects on TAM treatment for breast cancer. In our study, TAM can specifically bind with MRGPRX2, which was mainly driven by hydrophobic force. TAM formed hydrogen bonds with TRP243, TRP248, and GLU164 residues in MRGPRX2. TAM induced calcium mobilization and degranulation of mast cells via MRGPRX2. Besides, TAM induced passive cutaneous anaphylaxis and active systemic anaphylaxis in C57BL/6 mice. The release of β-hexosaminidase, histamine, tumor necrosis factor-α, monocyte chemoattractant protein 1, and interleukin-8 were increased by TAM in vitro and in vivo. Furthermore, we found that MCF-7 and T-47D breast cancer cells can recruit mast cells to adjacent cancerous tissues. Besides, mast cell activation induced by TAM via MRGPRX2 significantly promoted the proliferation and migration of MCF-7 and T-47D cells, which can be effectively reversed by mast cell membrane stabilizer clarithromycin and MRGPRX2 silencing. This study proposed an anti-allergic therapeutic strategy for breast cancer treatment with TAM, while also the potential of MRGPRX2 as an adjunctive target.

Tumor Microenvironment Modulation by Tumor-Associated Macrophages: Implications for Neoadjuvant Chemotherapy Response in Breast Cancer

Background

Tumor-associated macrophages (TAMs) constitute an important part of the tumor microenvironment of breast cancer (BC), and they play an essential role in modulating tumor growth and invasion. However, the role of TAMs in neoadjuvant chemotherapy (NAC) has not been fully elucidated. Therefore, the aim of this study was to assess the function of TAM subtypes and investigate their role in the response to NAC in BC.

Methods

Presence of TAMs was examined immunohistochemically (IHC) in pre- and post- NAC treatment tumor tissue in a cohort of 138 BC patients. IHC staining with monoclonal antibodies for CD68 and CD163 were performed. Positivity was defined as staining > 1% TAMs in stroma and tumor cell nests. Response to NAC was evaluated according to tumor size change and Residual Cancer Burden (RCB) index.

Results

CD68+ and CD163+ TAMs decreased significantly in both the stroma and tumor nests (TN) after NAC. The median CD68+ TAMs in the stroma decreased significantly from 5% to 1% (p < 0.005), while CD163+ TAMs showed a marked reduction from 20% to 5% (p < 0.001). Post-NAC, the persistence of CD68+ and CD163+ TAMs in the stroma was strongly correlated with larger residual tumor size (p < 0.005 and p < 0.001, respectively). Changes in CD163+ TAM levels in the stroma were significantly associated with RCB classes (p < 0.005). Pre-NAC, CD163+ TAMs in the stroma and TN showed a significant association with TILs; however, no correlations with TILs were observed post-NAC.

Conclusion

This study highlights the critical role of TAMs dynamics in shaping NAC response in BC. Notably, CD163+ TAMs may emerge as pivotal players in mechanisms of chemotherapy resistance and response, underscoring their potential as biomarkers and therapeutic targets in breast cancer treatment.

Fe/Mo-Based Lipid Peroxidation Nanoamplifier Combined with Adenosine Immunometabolism Regulation to Augment Anti-Breast Cancer Immunity

Immunogenic cell death (ICD)-mediated immunization strategies have great potential against breast cancer. However, traditional strategies neglect the increase in the immunosuppressive metabolite, adenosine (ADO), during ICD, leading to insufficient therapeutic outcomes. In this study, it is found that the adenosine A2A receptor (A2AR) is significantly expressed in breast cancer and positively associated with regulatory T (Treg) cells. Herein, a strategy combining Fe/Mo-based lipid peroxidation (LPO) nanoamplifiers and A2AR blockade is reported to maximize ICD-mediated anti-tumor immunity. This LPO nanoamplifier causes LPO explosion by the Fe (II)-mediated Fenton reaction and Mo(V)-mediated Russell mechanism. Subsequently, it elicits the ICD magnification of tumor cells by inducing multiple regulated cell death patterns of ferroptosis, apoptosis, and necroptosis. Additionally, the A2AR antagonist (SCH58261), an immunometabolic checkpoint blocker, is found to relieve ADO-related immunosuppression, amplify anti-tumor immunological effects, and elicit immune memory responses. This robust anti-tumor immunity is observed in primary, distant, pulmonary metastatic, and recurrent tumors. This study provides a novel strategy for optimizing ICD-mediated immunotherapy and highlights the benefits of combining LPO explosion with A2AR blockade to enhance breast cancer immunotherapy.

Identification of novel ferroptosis-related biomarkers associated with the oxidative stress pathways in ischemic cardiomyopathy

Background

Ferroptosis is a cell death process that depends on iron and reactive oxygen species. It significantly contributes to cardiovascular diseases. However, its exact role in ischemic cardiomyopathy (ICM) is still unclear.

Methods

Using bioinformatics methods, we identified new molecular targets associated with ferroptosis in ICM and conducted various analyses-including correlation analysis, pathway enrichment analysis, protein interaction network construction, and analysis of transcription factor and drug interactions, to reveal the potential mechanisms behind these genes.

Results

We evaluated two independent training sets of ICM, GSE57338 and GSE5406, comprising 203 ICM samples, and validation sets GSE76701 to examine differentially expressed genes (DEGs) related to ferroptosis. After extracting the intersection of the gene sets and ferroptosis-related genes, 53 DEGs were identified. Enrichment analyses showed that the alterations in ferroptosis-related DEGs were mainly enriched in oxidative stress response, and immune-related pathways. Furthermore, 11 hub genes were identified using protein-protein interaction network analysis. The key interactions between 11 hub genes were more pronounced in protein localization during ICM development. In addition, we construct a hub gene and transcription factor interaction network and a small molecule drug-gene interaction network. We found that among these hub genes, the N-acetylneuraminate outer membrane channel(NANC) gene is positively correlated with most of the small-molecule drugs used to treat ICM, and its high expression might increase resistance.

