De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017

De-escalated surgery following neoadjuvant chemoimmunotherapy for locally advanced oral squamous cell carcinoma: A retrospective cohort study

BACKGROUND

There remains considerable debate regarding whether the extent of surgery can be reduced in oral squamous cell carcinoma (OSCC) with significant tumor shrinkage after neoadjuvant chemoimmunotherapy. This study aims to report the feasibility and oncological safety of de-escalated surgery (DES) following neoadjuvant chemoimmunotherapy in locally advanced OSCC.

MATERIALS AND METHODS

We collected clinical data of patients with locally advanced OSCC (T3-4 N0-3 M0) treated at our cancer center between November 2019 and July 2023 who received platinum-based doublet chemotherapy combined with a PD-1 inhibitor followed by DES. DES was defined as surgery performed according to the extent of residual tumor after neoadjuvant therapy. Tumor response, flap reconstruction/mandibulectomy exemption rates, event-free survival (EFS), and overall survival (OS) were assessed.

RESULTS

A total of 111 patients were included, with tumors located in the tongue (73/111, 65.8 %), buccal-lip mucosa (15/111, 13.5 %), mandibular gingiva - floor of mouth (15/111, 13.5 %), and maxillary gingiva - hard palate (8/111, 7.2 %). The objective response rate (ORR) was 77.5 %, with a pathological complete response (pCR) rate of 40.5 %. Flap reconstruction was exempted in 80 (72.1 %) of patients. Among the 96 patients initially planned for mandibulectomy, 68 patients (70.8 %) were exempted from mandibulectomy. With a median follow-up of 27 months, the estimated 1-, 2-, and 3-year EFS rates were 90.1 %, 84.4 %, and 80.9 %, respectively. The estimated 1-, 2-, and 3-year OS rates were 97.3 %, 93.1 %, and 91.3 %, respectively.

CONCLUSION

Opting for DES after neoadjuvant chemoimmunotherapy appears to be feasible, with satisfactory oncological safety in OSCC patients.

Trajectories and predictors of financial toxicity in breast cancer patients: A multicenter longitudinal study in China

BACKGROUND

Patients with breast cancer experience varying levels of financial toxicity (FT), but the factors contributing to sustained financial toxicity remain poorly understood.

METHODS

This longitudinal study was conducted from November 2022 to March 2024 in China. Participants were recruited from four Tertiary Level A hospitals using convenient sampling. FT was assessed using the Comprehensive Score for Financial Toxicity (COST) at baseline (T1), 3 months (T2), 6 months (T3), and 12 months (T4) post-surgery. Growth Mixture Modeling was used to identify the different trajectories of the FT. Multivariable logistic regression were employed to explore the predictive factors with different trajectory categories.

RESULTS

Among 378 participants (all women; median [SD] age, 48.9 [9.97] years), the COST score was lowest at T2. Three distinct FT trajectories were identified: 91 patients (24 %) in the "Severe FT with Gradual Relief" group (trajectory 1), 190 patients (50 %) in the "Persistently Low-Level FT" group (trajectory 2), and 97 patients (26 %) in the "Moderate FT with Gradual Worsening" group (trajectory 3). Using trajectory 2 as the reference, predictors for trajectory 1 included symptom burden, location, cancer stage, cost-related health literacy, resilience, and difficulty affording basic expenses. For trajectory 3, predictors included monthly household income, symptom burden, location, and cancer stage.

CONCLUSIONS

The FT experienced by breast cancer patients changes over time and follows distinct dynamic trajectories, influenced by multiple factors. In future clinical practice, early identification and intervention for high-risk FT groups should be prioritized.

Analysis of Tumor Proliferation Markers in Early-Stage Luminal Breast Cancer: A Comprehensive Study Using Mitotic Activity Index, Ki-67, and Phosphohistone H3 Expression

Introduction and Aim: Routinely used proliferation markers such as mitotic activity index (MAI) and Ki-67 index show limited reproducibility due to high interobserver variability in breast cancer assessment. Phosphohistone H3 (PhH3), a novel proliferation marker, is gaining attention in breast cancer research. This study aimed to evaluate the inter-rater agreement among MAI, Ki-67, and PhH3 expressions in early-stage luminal breast cancer and assess the impact of replacing MAI with PhH3 index on tumor histological grading. Materials and Methods: Three pathologists assessed MAI, Ki-67, and PhH3 expressions in 66 early-stage luminal breast cancer specimens. Mitotic Activity Index was scored based on mitotic figures in an area of 2 mm2 while Ki-67 index utilized a 14% threshold for positively stained nuclei. Phosphohistone H3 expression cutoff was set at 13 positive cells per 2 mm2. The inter-rater agreement for the 3 variables was analyzed using Cohen kappa statistics. Results: Among the 3 parameters, the kappa score of the PhH3 expression reflected very strong agreement between the 3 observers (κ = 0.991, 0.907, and 0.916). Only moderate agreement was noted for MAI (κ = 0.898, 0.562, and 0.592) and substantial agreement for Ki-67 index (κ = 0.869, 0.673, and 0.678). Moreover, replacing MAI with PhH3 index led to upgrade of histological grade in 15% to 16% of patients. Conclusion: Our study demonstrated that PhH3 is a more reproducible proliferation marker than MAI and Ki-67. Incorporation of PhH3-based mitotic index in breast cancer grading might reduce the variation in the assessment of histological grade.

Survival Outcomes of Luminal Metastatic Breast Cancer Patients According to Changes in Molecular Subtype at Re-Biopsy: Insights from the GIM-13-AMBRA Study

Introduction: The treatment of MBC patients is guided by receptor status, with re-biopsy at relapse recommended to reassess hormone receptor (HR) status. Various treatment options are available for HER2-veMBC, including CDK4/6 inhibitors, PARP inhibitors, and checkpoint inhibitors. The study highlights the importance of determining receptor subtype for guiding treatment choices. Patients and Methods: The GIM 13 AMBRA study is a longitudinal cohort study involving 42 centers in Italy. It includes data from 939 HER2- MBC patients enrolled between May 2015 and September 2020. The study analyzes the impact of HR expression changes on clinical outcomes using Kaplan-Meier survival curves and other statistical methods. Results: Among the 939 patients, 588 were rebiopsied at first relapse. The study found no significant differences in disease-free survival (DFS), progression-free survival (PFS), or overall survival (OS) between patients whose tumors changed molecular subtype and those who did not. However, post-progression survival from first-line treatment (PPS1) was different between the two groups. Discussion: The study confirms the phenomenon of receptor discordance between primary tumors and metastases. It emphasizes the need for re-biopsy in recurrent MBC to guide treatment strategies. The findings align with previous studies and highlight the importance of understanding receptor changes for improving patient outcomes. Conclusions: The GIM 13 AMBRA study provides valuable insights into the impact of molecular subtype changes on survival outcomes in Luminal MBC patients. It underscores the importance of re-biopsy and personalized treatment strategies in managing metastatic breast cancer.

Prediction models of breast cancer molecular subtypes based on multimodal ultrasound and clinical features

BACKGROUND AND AIMS

Breast cancer classify into four molecular subtypes: Luminal A, Luminal B, HER2-overexpressing (HER2), and triple-negative (TNBC) based on immunohistochemical assessments. The multimodal ultrasound features correlate with biological biomarkers and molecular subtypes, facilitating personalized, precision-guided treatment strategies for patients. In this study, we aimed to explore the differences of multimodal ultrasound features generated from conventional ultrasound (CUS), shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) between molecular subtypes of breast cancer, investigate the value of prediction model of breast cancer molecular subtypes based on multimodal ultrasound and clinical features.