Conclusions

Ferroptosis exists in ICM and and is associated with oxidative stress. This association suggests that ferroptosis may facilitate the progression of ICM.

Impact of Pre-Existing Frailty on Cardiotoxicity Among Breast Cancer Patients Receiving Adjuvant Therapy

BACKGROUND

Prior research suggests that breast cancer patients with a high burden of frailty may face an increased risk of cardiotoxicity.

OBJECTIVES

This study sought to examine the association between frailty and cardiotoxicity rates in female breast cancer patients receiving adjuvant therapy after surgery.

METHODS

We analyzed data from the OneFlorida+ clinical research network, focusing on breast cancer patients treated with adjuvant chemotherapy and targeted therapy from 2012 to 2022. Cardiovascular rates during adjuvant treatments were calculated based on pre-existing frailty, measured using the cumulative deficit frailty index (electronic health record frailty index). We employed multivariable Gray's method to examine the association between frailty with cardiotoxicity.

RESULTS

The final cohort included 2,050 patients (mean age 50.6 years), with 415 (20.2%) experiencing nonfatal adverse cardiovascular events after adjuvant therapy. The incidence of adverse cardiovascular events was 17.8% in robust, 23.2% in prefrail, and 29.4% in frail patients. In multivariable analysis, prefrail (adjusted subdistribution HR [sHR]: 1.35; 95% CI: 1.06-1.71; P = 0.015) and frail (adjusted sHR: 1.70; 95% CI: 1.11-2.61; P = 0.015) patients had a higher likelihood of experiencing adverse cardiovascular events compared with robust patients. Among non-Hispanic White and Black patients, prefrail (adjusted sHR: 1.48; 95% CI: 1.04-2.11; P = 0.031; and adjusted sHR: 1.59; 95% CI: 1.06-2.37; P = 0.024, respectively) and frail (adjusted sHR: 1.96; 95% CI: 1.10-3.50; P = 0.022; and adjusted sHR: 2.13; 95% CI: 1.11-4.10; P = 0.023, respectively) patients were more likely to experience adverse cardiovascular events compared with robust patients. No significant differences were observed in other racial/ethnic groups.

CONCLUSIONS

These findings highlight the need for close monitoring of cardiotoxicity in frail breast cancer patients undergoing adjuvant treatments to improve cardiovascular risk management.

Nanoparticles Modulating the Immune Microenvironment in Breast Cancer Treatment

Breast cancer remains a significant therapeutic challenge, with the immune microenvironment playing a crucial role in its progression and treatment response. This review investigates the potential of nanoparticles to modulate the immune microenvironment in breast cancer therapy. Initially, we discuss the composition and influence of the immune microenvironment on breast cancer, followed by current strategies targeting these components. We then provide strategies of nanoparticles for targeting immune cells such as macrophages, dendritic cells, and T-cells. The role of nanoparticles in enhancing immune checkpoint blockade (ICB) and their application in cancer vaccines is also examined. Additionally, we explore the synergistic effects of combining nanoparticles with conventional therapies. The review addresses the challenges in clinical translation, focusing on safety, biocompatibility, and toxicity. Finally, we outline future research directions and the potential advancements in nanoparticle-based immunotherapy, emphasizing their transformative impact on breast cancer treatment.

RNA binding protein ILF3 increases CEP55 mRNA stability to enhance malignant potential of breast cancer cells and suppress ferroptosis

BACKGROUND

Ferroptosis has emerged as a promising therapeutic target in cancer treatment. CEP55, a key regulator of cell mitosis, plays a significant role in the tumorigenesis of many malignancies. In this study, we elucidated the function of CEP55 in the ferroptosis of breast cancer (BC).

METHODS

The protein levels of CEP55 and ILF3 were detected by immunoblotting or immunohistochemistry, and their mRNA levels were assessed by quantitative PCR. Cell invasion and migration were evaluated by transwell assay. Cell apoptosis and colony formation were tested by flow cytometry and colony formation assays, respectively. RNA immunoprecipitation (RIP) experiment and CEP55 mRNA stability assay were used to validate the relationship between ILF3 and CEP55 mRNA. Subcutaneous xenograft studies were performed to analyze the role of ILF3 depletion in tumor growth.

RESULTS

CEP55 and ILF3 were upregulated in most of human BC samples and MDA-MB-231 and MCF-7 BC cells. The depletion of CEP55 or ILF3 impaired the growth, invasion, and migration of MDA-MB-231 and MCF-7 cells, while promoted their ferroptosis and apoptosis. Mechanistically, ILF3 stabilized CEP55 mRNA to regulate CEP55 expression in BC cells. CEP55 restoration partially rescued the malignant potential defects of ILF3-depleted BC cells and attenuates their ferroptosis. Moreover, ILF3 depletion enhanced the anti-tumor growth activity of the ferroptosis inducer erastin in MDA-MB-231 subcutaneous xenograft tumors.

CONCLUSION

Our observations indicate that the depletion of ILF3 impairs the malignant potential of BC cells and promotes their ferroptosis by downregulating CEP55 expression. Silencing ILF3 or CEP55 could represent a potential therapeutic strategy for BC treatment.

Breast Cancer Histopathological Image Classification Based on Graph Assisted Global Reasoning

Breast cancer ranks as the most prevalent cancer among women globally. Histopathological image analysis stands as one of the most reliable methods for tumor detection. This study aims to utilize deep learning to extract histopathological features and automatically identify tumor information, thereby assisting doctors in high-precision pathological diagnosis. This study proposes a dual-stream global-local network (DSGLNet) for breast cancer histopathological image classification. The proposed DSGLNet employs a dual-stream feature extraction architecture that leverages a convolutional network to extract local image features and employs graph convolutional mapping to construct a global feature interaction space for capturing global information. By deeply integrating both local and global features, the network achieves precise image classification. Additionally, image preprocessing through feature engineering normalizes image colors and enhances the details of tissue cell boundaries. The proposed DSGLNet model was thoroughly evaluated on the publicly available BreakHis dataset, encompassing different magnification levels for the identification of tumor nature and tumor types. The 40 magnification histopathological images achieved the best diagnostic results, with the identification of tumor nature reaching 0.966 accuracy and 0.973 precision, outperforming other advanced methods.

SLC35A2 is a novel prognostic biomarker and promotes cell proliferation and metastasis via Wnt/β-catenin/EMT signaling pathway in breast cancer

Although it is a leading cause of cancer-related mortality among women globally, breast cancer (BC) has drawn increased attention owing to its poor prognosis and the challenges associated with limited treatment options. SLC35A2 was shown to be dysregulated in a number of tumor types according to multiple investigations. However, its function in BC was rarely reported. This study aims to investigate the expression of SLC35A2 in BC and its impact on the functionality and prognosis of BC cells. We collected 11 pairs of BC tissues and normal specimens, obtaining clinical information from 1,118 BC patients through RNA sequencing analysis. Different BC cell lines were used in experiments, and the roles of SLC35A2 in cell proliferation, invasion, and migration was assessed through gene silencing and functional assays. Additionally, a prognostic model, including SLC35A2 expression levels, age, T-stage, M-stage, N-stage, and clinical stage, was constructed, and its predictive performance in overall survival was validated using time-dependent receiver operating characteristic curves. High SLC35A2 expression was correlated positively with patient age and T-stage. Kaplan-Meier survival curves and Cox regression analysis confirmed the independent and significant prognostic value of SLC35A2 in overall survival. Functional experiments demonstrated that SLC35A2 silencing inhibited the proliferation, migration, and invasion of BC cells, affecting their metastatic potential through modulation of the Wnt/β-catenin/EMT signaling pathway. In conclusion, our study reveals the crucial role of SLC35A2 in BC, providing a novel biomarker for clinical management and valuable insights into the underlying mechanisms of BC pathogenesis.

A Novel Effective Models for Identifying BRCA Patients and Optimizing Clinical Treatments

OBJECTIVE

This study aimed to develop an effective model that identifies high-risk breast cancer (BRCA) patients and optimizes clinical treatments.

METHODS

This study includes five public datasets, TCGA-BRCA as the training dataset and other cohorts as the validation datasets. Machine learning algorithms for finding key tumor-associated immune gene pairs (TAIGPs). These TAIGPs were used to construct tumor-associated immune gene pair index (TAIGPI) by multivariate analysis and further validated on the validation datasets. In addition, the differences in clinical prognosis, biological characteristics, and treatment benefits between high and low TAIGPI groups were further analyzed.

RESULTS

The TAIGPI was established by 36 TAIGPs. Better clinical outcomes in the low TAIGPI patients, with consistent results, were also obtained in the validation datasets. The study showed that patients in the low TAIGPI group had a high infiltration of immune cells and low proliferative activity of tumor cells. In contrast, patients in the high TAIGPI group exhibited low infiltration of immune cells and high proliferative activity of tumor cells. In addition, patients in the low TAIGPI group are more likely to benefit from chemotherapy, adjuvant chemotherapy, or immunotherapy.

CONCLUSIONS

The TAIGPI can be an effective predictive strategy for the clinical prognosis of breast cancer patients, providing new insights into personalized treatment options for breast cancer patients.

A Real-World Comparison Between Adjuvant Docetaxel with Cyclophosphamide (TC) and Anthracycline-Taxane Chemotherapy in Early HER-2 Negative Breast Cancer

BACKGROUND

Anthracycline-taxane chemotherapy is the gold standard in high-risk breast cancer (BC), despite the potential risk of congestive heart failure (CHF). A suitable alternative for anthracycline-sparing chemotherapy is through the combination of docetaxel and cyclophosphamide (TC).

METHODS

Through a retrospective study of stage I-III HER2-negative BC, using administrative databases, we analyzed a total of 10,634 women treated with adjuvant chemotherapy in Ontario, Canada, between 2009 and 2017. We compared TC versus standardized anthracycline-taxane chemotherapies (ACT and FEC-D). We investigated the overall survival (OS), and explored the incidence of CHF, emergency department (ED) visits and febrile neutropenia.

RESULTS

With a median follow-up of 5.5 years, the 5-year analysis showed an increased OS in patients treated with TC, versus those treated with ACT, HR 0.77 (0.63-0.95, p = 0.015). Among ER+ BC, there was an increased OS in patients treated with ACT and FEC-D, versus those treated with TC, HR 0.70 (0.52-0.95, p = 0.021) and HR 0.71 (0.56-0.91, p = 0.007), respectively. There were no substantial differences in CHF, between TC and anthracycline-based treatments. Patients treated with TC and FEC-D had more ED visits, compared to those treated with ACT.

CONCLUSION

Our study shows that anthracycline-taxane regimens were the most commonly prescribed adjuvant chemotherapy options in HER2-negative BC. Women who received ACT had the lowest OS, likely due to their unfavorable pathology.