METHODS

Breast cancer patients who visited our hospital from January 2023 to June 2024 and underwent CUS, SWE and CEUS were selected, according to inclusion criteria. Based on the selected effective feature subset, binary prediction models of features of CUS, features of SWE, features of CEUS and full parameters were constructed separately for the four breast cancer subtypes Luminal A, Luminal B, HER2, and TNBC, respectively.

RESULTS

There were ten parameters that showed significant differences between molecular subtypes of breast cancer, including BI-RADS, palpable mass, aspect ratio, maximum diameter, calcification, heterogeneous echogenicity, irregular shape, standard deviation elastic modulus value of lesion, time of appearance, peak intensity. Full parameter models had highest area under the curve (AUC) values in every test set. In aggregate, judging from the values of accuracy, precision, recall, F1 score and AUC, models used features selected from full parameters showed better prediction results than those used features selected from CUS, SWE and CEUS alone (AUC: Luminal A, 0.81; Luminal B, 0.74; HER2, 0.89; TNBC, 0.78).

CONCLUSIONS

In conclusion, multimodal ultrasound features had differences between molecular subtypes of breast cancer and models based on multimodal ultrasound data facilitated the prediction of molecular subtypes.

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.

Axilla Management in Breast Cancer Surgery: Brief Review and Current Practice Recommendations

The diagnostic and therapeutic approach to the axilla in breast cancer patients has changed significantly over the past 30 years, with the replacement of complete axillary lymph node dissection practices by less invasive approaches. Reference is made to clinical findings that have led to practical treatment recommendations and are paving the way to new levels of de-escalation in breast cancer surgery.

Optimization of carbon membrane performance in reverse osmosis systems for reducing salinity, nitrates, phosphates, and ammonia in aquaculture wastewater

This study investigates the performance of various types of carbon membranes in reverse osmosis systems aimed at reducing salinity, nitrates, phosphates, and ammonia in aquaculture wastewater. As sustainable aquaculture practices become increasingly essential, effective treatment solutions are needed to mitigate pollution from nutrient-rich effluents. The research highlights several carbon membranes types, including carbon molecular sieves, activated carbon membranes, carbon nanotube membranes, and graphene oxide membranes, all of which demonstrate exceptional filtration capabilities due to their unique structural properties. Findings reveal that these carbon membranes can achieve removal efficiencies exceeding 90 % for critical pollutants, thereby significantly improving water quality and supporting environmental sustainability. The study also explores the development of hybrid membranes and nanocomposites, which enhance performance by combining the strengths of different materials, allowing for customized solutions tailored to the specific requirements of aquaculture wastewater treatment. Additionally, operational parameters such as pH, temperature, and feed water characteristics are crucial for maximizing membrane efficiency. The integration of real-time monitoring technologies is proposed to enable prompt adjustments to treatment processes, thereby improving system performance and reliability. Overall, this research emphasizes the importance of interdisciplinary collaboration among researchers and industry stakeholders to drive innovation in advanced filtration technologies. The findings underscore the substantial potential of carbon membranes in tackling the pressing water quality challenges faced by the aquaculture sector, ultimately contributing to the sustainability of aquatic ecosystems and ensuring compliance with environmental standards for future generations.

Accuracy of abbreviated magnetic resonance compared to 3-dimensional mammography and ultrasound in early detection of breast cancer

BACKGROUND

The purpose of this study is to assess the usefulness of the novel abbreviated MR (AB-MR) protocol in the screening of women with an intermediate risk of breast cancer. Sixty women with a Tyrer-Cuzick model-determined intermediate risk of breast cancer underwent AB-MR, mammography, and tomosynthesis examinations; as an auxiliary procedure, ultrasound imaging was carried out. Every modality was allocated a final BI-RADS category. Time spent on acquisition and interpretation was also noted. Pathological confirmation was obtained in all cases exhibiting malignant findings. The difference in sensitivity and specificity between the two modalities was evaluated using McNemar's test.

RESULTS

When compared to traditional screening methods, AB-MR demonstrated 100% NPV, 98% specificity, 66.7% PPV, and 100% sensitivity in women with intermediate risk of breast cancer. Comparing mammography/ultrasound to positive malignancies verified by biopsy, the results indicated 100% sensitivity, 96.5% specificity, 60% PPV, and 100% NPV. Complete agreement was observed between abbreviated MR and malignant biopsies (100% sensitivity, specificity, NPV, and PPV). For AB-MR and mammography, the average reading time was 4 min and 5 min, respectively. The average acquisition time for AB-MRI was around 10 min, whereas the average time for complete MR imaging is 17 min.

CONCLUSION

AB-MR has better sensitivity, specificity, PPV, and NPV in screening of intermediate- and high-risk breast cancer. Acquisition time was shorter than full MR protocol. Reading time was decreased in respect of mammography. MRI screening ought to be more practical with the AB-MR protocol.

Financial Toxicity Among Breast Cancer Patients: A Scoping Review of Risk Factors and Outcomes

BACKGROUND

Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.

OBJECTIVES

The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.

METHODS

We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.

RESULTS

A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.

CONCLUSION

Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.

IMPLICATIONS FOR PRACTICE

More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.

Body mass index as a predictive factor for efficacy of adjuvant taxane-based chemotherapy in early-stage breast cancer patients: A pooled analysis from adjuvant GEICAM Spanish Breast Cancer Group and TRIO Translational Research in Oncology Group studies

Adjuvant anthracyclines and taxanes reduce recurrence and death in early-stage breast cancer (EBC) patients, but toxicity is a concern. Studies show conflicting results on the correlation between body mass index (BMI) and outcomes. Limited data exist on the efficacy of adjuvant taxanes among BMI categories and the impact of different taxane-based chemotherapies (paclitaxel vs. docetaxel) on disease recurrence. Here, we present a pooled analysis of 13,486 EBC patients treated with adjuvant anthracyclines ± taxanes from seven GEICAM and TRIO trials (1996-2008) conducted. Patients were classified into four BMI categories: normal (<25.0), overweight (25.0-29.9), obese (30.0-34.9), and severely obese (≥35.0). BMI was evaluated as a predictive factor for the efficacy and toxicity of taxane-based chemotherapy. Our results show the following findings: patients' distribution by BMI was 44% normal, 33% overweight, 16% obese, and 8% severely obese. Seventy-nine percent received taxane-based chemotherapy. Ten-year invasive disease-free survival (iDFS) was 71%, 70%, 68%, and 64% for normal, overweight, obese, and severely obese patients, respectively. Obese and severely obese patients had significantly worse outcomes (HR 1.15 and 1.29, respectively). Invasive disease-free survival with docetaxel vs. non-docetaxel was significant in the normal BMI group, while iDFS with paclitaxel was significant in the obese group. Relevant toxicity was observed in 5%, 5.5%, 5.9%, and 9.3% of normal, overweight, obese, and severely obese patients who received docetaxel. In conclusion, heavier EBC patients had a worse prognosis with adjuvant taxane-based chemotherapy. Normal BMI patients benefited more from docetaxel, while obese patients benefited more from paclitaxel.

Local Recurrence and Survival Outcomes of Multifocal/Multicentric Breast Cancer After Breast Conserving Therapy: A systematic Review and Meta-Analysis

BACKGROUND

The appropriateness of BCT for MF/MCBC is debated, with concerns about higher recurrence rates. This study aims to provide an updated systematic review and meta-analysis of LR and survival outcomes for MF/MCBC patients undergoing BCT.

METHODS

PubMed, Web of Science, Embase, and the Cochrane Library were searched up to May 2024. Eligible studies included original research articles comparing LR, DFS, or OS in patients with MF/MC or UF breast cancer undergoing BCT or mastectomy. Meta-analyses for LR were conducted using the Mantel-Haenszel method. Published Kaplan-Meier curves for DFS and OS were digitized and aggregated to estimate summary survival curves.