Unraveling the causal relationship and potential mechanisms between osteoarthritis and breast cancer: insights from mendelian randomization and bioinformatics analysis

OBJECTIVE

To investigate the effect of osteoarthritis (OA) on the development of breast cancer (BC), and reveal the potential mechanisms underlying the association between them.

METHODS

A two-step, multivariable Mendelian Randomization (MR) analysis was performed, using statistics from genome-wide association studies (GWAS), to determine the effect of OA on BC and explore the role of major depressive disorder (MDD) in mediating it. Furthermore, transcriptomic analysis based on the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases were utilized to establish a prognostic model and explore the underlying mechanisms. Additionally, BC cells and nude mice were used to verify the role of RTN4 in BC.

RESULTS

The two-sample MR analysis implied a causal relationship between OA and BC at the genetic level, and the mediating MR analysis identified that MDD may play a potential role in mediating it, accounting for approximately 12.20%. Then, we constructed a prognostic model (OA-score) with six genes screened out from datasets and selected RTN4 as the representative gene for validation study. It was demonstrated that high OA-score was an independent risk factor for breast cancer, and patients with low OA-score were more likely to have better OS, higher infiltration level of DC and CD 4 + T cells, and higher expression of some immune checkpoints. Moreover, the knockdown of RTN4 inhibited breast cancer cell proliferation, migration and invasion.

CONCLUSION

Our study identified the causal influence of OA on BC mediated by MDD at the genetic level. OA-Score may potentially serve as a new prognostic biomarker for OA related BC patients.

SENP1 promotes deacetylation of isocitrate dehydrogenase 2 to inhibit ferroptosis of breast cancer via enhancing SIRT3 stability

Breast cancer, one of the most prevalent malignant tumors in women worldwide, is characterized by a poor prognosis and high susceptibility to recurrence and metastasis. Ferroptosis, a lipid peroxide-dependent programed cell death pathway, holds significant potential for breast cancer treatment. Therefore, investigating the regulatory targets and associated mechanisms of ferroptosis is crucial. In this study, we conducted proteomic screening and identified isocitrate dehydrogenase 2 (IDH2) as an important player in breast cancer progression. Our findings were further supported by CCK-8 assays, transwell experiments, and scratch assays, which demonstrated that the elevated expression of IDH2 promotes breast cancer progression. Through both in vitro and in vivo experiments along with the erastin treatment, we discovered that increased expression of IDH2 confers resistance to ferroptosis in breast cancer cells. By employing Western blot analysis, Co-IP techniques, and immunofluorescence staining methods, we elucidated the upstream molecular mechanism involving SENP1-mediated SIRT3 de-SUMOylatase, which enhances IDH2 enzyme activity through deacetylation, thereby regulating cell ferroptosis. In conclusion, our study highlights the role of the SENP1-SIRT3 axis in modulating ferroptosis via IDH2 in breast cancer cells, providing valuable insights for developing targeted therapies aimed at enhancing ferroptosis for improved management of breast cancer.

Changes in sST2 and NT-proBNP levels predict early cardiac arrhythmia in breast cancer patients treated with anthracycline-containing chemotherapies

Background

Cardiovascular biomarkers are crucial for monitoring cancer therapy-related cardiac toxicity, but the effects on early stage are still inadequate. To screen biomarkers in patients with breast cancer who receive anthracycline-containing chemotherapy, we studied the behavior of six biomarkers during chemotherapy and their association with chemotherapy-related cardiac toxicity.

Methods

In a prospective cohort of 73 patients treated with anthracycline-containing chemotherapy, soluble suppression of tumorigenicity 2 (sST2), high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), myoglobin, creatine kinase isoenzyme MB, and heart-fatty acid binding protein were measured at baseline, during chemotherapy cycle (C1-C6). According to whether arrhythmia occurred, patients were divided into two groups (healthy group or arrhythmias group), and basic clinical characteristics were collected and compared. Logistic regression analyses and receiver operating characteristic (ROC) curves were conducted to investigate the association between the changes in biomarkers and arrhythmia.

Results

sST2 levels increased significantly from baseline to C1 (P < 0.01). NT-proBNP levels decreased from baseline to C1 and C5 (P < 0.01). The logistic regression analysis showed a greater risk of arrhythmia was associated with interval changes in sST2 [odds ratio (OR): 1.27; 95% CI: 1.03-1.56; P = 0.024] and NT-proBNP (OR: 0.83; 95% CI: 0.70-0.98; P = 0.029). The ROC curves showed that ΔsST2, ΔNT-proBNP, and ΔsST2 + ΔNT-proBNP had good predictive value for arrhythmia (areas under the curves were 0.631, 0.633, and 0.735, respectively, P < 0.05).

Conclusions

Early changes in sST2 and NT-proBNP levels offer additive information for early arrhythmia prediction in breast cancer patients who receive anthracycline-containing chemotherapy.

The Genomic and Biologic Landscapes of Breast Cancer and Racial Differences

Breast cancer is a significant health challenge worldwide and is the most frequently diagnosed cancer among women globally. This review provides a comprehensive overview of breast cancer biology, genomics, and microbial dysbiosis, focusing on its various subtypes and racial differences. Breast cancer is primarily classified into carcinomas and sarcomas, with carcinomas constituting most cases. Epidemiology and breast cancer risk factors are important for public health intervention. Staging and grading, based on the TNM and Nottingham grading systems, respectively, are crucial to determining the clinical outcome and treatment decisions. Histopathological subtypes include in situ and invasive carcinomas, such as invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC). The review explores molecular subtypes, including Luminal A, Luminal B, Basal-like (Triple Negative), and HER2-enriched, and delves into breast cancer's histological and molecular progression patterns. Recent research findings related to nuclear and mitochondrial genetic alterations, epigenetic reprogramming, and the role of microbiome dysbiosis in breast cancer and racial differences are also reported. The review also provides an update on breast cancer's current diagnostics and treatment modalities.