RESULTS

21 studies were included in the meta-analysis for LR, comprising 28,589 participants, and 7 studies for survival analysis. The meta-analysis revealed that MF/MC breast cancer patients undergoing BCT had a significantly higher LR rate compared to UF patients (OR = 1.76, 95% CI: 1.24-2.49, P = .002), though recent studies indicated comparable LR rates. No significant difference in LR was found between MF/MC patients treated with BCT versus mastectomy (OR = 1.72, 95% CI: 0.96-3.10, P = .07). The estimated 3-, 5-, and 8-year DFS rates were 92.4%, 88.3%, and 84.5%, respectively, while the OS rates were 98.0%, 95.8%, and 91.8%.

CONCLUSION

BCT for MF/MC breast cancer was associated with higher LR rates compared to UF breast cancer, but the disparity was reducing in recent years. BCT offers comparable LR outcomes to mastectomy in MF/MC patients. Survival outcomes for MF/MC patients treated with BCT were favorable, affirming its oncological safety.

Proliferative Markers in Breast Cancer and Chemotherapy Implications: A Comprehensive Review

Background and Aims

Breast cancer is the most common cancer and a leading cause of cancer-related death among women globally. Determining which patients will benefit from chemotherapy remains challenging. Proliferative markers such as Ki-67, mini chromosome maintenance (MCM) proteins, and proliferating cell nuclear antigen (PCNA) offer valuable insights into tumor growth and treatment response. This review evaluates their clinical roles, with a focus on chemotherapy implications and emerging digital pathology techniques for marker quantification.

Methods

A narrative review was conducted by searching PubMed, Scopus, and Google Scholar for studies related to Ki-67, MCM, PCNA, breast cancer, and chemotherapy. Studies were thematically categorized into five areas. A bibliometric analysis of publications from 2000 to April 2023 was performed using the Bibliometrix R package and VOSviewer to assess research trends and thematic evolution.

Results

Eighty studies were included in the narrative synthesis. Ki-67 is the most commonly used marker, particularly useful in predicting response to neoadjuvant chemotherapy (NAC). MCM proteins show promise for identifying proliferative potential across tumor grades, while PCNA is associated with aggressive tumor features and poor prognosis. Post-chemotherapy changes in Ki-67 levels are linked to survival outcomes. Bibliometric analysis revealed a shift in research focus from basic mechanisms to clinical applications and digital quantification.

Conclusion

Proliferative markers play an essential role in breast cancer management. Ki-67 remains a key predictor of chemotherapy response, while MCM and PCNA offer complementary prognostic insights. Integration of these markers with digital pathology and AI-driven tools may enhance diagnostic accuracy and personalized treatment strategies. Standardization of assessment methods is crucial for broader clinical application.

Characterisation of HER2-Driven Morphometric Signature in Breast Cancer and Prediction of Risk of Recurrence

INTRODUCTION

Human epidermal growth factor receptor 2-positive (HER2-positive) breast cancer (BC) is a heterogeneous disease. In this study, we hypothesised that the degree of HER2 oncogenic activity, and hence response to anti-HER2 therapy is translated into a morphological signature that can be of prognostic/predictive value.

METHODS

We developed a HER2-driven signature based on a set of morphometric features identified through digital image analysis and visual assessment in a sizable cohort of BC patients. HER2-enriched molecular sub-type (HER2-E) was used for validation, and pathway enrichment analysis was performed to assess HER2 pathway activity in the signature-positive cases. The predictive utility of this signature was evaluated in post-adjuvant HER2-positive BC patients.

RESULTS

A total of 57 morphometric features were evaluated; of them, 22 features were significantly associated with HER2 positivity. HER2 IHC score 3+/oestrogen receptor-negative tumours were significantly associated with HER2-related morphometric features compared to other HER2 classes including HER2 IHC 2+ with gene amplification, and they showed the least intra-tumour morphological heterogeneity. Tumours displaying HER2-driven morphometric signature showed the strongest association with PAM50 HER2-E sub-type and were enriched with ERBB signalling pathway compared to signature-negative cases. BC patients with positive HER2 morphometric signature showed prolonged distant metastasis-free survival post-adjuvant anti-HER2 therapy (p = 0.007). The clinico-morphometric prognostic index demonstrated an 87% accuracy in predicting recurrence risk.

CONCLUSION

Our findings underscore the strong prognostic and predictive correlation between HER2 histo-morphometric features and response to targeted anti-HER2 therapy.

Radiomics of Multimodal Ultrasound for Early Prediction of Pathologic Complete Response to Neoadjuvant Chemotherapy in Breast Cancer

RATIONALE AND OBJECTIVES

To construct and validate a clinical-radiomics model based on radiomics features extracted from two-stage multimodal ultrasound and clinicopathologic information for early predicting pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer patients treated with NAC.

MATERIALS AND METHODS

Consecutive women with biopsy-proven breast cancer undergoing multimodal US pretreatment and after two cycles of NAC and followed by surgery between January 2014 and November 2023 were retrospectively collected for clinical-radiomics model construction (n = 274) and retrospective test (n = 134). The predictive performance of it was further tested in a subsequent prospective internal test set recruited between January 2024 to July 2024 (n = 76). Finally, a total of 484 patients were enrolled. The clinical-radiomics model predictive performance was compared with radiomics model, clinical model and radiologists' visual assessment by area under the receiver operating characteristic curve (AUC) analysis and DeLong test.

RESULTS

The proposed clinical-radiomics model obtained the AUC values of 0.92 (95%CI: 0.88, 0.94) and 0.85 (95%CI: 0.79, 0.89) in retrospective and prospective test sets, respectively, which were significantly higher than that those of the radiomics model (AUCs: 0.75-0.85), clinical model (AUCs: 0.68-0.72) and radiologists' visual assessments (AUCs:0.59-0.68) (all p < 0.05). In addition, the predictive efficacy of the radiologists was improved under the assistance of the clinical-radiomics model significantly.

CONCLUSION

The clinical-radiomics model developed in this study, which integrated clinicopathologic information and two-stage multimodal ultrasound features, was able to early predict pCR to NAC in breast cancer patients with favorable predictive effectiveness.

The prognostic value of changes in Ki67 following neoadjuvant chemotherapy in residual triple-negative breast cancer: a Swedish nationwide registry-based study

PURPOSE

To evaluate the prognostic significance of changes in pre- and post-neoadjuvant chemotherapy (NACT) Ki67 in patients with primary invasive triple-negative breast cancer (TNBC).

METHODS

Population-based registry data were retrieved for patients diagnosed with TNBC between 2007 and 2021 (n = 9262). Multivariable Cox regression analysis was performed for disease-specific survival (DSS) and overall survival (OS) adjusted for age and residual disease in the breast and nodes (RDBN).

RESULTS

Of the 1777 TNBC patients receiving NACT, 54 achieved pathologic complete response (pCR) and 755 had residual disease. Most patients were overweight with stage II disease (78%), grade 3 tumors (53%), and RDBN score 3 (42%). Compared to baseline, tumor size (30 vs. 15 mm; P < 0.0001) and Ki67 levels (63% vs. 48%; P < 2.2e - 16) generally decreased after NACT. Although only 5% of samples increased in size, Ki67 levels often remained unchanged (75%) or increased (0.9%) after treatment, respectively. However, 34% of patients discontinued treatment. Patients showing no changes in Ki67% had more unfavorable OS (P < 0.0001) and DSS (P = 0.00032), with significantly lower 5-year survival probabilities (OS: 66%; DSS: 78%) than those with decreased Ki67% (OS: 87%; DSS: 89%). All patients reaching pCR were alive 5 years after diagnosis. However, only the RDBN score was an independent predictor of survival in the multivariable analyses.

CONCLUSION

Ki67 often remained unchanged in TNBC patients treated with neoadjuvant chemotherapy, resulting in adverse clinical outcomes. These findings highlight the need for individualized treatment regimens and dynamic monitoring of TNBC patients with high Ki67 post-NACT.

Exploring utilities of [ 64 Cu]Cu-DOTA-trastuzumab immunoPET in breast cancer: a systematic review and meta-analysis

[ 64 Cu]Cu-DOTA-trastuzumab represents a novel immunopositron emission tomography (immunoPET) agent with emerging diagnostic applications in human epidermal growth factor receptor-2 (HER2)-expressing breast cancer (BC). This systematic review and meta-analysis evaluates the current diagnostic utilities of [ 64 Cu]Cu-DOTA-trastuzumab PET/computed tomography (CT) and explores tumor uptake metrics in HER2-positive BC lesions. A systematic literature search of PubMed , Scopus , and Ovid databases was conducted using relevant keywords to identify eligible studies. Of the 123 articles reviewed, six met the inclusion criteria. Qualitative data analysis was applied to all included studies. Several promising utilities were identified, including [ 64 Cu]Cu-DOTA-trastuzumab's capacity to detect HER2-positive primary BC lesions, lymph nodes, and distant metastases. Additionally, [ 64 Cu]Cu-DOTA-trastuzumab PET/CT demonstrated potential in predicting therapy response in HER2-positive lesions. The overall lesion detectability was 91% [95% confidence interval (CI), 81-98%] for HER2-positive BC. HER2-positive BC lesions exhibited significantly higher maximum standardized uptake values compared to HER2-negative lesions, with a weighted mean difference of 2.14 (95% CI, 0.18-4.09; P  = 0.03). These findings underscore the need for further large-scale and prospective investigations of this promising radiotracer in the near future.

Mapping the current landscape of locoregional therapy de-escalation trials in early breast cancer: a systematic review

A systematic review undertaken to map the current landscape of locoregional de-escalation trials to inform future research. Online databases and trial registries were searched to identify ongoing, recently completed or published studies de-escalating surgery or radiotherapy in patients with early breast cancer. 97 trials evaluated de-escalation of surgery or radiotherapy in up to 94,866 participants. Surgery studies more commonly evaluated treatment omission/reduction after neoadjuvant systemic therapy (NST) and de-escalation of nodal treatment. Radiotherapy studies were more frequently biomarker stratified. Patients were rarely involved in study design. Research questions focused on response-adjusted treatment after NST and omission/reduction of locoregional therapy in patients with low- or intermediate-risk disease. Significant duplication was identified with multiple studies addressing similar questions. This systematic review demonstrates that the current de-escalation portfolio is inefficient, lacks patient focus and needs improvement. An internationally collaborative approach using innovative study designs and patient partnership will be essential to address this.

Development and validation of a postoperative prognostic model for hormone receptor positive early stage breast cancer recurrence

Predicting recurrence among early-stage hormone receptor-positive human epidermal growth factor receptor-negative breast cancer (HR+/HER2- BC) is crucial for guiding adjuvant therapy. However, studies are limited for patients with low recurrence risk. HR+/HER2- early-stage (T1-2N0-1) invasive BC patients who received definitive surgery and followed by endocrine therapy from four independent medical centers were included in this retrospective study. Patients from center 1 were used as derivation cohort, while those from other centers were combined as an external test cohort. A deep learning prognostic model, HERPAI, was developed based on Transformer to predict risk of invasive disease-free survival (iDFS) utilizing clinical and pathological predictors. The model performance was evaluated using C-index for the overall population and subgroups. Threshold for selecting 5-year recurrence risk > 10% was determined. Hazard ratio (HR) was estimated between risk groups for iDFS. A total of 6340 patients were included, of whom 5424 were assigned to the derivation cohort (training and validation [N = 4882] and internal test cohort [N = 542]), while 916 patients were utilized as external cohort. HERPAI yielded a C-index of 0.73 (95% CI 0.65-0.81), 0.73 (95% CI 0.62-0.85), and 0.68 (95% CI 0.60-0.77), in the validation, internal, and external test cohort, respectively. Consistent performances were observed for pre-specified subgroups. High-risk patients were associated with an increased risk of recurrence for validation (HR, 2.56 [95% CI 1.25-5.22], P = 0.01), internal test (HR, 2.52 [95% CI 0.97-6.57], P = 0.06) and external test (HR, 1.94 [95% CI 1.00-3.74], P = 0.049) cohort, respectively. HERPAI was a promising tool for selecting vulnerable early-stage HR+/HER2- BC patients who were at high-risk of recurrence. It could facilitate the prioritization of patients who may benefit more from escalating adjuvant treatment.

Axillary lymph node metastasis in breast cancer: from historical axillary surgery to updated advances in the preoperative diagnosis and axillary management

Axillary lymph node status, which was routinely assessed by axillary lymph node dissection (ALND) until the 1990s, is a crucial factor in determining the stage, prognosis, and therapeutic strategy used for breast cancer patients. Axillary surgery for breast cancer patients has evolved from ALND to minimally invasive approaches. Over the decades, the application of noninvasive imaging techniques, machine learning approaches and emerging clinical prediction models for the detection of axillary lymph node metastasis greatly improves clinical diagnostic efficacy and provides optimal surgical selection. In this work, we summarize the historical axillary surgery and updated perspectives of axillary management for breast cancer patients.

Use of medications in women with triple-negative breast cancer between 2018 and 2019 in a Brazilian public hospital: a retrospective study

OBJECTIVE

To describe the profile of medication use in women with triple-negative breast cancer treated between 2018 and 2019 in a Brazilian public hospital.

METHODS

Descriptive and retrospective study, with data obtained from the Hospital Cancer Registry and physical and electronic medical records from a public hospital that is a reference in cancer treatment, in Rio de Janeiro. Descriptive analyses and analyses of time to treatment failure and overall survival were performed using the Kaplan Meier method.

RESULTS

Of the 176 patients, 39.0% were under 50 years of age and 47.7% were diagnosed at an advanced stage. Use of 12 chemotherapy regimens was identified, with neoadjuvant or adjuvant intent, for treatment of triple-negative breast cancer. The most commonly used treatment regimen included doxorubicin, cyclophosphamide and taxanes (docetaxel or paclitaxel). After 180 days, 76.1% of patients remained on the initial treatment. Average time until treatment failure was 7.6 months for those who followed the main regimen. Median overall survival was 34 months, and 55.7% of patients died by the end of the follow-up period (48 months).

CONCLUSION

The results showed that treatment with doxorubicin, cyclophosphamide and taxanes (docetaxel or paclitaxel) was the most used in the patients analyzed, that average time to treatment failure using this regimen was less than one year and that more than half of the patients died within four years after diagnosis.

Physical Health Decline After Chemotherapy or Endocrine Therapy in Breast Cancer Survivors

Importance

Women with a history of breast cancer (BC) experience greater physical health decline compared with age-matched women without cancer. However, whether this decline differs in patients who received chemotherapy and endocrine therapy is not well understood.

Objective

To investigate physical health decline in BC survivors who received chemotherapy or endocrine therapy compared with age-matched women without cancer.

Design, Setting, and Participants

This prospective cohort study was conducted as part of the Cancer Prevention Study-3, a prospective US cohort study that enrolled participants in 35 states, the District of Columbia, and Puerto Rico between 2006 and 2013. Follow-up for this analysis was through April 1, 2020. Statistical analyses were conducted between May 2023 and December 2024. Female participants diagnosed with nonmetastatic BC who returned a survey at least 90 days after their diagnosis were matched on age and year of survey return with up to 5 women without cancer.