Genetic Polymorphisms of DNA Repair Genes and their Influence on Paclitaxel based Chemotherapy Induced Toxicity Reactions in Breast Cancer Patients

BACKGROUND

Systemic chemotherapy constitutes an indispensable component of breast cancer (BC) management, where therapeutic drug combinations such as anthracyclines, platinum compounds, and taxanes form the cornerstone of standard treatment protocols. Although DNA repair genes are pivotal in cancer susceptibility, their specific roles in mediating acute or chronic toxicity outcomes induced by chemotherapy remain undetermined. Consequently, this study was planned  to elucidate the impact of polymorphisms in base excision repair (BER) genes, including XRCC1, XRCC2, XRCC3, APE1, and hOGG1, on treatment response and toxicity outcomes in BC patients undergoing paclitaxel and doxorubicin-based chemotherapy within an Indian population.

METHODS

One hundred and four (104) BC patients receiving combined paclitaxel and doxorubicin chemotherapy were enrolled with documentation of both hematological and non-hematological toxicity reactions induced by the treatment. Genetic polymorphism of XRCC1, XRCC2, XRCC3, APE1, and hOGG1 genes was investigated using Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP) analysis.

RESULTS

Analysis of the demographic characteristics of BC patients revealed a significant association between mucositis and peripheral neuropathy with advancing age. An increased body mass index was also significantly correlated with hematological toxicities, such as neutropenia (p=0.022) and febrile neutropenia (p=0.048), as well as with peripheral neuropathy (p=0.001). Univariate logistic regression analysis demonstrated a significant association between the XRCC3 (Ser241Cys) polymorphism and peripheral neuropathy (OR=3.00, 95% CI: 1.29-6.95; p=0.010). Similarly, regression analysis indicated a significant association of APE-1 (Asp148Glu) polymorphism with febrile neutropenia (OR=3.55, 95% CI: 1.03-12.21; p=0.044) and chemotherapy-induced nausea and vomiting (CINV) (OR=4.19, 95% CI: 1.61-10.94; p=0.003) in BC patients treated with paclitaxel and Doxorubicin regimen.

CONCLUSION

The findings from this study underscore the significant influence of genetic polymorphisms in XRCC3 (Ser241Cys) and APE-1 (Asp148Glu) on the acute toxicity effects induced by paclitaxel in BC patients.

Unveiling the future of breast cancer therapy: Cutting-edge antibody-drug conjugate strategies and clinical outcomes

Breast cancer has become the most prevalent malignant tumor worldwide and remains one of the leading causes of cancer-related mortality among women globally. The prognosis for patients with metastatic breast cancer remains poor, necessitating the exploration of novel therapeutic strategies to improve survival rates. In the era of precision medicine, antibody-drug conjugates (ADCs) have gained significant attention as a targeted therapeutic strategy in breast cancer treatment. ADCs, a relatively new treatment for breast cancer, deliver cytotoxic drugs (payloads), directly into the tumor space, turning chemotherapy into a targeted agent, which enables patients to experience significant improvements with manageable drug toxicity. For the treatment of breast cancer, there are three ADCs approved for breast cancer treatment: Trastuzumab emtansine (T-DM1), Trastuzumab Deruxtecan (T-Dxd) targeting HER-2, and Sacituzumab Govitecan (SG) targeting Trop-2. Recent clinical studies have demonstrated that the benefits of ADC therapies extend beyond HER2-positive breast cancer toinclude hormone receptor (HR)-positive breast cancer, triple-negative breast cancer (TNBC), and HER2-low expressing breast cancer. Notably, the DESTINY-Breast series of studies, particularly focusing on T-Dxd, encompass neoadjuvant, adjuvant, and multiple lines of therapy for advanced breast cancer. This marks the advent of a comprehensive ADC era in breast cancer treatment. This review summarizes the efficacy and adverse effects of ADC therapies that have completed or are currently undergoing phase I-III clinical trials. Additionally, it analyzes potential combination strategies to overcome ADC resistance, aiming to provide clinicians with a comprehensive clinical guide to the use of ADCs in breast cancer treatment.

The Impact of Chemotherapy on the Nutritional Status of Breast Cancer Patients

BACKGROUND

Breast cancer is one of the most common cancers among Pakistani women. It is mostly diagnosed at stage 2, requiring chemotherapy in certain cases. Chemotherapy is of two types: adjuvant and neoadjuvant. It can be recommended at any stage of cancer, either in early stages to shrink the tumor or in late stages to improve quality of life. The side effects may include weight loss, fatigue, hair loss, sores in the mouth, loss of appetite, nausea, vomiting, difficulty swallowing, throat problems, diarrhea, infections, and anemia, which can deteriorate health. Some women may experience weight gain during treatment, which is a risk factor for cancer recurrence. Chemotherapy has many side effects that can directly affect dietary patterns and worsen nutritional status.

OBJECTIVES

This study aimed to evaluate the changes in dietary patterns of breast cancer patients during and after chemotherapy and assess how the side effects of chemotherapy affect their nutritional status.

METHODOLOGY

Data were collected from 200 breast cancer patients undergoing chemotherapy at Jinnah Hospital, Lahore, using a questionnaire and the Patient-Generated Subjective Global Assessment (PG-SGA) screening tool. The questionnaire included sociodemographic information, questions about disease, treatment, and dietary recall. PG-SGA was used to screen for malnutrition and assess nutritional status. Data collection occurred from September to December 2023.