Exposure

Cancer status and treatment information.

Main Outcomes and Measures

Outcomes of interest were measures of physical health, assessed using the Patient-Reported Outcomes Measurement Information System Global Health Scale instrument. Linear regression was used to estimate associations (β) and 95% CIs of treatment with physical health.

Results

This analysis included 2566 individuals diagnosed with BC and 12 826 age-matched women without cancer. Median (IQR) age at diagnosis was 56.3 (49.9-61.9) years. Of women with BC, 1223 (47.7%) received endocrine therapy, 276 (10.8%) received chemotherapy, and 634 (24.7%) received both. Compared with women without cancer, there was a greater physical health decline within 2 years of diagnosis for BC survivors receiving endocrine therapy (β = -1.12; 95% CI, -1.64 to -0.60), chemotherapy (β = -3.13; 95% CI, -4.19 to -2.07), or both (β = -3.26; 95% CI, -3.97 to -2.55). The decline among endocrine therapy users was restricted to women receiving aromatase inhibitors. More than 2 years after diagnosis, the decline was only observed in women who received chemotherapy.

Conclusions and Relevance

In this cohort study of 15 392 BC survivors and age-matched women without cancer, BC survivors who received chemotherapy had a long-lasting physical health decline, unlike survivors who received endocrine therapy without chemotherapy. Further studies are needed to confirm these results and to better understand the health consequences of these treatments.

Complex Role of Circulating Triglycerides in Breast Cancer Onset and Survival: Insights From Two-Sample Mendelian Randomization Study

BACKGROUND

Reducing the incidence of breast cancer and improving its prognosis have become significant challenges for the global public health sector. We aimed to investigate the role of circulating triglycerides in the occurrence and survival of patients with breast cancer, while focusing on the possible differential effects by molecular subtypes of breast cancer.

METHODS

We used a Mendelian randomization approach to analyze publicly accessible genome-wide association study data, including triglyceride levels, breast cancer risk, and survival prognosis. We performed a two-sample causality inference analysis using the inverse-variance weighted method. We used both Mendelian randomization-Egger regression and weighted median methods for model verification. Heterogeneity was evaluated using Cochran's Q test, and sensitivity analyses were performed using the leave-one-out method, Mendelian randomization-Egger intercept test, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier test.

RESULTS

The results revealed a negative causal relationship between triglyceride levels and overall breast cancer risk (odds ratio [OR] = 0.94, confidence interval [CI] = 0.89-0.99, p = 0.011), luminal A breast cancer risk (OR = 0.93, CI = 0.87-0.99, p = 0.014), and human epidermal growth factor receptor 2 (HER2)-enriched breast cancer risk (OR = 0.84, CI = 0.73-0.96, p = 0.010). However, no statistically significant correlations were observed for the luminal B, luminal B HER2-negative, and triple-negative subtypes. Furthermore, triglyceride levels showed a positive causal relationship with the risk of survival prognosis in patients with estrogen receptor-negative breast cancer (OR = 1.33, CI = 1.00-1.76, p = 0.047). However, no statistically significant impact was observed on the survival of patients with overall breast cancer or patients with estrogen receptor-positive, HER2-positive, and HER2-negative breast cancer.

CONCLUSIONS

The potentially complex role of circulating triglycerides in the incidence and survival of patients with breast cancer provides a new perspective on the heterogeneity of the effects of triglycerides on breast cancer, thereby promoting the development of precise medical strategies. Moreover, our findings contribute to an increased understanding of overall health among patients and clinicians alike.

Systemic hormone therapy after breast and gynecological cancers: an Italian expert group consensus opinion

The specific Italian Group of Study of the Menopause formulated a consensus opinion on the use of estrogen therapy (ET) or combined estro-progestin hormone therapy (HT) after breast and gynecological cancers. This consensus is based on the risk of recurrence of the specific cancer during ET/HT, the presence of steroid receptors in cancer cells, the use of adjuvant hormone therapies and data on the use of ET/HT after cancer. The following positions were reached. ET/HT can be used after vulvar cancers and melanoma, but with great caution after the rare adenocarcinomas. ET/HT can be used after cervical cancer, but ET should be used with caution after adenocarcinomas. ET/HT can be used after International Federation of Obstetrics and Gynecology (FIGO) stage I-II estrogen-dependent endometrial cancers, except in Black women, and can probably be used after estrogen-independent endometrial cancers. ET/HT cannot be administered or should be used with great caution after most uterine sarcomas. ET/HT can probably be used after ovarian neoplasms except for granulosa cell tumors, and with great caution after low-grade serous ovarian carcinoma and serous borderline ovarian tumors. ET/HT can be used with great caution in women after estrogen receptor (ER)/progesterone receptor (PR)-positive breast cancer and is probably allowed after ER/PR-negative breast cancer.

The INFLUENCE 3.0 model: Updated predictions of locoregional recurrence and contralateral breast cancer, now also suitable for patients treated with neoadjuvant systemic therapy

BACKGROUND

Individual risk prediction of 5-year locoregional recurrence (LRR) and contralateral breast cancer (CBC) supports decisions regarding personalised surveillance. The previously developed INFLUENCE tool was rebuild, including a recent population and patients who received neoadjuvant systemic therapy (NST).

METHODS

Women, surgically treated for nonmetastatic breast cancer, diagnosed between 2012 and 2016, were selected from the Netherlands Cancer Registry. Cox regression with restricted cubic splines was compared to Random Survival Forest (RSF) to predict five-year LRR and CBC risks. Separate models were developed for NST patients. Discrimination and calibration were assessed by 100x bootstrap resampling.

RESULTS

In the non-NST and NST group, 49,631 and 10,154 patients were included, respectively. Age, mode of detection, histology, sublocalisation, grade, pT, pN, hormonal receptor status ± endocrine treatment, HER2 status ± targeted treatment, surgery ± immediate reconstruction ± radiation therapy, and chemotherapy were significant predictors for LRR and/or CBC in non-NST patients. For NST patients this was similar, but excluding (y)pT and (y)pN status, and including presence of ductal carcinoma in situ, axillary lymph node dissection and pathologic complete response. For non-NST patients, the Cox and RSF models were integrated in the online tool with 5-year AUCs of 0.77 (95%CI:0.77-0.77) and 0.68 (95%CI:0.67-0.68)] for LRR and CBC prediction, respectively. For NST patients, the RSF model performed best (AUCs 0.77 (95%CI:0.76-0.78) and 0.73 (95%CI:0.69-0.76) for LRR and CBC, respectively). Regarding calibration, observed-predicted differences were all <1 %.

CONCLUSION

This INFLUENCE 3.0 models showed moderate performance in LRR and CBC prediction. The models have been made available as online tool to enable clinical decision support regarding personalised follow-up.

Diagnostic Value of Gastrin-Releasing Peptide Receptor-Targeted PET Imaging in Oncology: A Systematic Review

Gastrin-releasing peptide receptor (GRPR), overexpressed in various cancers, is a promising target for positron emission tomography (PET). This systematic review investigated the diagnostic value of GRPR-targeted PET imaging in oncology. A systematic search was conducted on major medical databases until May 23, 2024. Keywords were modified to include clinical original studies on GRPR-targeted PET in cancer patients. Out of 1624 searched studies initially, 107 were eligible for the full-text review. Overall, data from 38 studies met inclusion criteria, investigating GRPR-targeting radiotracers in breast cancer, prostate cancer, gastrointestinal stromal tumours (GIST) and gliomas (including optic pathway glioma and glioblastoma multiforme). In breast cancer, GRPR-targeted PET effectively detected primary tumours and metastases, particularly in estrogen receptor (ER)-positive patients, and predicted treatment response. In prostate cancer, high sensitivity (up to 88%) and specificity (up to 90%) for detecting primary tumours were observed, providing added value when combined with magnetic resonance imaging (MRI). In biochemical recurrence, sites of prostate cancer were identified even at PSA levels below 0.5ng/dL. Compared with PSMA PET, GRPR-targeted PET showed comparable or superior detection rates. Considering GIST, GRPR-targeted PET imaging proved to be a valuable diagnostic tool, particularly when [18F] FDG PET results were inconclusive. Regarding gliomas, GRPR-targeted PET achieved a 100% detection rate (MRI reference), aiding localization, preoperative planning, and differentiation between recurrence and malignant transformation. GRPR-targeted PET shows promise in improving cancer diagnostics, particularly in ER-positive breast cancer, prostate cancer, and gliomas, and may enhance clinical decision-making.

Endocrine treatment mechanisms in triple-positive breast cancer: from targeted therapies to advances in precision medicine

Triple-positive breast cancer (TPBC), defined by the co-expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), poses unique therapeutic challenges due to complex signaling interactions and resulting treatment resistance. This review summarizes key findings on the molecular mechanisms and cross-talk among ER, PR, and HER2 pathways, which drive tumor proliferation and resistance to conventional therapies. Current strategies in TPBC treatment, including endocrine and HER2-targeted therapies, are explored alongside emerging approaches such as immunotherapy and CRISPR/Cas9 gene editing. Additionally, we discuss the tumor microenvironment (TME) and its role in treatment resistance, highlighting promising avenues for intervention through combination therapies and predictive biomarkers. By addressing these interdependent pathways and optimizing therapeutic strategies, precision medicine holds significant potential for improving TPBC patient outcomes and advancing individualized cancer care.

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.

Who Are Suitable Patients for Omitting Breast Surgery as an Exceptional Responder in Selected Molecular Subtypes of Breast Cancer After Neoadjuvant Systemic Treatment?

Background and Objectives: Among breast cancer molecular types, HER2 positive and triple negative (TN) subtypes have the highest likelihood of pathological complete response (pCR), which is a surrogate marker for reduced recurrence and improved patient survival after neoadjuvant systemic treatment (NST). Preoperative pathological identification of these exceptional responders is a new era. Therefore, we aimed to determine the accuracy of trucut biopsy in identifying the exceptional responders in selected molecular subtypes of breast cancer patients. Materials and Methods: This two-centre, observational, single-arm, prospective, pilot study was conducted between January and September 2024. The patients with TN or HER2 positive breast cancer whose breast tumour had completely disappeared on the radiological assessment including MRI after neoadjuvant therapy were enrolled. To assess neoadjuvant treatment response, a standardised biopsy protocol was used, consisting of 10 samples from the marked tumour area per patient by 12 G core needle. Then, all patients underwent surgery. The pathological results of both postchemo-presurgical biopsy and surgical breast specimen were compared. Results: The study included 20 patients. The mean age of the patients was 47.3 years. The median tumour size at diagnosis was 23.1 mm. All biopsy results were concordant with the findings of surgical specimen. Seventeen patients had a complete response. The remaining 3 patients had residual disease. Conclusions: Along with thorough patient selection, post-chemo radiological assessment and the reliable biopsy technique are the key points in accurately predicting response to neoadjuvant treatment. If an image-guided core biopsy confirms elimination of tumour tissue at the marked tumour area with a radiological complete response on MRI after NST in breast cancer patients with selected molecular subtypes, these may be suitable patients as exceptional responders in whom we can omit breast surgery.

Correlation of Histopathological and Radiological Response Patterns and Their Prognostic Implications in Breast Cancer After Neoadjuvant Chemotherapy

Purpose

In breast cancer (BC), neoadjuvant chemotherapy (NAC) responses can be categorized as concentric shrinkage (CS), non-concentric shrinkage (non-CS), and complete response, influencing surgical planning and survival. This study evaluates the correlation between histopathological and radiological response patterns in BC patients after NAC and their impact on overall survival (OS) and disease-free survival (DFS).

Patients and Methods

This retrospective study analyzed 168 BC patients who received NAC between 2018 and 2022. Tumor response was evaluated radiologically using MRI and histopathologically after surgery. Radiological response patterns were categorized into CS, non-CS, and radiological complete response (rCR). Histopathologically, patients were classified into CS, non-CS, and pathological complete response (pCR). Concordance between radiological and histopathological classifications was assessed using the kappa statistic. Survival outcomes, including OS and DFS, were analyzed using Kaplan-Meier methods.

Results

Histopathological response patterns were distributed as CS (31.5%), non-CS (34.5%), and pCR (34%). Moderate agreement was observed between radiological and histopathological assessments (κ: 0.439, p < 0.001). Radiological evaluation identified 64% of CS, 50% of non-CS, and 74% of pCR cases accurately. Tumor molecular subtypes significantly correlated with both radiologic and histopathologic response patterns (p < 0.001). Subtype analysis revealed higher pCR rates in TN, HER2-enriched, and Luminal B-HER2(+) tumors, while non-CS was predominant in Luminal A tumors. No significant correlation was observed between histopathological or radiological patterns and OS (p: 0.291, p: 0.515) or DFS (p: 0.599, p: 0.899). However, patients achieving pCR tended to have better survival outcomes.

Conclusion

We observed moderate concordance between histopathological and radiological response patterns in BC patients after NAC, but discrepancies highlight the limitations of radiological evaluation alone. These patterns did not significantly correlate with prognosis. Higher pCR rates were associated with better outcomes, but response patterns alone may not predict survival, warranting further research in larger cohorts.

GRK6 palmitoylation dictates triple-negative breast cancer metastasis via recruiting the β-Arrestin 2/MAPKs/NF-κB signaling axis

BACKGROUND

Triple negative breast cancer (TNBC) belongs to the worst prognosis of breast cancer subtype probably because of distant metastasis to other organs, e.g. lungs. However, the mechanism underlying TNBC metastasis remains largely unknown.

METHODS

Bioinformatics analysis was conducted to evaluate the mRNA/protein expression and prognostic significance of G protein-coupled receptor kinase 6 (GRK6) in BC subtypes. RT-PCR assays were used to test the GRK6 expression in human BC tissues and cell lines. The in vitro cellular migration and in vivo lung colony-forming assays were established to estimate the metastatic potentials of TNBC cells. Western blotting was employed to examine protein phosphorylation, translocation and expression in the designed experiments.

RESULTS

Here we show that GRK6 upregulation is extensively detected in TNBC compared to normal mammary tissues and other BC subtypes and correlates with an increased risk for distant metastasis in TNBC patients. GRK6 knockdown suppressed but overexpression potentiated the cellular migration and lung colony-forming abilities of TNBC cells. Moreover, our data demonstrated that the posttranslational palmitoylation of GRK6 is extremely critical for activating β-Arrestin 2/mitogen-activated protein kinases (MAPKs)/NF-κB signaling axis and fostering the metastatic potentials of TNBC cells. Accordingly, the pharmaceutical inhibition of GRK6 kinase activity dramatically suppressed the activation of β-Arrestin 2, MAPKs and NF-κB and the cellular migration ability of highly metastatic MDA-MB231 cells. Sequentially blocking the β-Arrestin 2/MAPKs/NF-κB axis with their inhibitors predominantly mitigated the GRK6-promoted migration ability of poorly metastatic HCC1937 cells.

CONCLUSION

Our results not only provide a novel mechanism for TNBC metastasis but also offer a new therapeutic strategy to combat metastatic TNBC via targeting GRK6 activity.