RESULTS

Most participants were female (99%), married (73.5%), and of low socioeconomic status (60.5%). The common stage of cancer was stage 3, and neoadjuvant chemotherapy was recommended for most participants. Effects on body weight varied, with some experiencing weight loss, others weight gain, and some no change. Side effects such as vomiting, nausea, diarrhea, dry mouth, loss of appetite, altered taste and smell, and anemia were commonly reported. Most participants were moderately malnourished or suspected of malnutrition and needed intervention for symptom management. A majority (82%) were overweight or obese according to BMI, indicating a higher risk of cancer recurrence. Participants' dietary intake mainly consisted of carbohydrate- and protein-rich foods during treatment.

CONCLUSION

The side effects of chemotherapy varied among patients. The impact on body weight also differed, with some experiencing weight loss, others weight gain, and some no change. Regarding nutritional status, most patients were moderately malnourished, while a few were severely malnourished.

TBL2 Promotes Tumorigenesis via PRMT5/WDR77-Mediated AKT Activation in Breast Cancer

Breast cancer (BC) is a common malignancy that affects women worldwide. Although transducing beta-like 2 (TBL2), a member of the WD40 repeat protein family, has been implicated in various intracellular signaling pathways, its precise function in BC remains unclear. The expression of TBL2 is analyzed using real-time PCR, western blotting, and immunohistochemistry in BC patient specimens. Kaplan-Meier survival analysis is employed to assess its prognostic significance. Proteomic analysis, immunoprecipitation tests, and protein immunoblotting are employed to examine the impact of TBL2 on AKT phosphorylation activation. The findings reveal selective overexpression of TBL2 in BC, correlating significantly with various clinicopathological characteristics and poor survival outcomes in patients with BC. Through in vivo and in vitro experiments, it is observed that TBL2 suppression inhibits BC cell proliferation, while TBL2 overexpression has the opposite effect. Mechanistically, TBL2 is identified as a scaffolding protein that promotes PRMT5 and WDR77 interaction. This interaction enhances the methyltransferase activity of PRMT5, leading to increased AKT phosphorylation activation and promotion of breast cancer cell proliferation. In conclusion, this study uncovers a novel function of TBL2 in the activation of AKT by PRMT5 and suggests TBL2 as a potential therapeutic target for BC treatment.

The Assisi think tank focus review on postoperative radiation for lobular breast cancer

The "Assisi Think Tank Meeting" (ATTM) on Breast Cancer, endorsed by the European Society for Radiotherapy & Oncology (ESTRO) and the Italian Association of Radiotherapy and Clinical Oncology (AIRO), and conducted under the auspices of the European Society of Breast Cancer Specialists (EUSOMA), is a bi-annual meeting aiming to identify major clinical challenges in breast cancer radiation therapy (RT) and proposing clinical trials to address them. The topics discussed at the meeting are pre-selected by the steering committee. At the meeting, these topics are discussed in different working groups (WG), after preparation of the meeting by performing a systematic review of existing data and of ongoing trials. Prior to the meeting, each WG designs a survey on the topic to be discussed to reflect current clinical practice and to identify areas requiring further research. Herein, we present the work done by the Assisi WG focusing on lobular carcinoma and the RT perspectives in its treatment, including providing recommendations for locoregional therapy, mainly RT for patients with non-metastatic lobular breast cancer.

Neoadjuvant chemotherapy for breast cancer in Italy: A Senonetwork analysis of 37,215 patients treated from 2017 to 2022

BACKGROUND

Adoption of neoadjuvant chemotherapy (NACT) in the "real world" has been poorly investigated. Aim of this study was to examine the rate of NACT in Italy, trends over time and determinants of therapeutic choices.

METHODS

Senonetwork, the recognized network of Breast Centers in Italy, has developed a voluntary national data warehouse with the aim to monitor and improve treatments quality. A retrospective analysis was conducted among 58,661 breast cancer (BC) patients treated between 2017 and 2022 by 24 high-volume Breast Centers participating in the project.

RESULTS

After subset exclusion, 37,215 primary BC patients were analysed, 32,933 underwent primary-breast-surgery and 4,282 underwent NACT. From 2017 to 2022, the overall NACT incidence increased particularly for HR-/HER2+, Triple-Negative, and HR+/HER2+ BC (p < 0.001). In cN + patients the recommendation to axillary lymph-node dissection after NACT decreased over time along with an increase of <4 lymph-nodes removed (p < 0.001). Immediate breast reconstruction and indication for nipple sparing mastectomy increased significantly over time (OR = 1.10, p = 0.011 and OR 1.14, p < 0.001, respectively). On multivariate analysis, there was a trend towards an increased adoption of conservative treatment for HR-/HER2+ (p = 0.01) and Triple Negative tumors (p = 0.06). Implementation of NACT varied significantly among Breast-Centers from 3.8 to 17.7 % (p < 0.001).

CONCLUSION

The impact of NACT on the subsequent surgical management is substantial and continues to evolve over time, resulting in less-extensive surgery. Even among high-volume Centers NACT implementation rate is still highly variable. Although we registered a significant increase in its use during the study period, these results need to be further improved.

Prevalence and clinicopathological characteristics of de novo metastatic cancer at a major radiotherapy centre in West Africa: a cross-sectional study

Background

Cancer is a major public health challenge in West Africa, with a significant proportion of cancer-related deaths attributed to distant metastasis. De novo metastatic cancer (DnMC), where metastasis is detected at diagnosis, presents considerable therapeutic challenges, particularly in limited-resource settings where novel treatments are often unavailable and/or unaffordable.

Aim

To determine the prevalence, incidence and clinicopathological characteristics of patients diagnosed with DnMC at a major radiotherapy center in West Africa.