Impact of prolactin treatment on enhancing the cellular responses of MCF7 breast cancer cells to tamoxifen treatment

Breast cancer remains one of the most challenging diseases to treat due to its heterogeneity, propensity to recur, capacity to spread to distant vital organs, and, ultimately, patient death. Estrogen receptor-positive illness comprises the most common breast cancer subtype. Preclinical progress is hampered by the scarcity of medication-naïve estrogen receptor-positive tumour models that recapitulate metastatic development and treatment resistance. It is becoming increasingly clear that loss of differentiation and increased cellular stemness and plasticity are important causes of cancer evolution, heterogeneity, recurrence, metastasis, and treatment failure. Therefore, it has been suggested that reprogramming cancer cell differentiation could offer an effective method of reversing cancer through terminal differentiation and maturation. In this context, the hormone prolactin is well recognized for its pivotal involvement in the development of the mammary glands lobuloalveolar tissue and the terminal differentiation that drives the production of the milk protein gene and lactation. Additionally, numerous studies have examined the engagement of prolactin in breast cancer as a differentiation player that resulted in the ablation of tumour growth and progression. Here, we showed that a pre-treatment of the estrogen-positive breast cancer cell line with prolactin led to a considerable improvement in the sensitivity of this cancer cell to Tamoxifen endocrine therapy. We also showed a favourable prognostic value of prolactin receptors/estrogen receptors 1 (or alpha) co-expression on breast cancer patients outcomes, and this co-expression is highly correlated with the well-differentiated breast tumour type. Our results revealed a fruitful aspect of the effects of prolactin in improving the responses of breast cancer cells to conventional endocrine therapy. Moreover, these findings further validated the ability of prolactin as a persuader of a more differentiated and less aggressive breast cancer phenotype. Hence, it suggested a potential implication of prolactin as a therapeutic candidate.

Expert Consensus Methods In The Humanities: An Exploration of their Potential

Background

Despite the significant role of consensus and dissensus in knowledge production, formal approaches to consensus are notably less common in the humanities compared to their frequent application in natural, social, and life sciences. This article therefore explores the potential of expert consensus methods in humanities-related research.

Methods

In order to do so, an interdisciplinary team of both sciences researchers experienced in consensus methods and researchers familiar with the domain of the humanities and epistemology, conducted a literary review and exchanged their expertise in multiple brainstorm sessions.

Results

This resulted in the identification of six key elements of expert consensus methods. It also provided for an overview of different types of expert consensus methods that regularly used in the natural, social, and life sciences: Delphi studies, nominal groups, consensus conferences, and Glaser's state of the art method and illustrative examples from both sciences and humanities-related studies. An overview of possible purposes for applying these methods is provided to identify the research contexts in which these methods have proven their value, which can be extrapolated to humanities related issues for which these methods seem promising.

Conclusions

The comparisons and categorisation show that, when focusing on the purposes, there seem to be humanities-related issues that may lend themselves better to structured expert consensus methods than their subject matter and research methods might suggest. When deliberately applied in context chosen by researchers with expertise in a specific humanities domain, expert consensus methods can accelerate epistemic process, enhance transparency, increase replicability, stimulate diversity, and encourage fair processes in humanities research and the application of its findings.

Contrast-Enhanced Mammography: A Literature Review of Clinical Uses for Cancer Diagnosis and Surgical Oncology

Contrast-enhanced mammography (CEM) uses intermittent dual-energy (low- and high-energy) exposures to produce low-energy mammograms and recombine enhanced images after the administration of iodized contrast medium, which provides more detailed information to detect breast cancers by using the features of morphology and abnormal uptake. In this article, we reviewed the literature to clarify the clinical applications of CEM, including (1) the fundamentals of CEM: the technique, radiation exposure, and image interpretation; (2) its clinical uses for cancer diagnosis, including problem-solving, palpable mass, suspicious microcalcification, architecture distortion, screening, and CEM-guided biopsy; and (3) the concerns of surgical oncology in pre-operative and neoadjuvant chemotherapy assessments. CEM undoubtedly plays an important role in clinical practice.

Integration of Longitudinal and Transverse Radiomics from Ultrasound Images with Clinical Factors for HER-2 Status Prediction in Invasive Breast Cancer Patients

OBJECTIVE

This study developed a nomogram combining longitudinal and transverse ultrasound radiomics with clinical factors to identify human epidermal growth factor receptor 2 (HER2) status in invasive breast cancer (BC).

MATERIALS AND METHODS

We analyzed 537 invasive BC patients from two hospitals: 436 in the training cohort (Hospital A) and 101 in the test cohort (Hospital B). From longitudinal and transverse ultrasound planes, 788 radiomics features were extracted, with dimensionality reduced using least absolute shrinkage and selection operator regression. A radiomics nomogram integrating clinical predictors and radiomics scores (Rad-scores) was constructed.

RESULTS

Fifteen and sixteen features from longitudinal and transverse ultrasound planes, respectively, were selected to generate Rad-scores, which differed significantly between HER2-positive and HER2-negative groups in both cohorts (p < 0.05). The combined radiomics model outperformed individual models with AUCs of 0.783 and 0.762 in the training and external test cohorts, respectively. Tumor size was an independent clinical predictor. The nomogram, incorporating Rad-scores and tumor size, achieved AUCs of 0.790 (training cohort) and 0.774 (test cohort). Decision curve analysis demonstrated its potential clinical utility.

CONCLUSION

A biplanar ultrasound radiomics nomogram effectively predicts HER2 status in invasive BC, potentially reducing the need for biopsies and supporting personalized treatment strategies.

Radiotherapy Trends and Variations in Invasive Non-metastatic Breast Cancer Treatment in the Netherlands: A Nationwide Overview From 2008 to 2019

AIMS

This nationwide study provides an overview of trends and variations in radiotherapy use as part of multimodal treatment of invasive non-metastatic breast cancer in the Netherlands in 2008-2019.

MATERIALS AND METHODS

Women with invasive non-metastatic breast cancer were selected from the population-based Netherlands Cancer Registry. Treatments trends were presented over time. Factors associated with (1) boost irradiation in breast-conserving therapy and (2) regional radiotherapy instead of axillary lymph node dissection (ALND) in N+ disease were identified using multilevel logistic regression analyses.

RESULTS

Radiotherapy use increased from 61% (2008) to 70% (2016), caused by breast-conserving therapy instead of mastectomy, increased post-mastectomy radiotherapy, and increased regional radiotherapy (32% in 2011 to 61% in 2019) instead of ALND in N+ disease. Omission of radiotherapy after breast-conserving surgery (BCS) in 2016-2019 (4-9%, respectively), mainly in elderly, decreased overall radiotherapy use to 67%. Radiotherapy treatment was further de-escalated by decreased boost irradiation in breast-conserving therapy (66% in 2011 to 37% in 2019) and partial (1% in 2011 to 6% in 2019) instead of whole breast irradiation following BCS. Boost irradiation was associated with high-risk features: younger age (OR>75 vs <50:0.04, 95%CI:0.03-0.05), higher grade (OR grade III vs I:11.46, 95%CI:9.90-13.26) and residual disease (OR focal residual vs R0-resection:28.08, 95%CI:23.07-34.17). Variation across the country was found for both boost irradiation use (OR South vs North:0.58, 95%CI:0.49-0.68), and regional radiotherapy instead of ALND (OR Southwest vs North:0.55, 95%CI:0.37-0.80).

CONCLUSION

Overall radiotherapy use increased in 2008-2016, while a decreasing trend was observed after 2016, caused by post-BCS radiotherapy omission. Boost irradiation in breast-conserving therapy became omitted in low-risk patients, and regional radiotherapy use increased as an alternative for ALND in N+ disease.