Methods

This was a single-institution-based quantitative cross-sectional study. Data on the prevalence and incidence of DnMC were retrieved from a hospital-based cancer registry whereas patients' demographic and clinicopathologic data were extracted from patients' medical records and analysed with STATA software (version 16). Descriptive statistics were used to summarise patient- and tumour-related characteristics.

Results

The prevalence and incidence of DnMC were 15.2% and 5.3%, respectively, with a 36% overall incidence rate of metastatic cancer. The mean age was 50.9 years (SD 15.2), ranging from 15 to 90 years, with a male-to-female ratio of 1:1.6. Also, 28.8% had a history of alcohol intake whereas 13.7% were (tobacco) smokers. Additionally, 10.3% of the patients had a positive family history of cancer. Pain (28.2%) was the most common presenting symptom, followed by bleeding (16.5%). In all, 34.9% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 whereas 33.3% were ECOG 1. The gastrointestinal tract (25.8%) and breasts (17.6%) were the most frequent primary cancer sites, whereas 4.4% had metastatic cancers of unknown primary origin. The most frequent sites of distant metastasis were the lungs (34.6%), liver (28.9%) and bone (13.8%). Adenocarcinoma was the most prevalent histological type (35.2%).

Conclusion

There was a relatively high rate of DnMC compared with high-income countries, emphasising the need for early detection and expanded access to comprehensive cancer care in limited-resource settings.

Immersive Virtual Reality as a Tool to Reduce Anxiety and Distress in Patients With Breast Cancer During Radiotherapy

BACKGROUND

Virtual reality (VR) can be an innovative method to reduce patients' anxiety and support their psychological health.

OBJECTIVE

To evaluate the anxiety and distress-reducing effects of using immersive VR (IVR) intervention in breast cancer patients undergoing radiotherapy (RT).

METHODS

Sixty breast cancer patients undergoing RT were recruited for the quasi-experimental study. The participants were divided into the intervention group and the control group. Anxiety and distress, the primary outcome measures, were assessed before the first and after the last radiation session using reliable scales. Patients in the intervention group watched a tranquil forest view with birdsong and meditation music during each RT session using IVR goggles.

RESULTS

Both group patients had similar levels of anxiety and distress before the start of RT. After the intervention, the anxiety and distress of the patients in the intervention group decreased significantly compared with the control group. In addition, treatment-related comfort was higher in the intervention group. Overall, the majority of patients in the intervention group expressed a high level of satisfaction with this IVR experience.

CONCLUSION

Patients who experienced an IVR intervention showed less anxiety and distress, greater comfort, and higher satisfaction. This innovative technique can be used as a practical solution to alleviate anxiety and distress in various healthcare settings.

IMPLICATIONS FOR PRACTICE

Immersive VR can be used in treatment and care interventions that cause anxiety and distress in oncology patients.

Integration of Machine Learning and Experimental Validation to Identify Anoikis-Related Prognostic Signature for Predicting the Breast Cancer Tumor Microenvironment and Treatment Response

Background/Objectives: Anoikis-related genes (ANRGs) are crucial in the invasion and metastasis of breast cancer (BC). The underlying role of ANRGs in the prognosis of breast cancer patients warrants further study. Methods: The anoikis-related prognostic signature (ANRS) was generated using a variety of machine learning methods, and the correlation between the ANRS and the tumor microenvironment (TME), drug sensitivity, and immunotherapy was investigated. Moreover, single-cell analysis and spatial transcriptome studies were conducted to investigate the expression of prognostic ANRGs across various cell types. Finally, the expression of ANRGs was verified by RT-PCR and Western blot analysis (WB), and the expression level of PLK1 in the blood was measured by the enzyme-linked immunosorbent assay (ELISA). Results: The ANRS, consisting of five ANRGs, was established. BC patients within the high-ANRS group exhibited poorer prognoses, characterized by elevated levels of immune suppression and stromal scores. The low-ANRS group had a better response to chemotherapy and immunotherapy. Single-cell analysis and spatial transcriptomics revealed variations in ANRGs across cells. The results of RT-PCR and WB were consistent with the differential expression analyses from databases. NU.1025 and imatinib were identified as potential inhibitors for SPIB and PLK1, respectively. Additionally, findings from ELISA demonstrated increased expression levels of PLK1 in the blood of BC patients. Conclusions: The ANRS can act as an independent prognostic indicator for BC patients, providing significant guidance for the implementation of chemotherapy and immunotherapy in these patients. Additionally, PLK1 has emerged as a potential blood-based diagnostic marker for breast cancer patients.

Transcriptional factor KLF9 overcomes 5-fluorouracil resistance in breast cancer via PTEN-dependent regulation of aerobic glycolysis

The emergence of resistance to 5-Fluorouracil (5-FU) is a staple in breast cancer chemotherapy. This paper delves into the role of PTEN in breast cancer resistance to 5-FU and examines the underlying molecular pathways. PTEN expression was detected in bioinformatics databases and upstream transcription factors (TFs) were identified. PTEN mRNA and protein levels, aerobic glycolysis proteins, lactate production, glucose consumption, and cell viability were measured. Binding interactions were confirmed, and cell proliferation assessed. In breast cancer cells, PTEN expression was downregulated. PTEN overexpression counteracted 5-FU resistance through the suppression of aerobic glycolysis. KLF9, as a TF upstream of PTEN, enhanced the levels of PTEN. In conclusion, the TF KLF9 inhibits the aerobic glycolysis level of breast cancer cells by up-regulating PTEN expression, thereby reducing their resistance to 5-FU. The discovery of this mechanism provides a new theoretical basis for the treatment of breast cancer.

Inhibitors of the mTOR signaling pathway can play an important role in breast cancer immunopathogenesis

This study explores the critical role of inhibitors targeting the mammalian target of rapamycin (mTOR) signaling pathway in breast cancer research and treatment. The mTOR pathway, a central regulator of cellular processes, has been identified as a crucial factor in the development and progression of breast cancer. The essay explains the complex molecular mechanisms through which mTOR inhibitors, such as rapamycin and its analogs, exert their anticancer effects. These inhibitors can stop cell growth, proliferation, and survival in breast cancer cells by blocking critical signaling pathways within the mTOR pathway. Furthermore, the essay discusses the implications of using mTOR inhibitors as a comprehensive therapeutic strategy. It emphasizes the potential benefits of combining mTOR inhibitors with other treatment approaches to enhance the effectiveness of breast cancer treatment. The evolving landscape of breast cancer research underscores the significance of mTOR as a therapeutic target and highlights ongoing efforts to improve and optimize mTOR inhibitors for clinical use. In conclusion, the essay asserts that inhibitors of the mTOR signaling pathway offer a promising approach in the fight against breast cancer. These inhibitors provide a focused and effective intervention targeting specific dysregulations within the mTOR pathway. As research advances, the integration of mTOR inhibitors into customized combination therapies holds excellent potential for shaping a more effective and personalized approach to breast cancer treatment, ultimately leading to improved outcomes for individuals affected by this complex and diverse disease.

Deep learning Radiomics Based on Two-Dimensional Ultrasound for Predicting the Efficacy of Neoadjuvant Chemotherapy in Breast Cancer

We investigate the predictive value of a comprehensive model based on preoperative ultrasound radiomics, deep learning, and clinical features for pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) for the breast cancer. We enrolled 155 patients with pathologically confirmed breast cancer who underwent NAC. The patients were randomly divided into the training set and the validation set in the ratio of 7:3. The deep learning and radiomics features of pre-treatment ultrasound images were extracted, and the random forest recursive elimination algorithm and the least absolute shrinkage and selection operator were used for feature screening and DL-Score and Rad-Score construction. According to multifactorial logistic regression, independent clinical predictors, DL-Score, and Rad-Score were selected to construct the comprehensive prediction model DLRC. The performance of the model was evaluated in terms of its predictive effect, and clinical practicability. Compared to the clinical, radiomics (Rad-Score), and deep learning (DL-Score) models, the DLRC accurately predicted the pCR status, with an area under the curve (AUC) of 0.937 (95%CI: 0.895-0.970) in the training set and 0.914 (95%CI: 0.838-0.973) in the validation set. Moreover, decision curve analysis confirmed that the DLRC had the highest clinical value among all models. The comprehensive model DLRC based on ultrasound radiomics, deep learning, and clinical features can effectively and accurately predict the pCR status of breast cancer after NAC, which is conducive to assisting clinical personalized diagnosis and treatment plan.

Repurposing propofol for breast cancer therapy through promoting apoptosis and arresting cell cycle

Breast cancer is the most prevalent cancer among women worldwide, characterized by a high mortality rate and propensity for metastasis. Although surgery is the standard treatment for breast cancer, there is still no effective method to inhibit tumor metastasis and improve the prognosis of patients with breast cancer after surgery. Propofol, one of the most widely used intravenous anesthetics in surgery, has exhibited a positive association with improved survival outcomes in patients with breast cancer post‑surgery. However, the underlying molecular mechanism remains to be elucidated. The present study revealed that triple negative breast cancer cells, MDA‑MB‑231 and 4T1, exposed to propofol exhibited a significant decrease in cell viability. Notably, propofol exhibited minimal cytotoxic effects on HUVECs under the same conditions. Furthermore, propofol significantly inhibited the migration and invasion ability of MDA‑MB‑231 and 4T1 cells. Propofol promoted apoptosis in 4T1 cells through upregulation of Bax and cleaved caspase 3, while downregulating B‑cell lymphoma‑extra large. Concomitantly, propofol induced cell cycle arrest of 4T1 cells by downregulating cyclin E2 and phosphorylated cell division cycle 6. Furthermore, propofol exhibited excellent anticancer efficacy in a 4T1 breast cancer allograft mouse model. The present study sheds light on the potential of propofol as an old medicine with a novel use for breast cancer treatment.

Amphiphilic Single-Chain Polymer Nanoparticles as Imaging and Far-Red Photokilling Agents for Photodynamic Therapy in Zebrafish Embryo Xenografts

This work introduces rationally designed, improved amphiphilic single-chain polymer nanoparticles (SCNPs) for imaging and photodynamic therapy (PDT) in zebrafish embryo xenografts. SCNPs are ultrasmall polymeric nanoparticles with sizes similar to proteins, making them ideal for biomedical applications. Amphiphilic SCNPs result from the self-assembly in water of isolated synthetic polymeric chains through intrachain hydrophobic interactions, mimicking natural biomacromolecules and, specially, proteins (in size and when loaded with drugs, metal ions or fluorophores also in function). These ultrasmall, soft nanoparticles have various applications, including catalysis, sensing, and nanomedicine. Initial in vitro experiments with nonfunctionalized, amphiphilic SCNPs loaded with a photosensitizing Zn phthalocyanine with four nonperipheral isobutylthio substituents, ZnPc, showed promise for PDT. Herein, the preparation of improved, amphiphilic SCNPs containing ZnPc as highly efficient photosensitizer encapsulated within the nanoparticle and surrounded by anthracene units is disclosed. The amount of anthracene groups and ZnPc molecules within each single-chain nanoparticle controls the imaging and PDT properties of these nanocarriers. Critically, this work opens the way to improved PDT applications based on amphiphilic SCNPs as a first step toward ideal, long-term artificial photo-oxidases (APO).