Monitoring Over Time of Pathological Complete Response to Neoadjuvant Chemotherapy in Breast Cancer Patients Through an Ensemble Vision Transformers-Based Model

BACKGROUND

Morphological and vascular characteristics of breast cancer can change during neoadjuvant chemotherapy (NAC). Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)-acquired pre- and mid-treatment quantitatively capture information about tumor heterogeneity as potential earlier indicators of pathological complete response (pCR) to NAC in breast cancer.

AIMS

This study aimed to develop an ensemble deep learning-based model, exploiting a Vision Transformer (ViT) architecture, which merges features automatically extracted from five segmented slices of both pre- and mid-treatment exams containing the maximum tumor area, to predict and monitor pCR to NAC.

MATERIALS AND METHODS

Imaging data analyzed in this study referred to a cohort of 86 breast cancer patients, randomly split into training and test sets at a ratio of 8:2, who underwent NAC and for which information regarding the pCR status was available (37.2% of patients achieved pCR). We further validated our model using a subset of 20 patients selected from the publicly available I-SPY2 trial dataset (independent test).

RESULTS

The performances of the proposed model were assessed using standard evaluation metrics, and promising results were achieved: area under the curve (AUC) value of 91.4%, accuracy value of 82.4%, a specificity value of 80.0%, a sensitivity value of 85.7%, precision value of 75.0%, F-score value of 80.0%, and G-mean value of 82.8%. The results obtained from the independent test show an AUC of 81.3%, an accuracy of 80.0%, a specificity value of 76.9%, a sensitivity of 85.0%, a precision of 66.7%, an F-score of 75.0%, and a G-mean of 81.2%.

DISCUSSION

As far as we know, our research is the first proposal using ViTs on DCE-MRI exams to monitor pCR over time during NAC.

CONCLUSION

Finally, the changes in DCE-MRI at pre- and mid-treatment could affect the accuracy of pCR prediction to NAC.

Exploring the value of FAP-targeted PET/CT in differentiating breast cancer molecular subtypes: a preliminary study

PURPOSE

This prospective study aims to evaluate the value of [18F]AlF-NOTA-fibroblast activation protein inhibitor (FAPI)-04 positron emission tomography-computed tomography (PET/CT) in predicting molecular subtypes of breast cancer.

METHODS

The study consecutively recruited patients suspected of having breast cancer from a single center who were prospectively enrolled from July 2023 to May 2024 and underwent [18F]AlF-NOTA-FAPI-04 PET/CT. This study compared the differences in tracer uptake among breast cancers with different adverse prognostic factors and molecular subtypes. The classification performance for each molecular subtype of breast cancer was assessed using a receiver operating characteristic (ROC) curve.

RESULTS

Fifty-three participants (mean age, 51 ± 11 years; 52 females) were evaluated. Breast cancer lesions with adverse prognostic factors showed higher tracer uptake. The five different molecular subtypes exhibited varying levels of uptake. The luminal A and luminal B (HER2-negative) subtypes had relatively low uptake, while the luminal B (HER2-positive), HER2-positive, and triple-negative subtypes had relatively high uptake. ROC analysis identified the max standardized uptake value (SUVmax) as a significant classifier (AUC = 0.912, P = 0.0005) for the luminal A subtype, with 100% sensitivity and 83% specificity. For predicting the luminal B (HER2-negative) subtype, SUVmax had an AUC of 0.770 (P = 0.0015). SUVmax, with an AUC of 0.781 (P = 0.003), was used to identify the triple-negative subtype tumors, resulting in a sensitivity of 100% and specificity of 51%. Lastly, the ROC curve showed the cut-off 15.40 (AUC = 0.921, P < 0.0001) could classify luminal A & luminal B (HER2-negative), and luminal B (HER2-positive) & HER2-positive & triple-negative, yielding a sensitivity of 94% and specificity of 79%.

CONCLUSION

The uptake of [18F]AlF-NOTA-FAPI-04 is significantly correlated with the molecular subtypes of breast cancer, and [18F]AlF-NOTA-FAPI-04 PET/CT is a potential tool for noninvasive identification of luminal A subtypes and guidance of FAP-targeted therapies.

Uncovering immune cell-associated genes in breast cancer: based on summary data-based Mendelian randomized analysis and colocalization study

BACKGROUND

Breast cancer, which is the most prevalent form of cancer among women globally, encompasses various subtypes that demand distinct treatment approaches. The tumor microenvironment and immune response are of crucial significance in the development and progression of breast cancer. Nevertheless, there has been scant evidence concerning the genes within breast cancer - specific immune cells.

METHODS

We utilized summary data-based Mendelian randomization (SMR) to identify genes associated with breast cancer by utilizing expression quantitative trait loci (eQTL) datasets for 14 different immune cell types and genome-wide association studies (GWAS) for overall breast cancer and its subtypes. Furthermore, colocalization analysis was carried out to evaluate whether the observed association in SMR analyses is influenced by the same causal variant. Replication analysis and bulk RNA sequencing (bulkRNA-seq) analysis were employed to validate promising immune genes as potential drug targets.

RESULTS

After correcting for the rate of false discovery, we discovered a total of 17 genes in 9 immune cell types that were significantly associated with overall breast cancer and its subtypes. The genes KCNN4, L3MBTL3, ZBTB38, MDM4, and TNFSF10 were identified in overall breast cancer and its subtypes. Colocalization analyses provided robust evidence in support of these associations. Notably, the KCNN4 gene in non-classical MONOcytes (MONOnc) was further validated through replication analysis and bulkRNA-seq analysis.

CONCLUSION

In summary, our research has revealed a repertoire of genes within diverse immune cells associated with breast cancer. KCNN4 gene in non-classical MONOcytes (MONOnc) exhibited a negative association with overall breast cancer and its subtypes, which was identified as a potential drug target for breast cancer, opening up new avenues for therapeutic interventions.

Adherence to adjuvant endocrine therapy after breast cancer in Sweden - a nationwide cohort study in 1-, 3- and 5-year survivors with a focus on regional differences

BACKGROUND AND PURPOSE

Adjuvant endocrine treatment (AET) is crucial in early oestrogen receptor (ER)-positive breast cancer (BC), providing reduced recurrence rate and increased overall survival. The aim of this study was to estimate AET adherence rates by age at diagnosis and region in Sweden.

PATIENTS AND METHODS

In total, 10,422 women diagnosed with ER-positive BC in 2008-2010 were identified in the Swedish National BC Registry. Information on prescriptions and dispensation of AET was gathered through record linkage to the Swedish Prescription Registry. 1, 3- and 5-year medication possession ratios (MPRs) were calculated. Good adherence was set as MPR ≥ 80%.

RESULTS

The 1-, 3- and 5-year AET age-adjusted adherence rates were 94.4, 87.6 and 81.6%, respectively. The 1-, 3- and 5- year adherence rate was significantly highest in the South region (96.2, 90.5 and 86.2%). Regions with an oncologic clinic had higher adherence rate than regions without, 82.8% versus 75.5% at 5-year FU. Women at age 40-64 years (95.6, 89.9 and 84.1%) and 65-74 years at diagnosis (95.7, 89.5 and 84.6%) had significantly higher adherence rate than women ≥ 75 years at diagnosis (89.1, 79.2 and 68.3%).

INTERPRETATIONS

Despite guidelines being national, there were significant differences in adherence between regions in Sweden. As the largest differences were between age groups invited and not invited to mammography screening intervention should focus on women < 40 and ≥ 75 years at diagnosis. Further studies are needed to find strategies to increase overall adherence to AET in early BC.

PET/CT Assessment of Estrogen Receptor positivity for Breast Cancer using [68Ga]Ga-RM2 Bombesin Receptor Antagonist: A Systematic Review and Meta-Analysis

[68Ga]Ga-RM2 is a novel gastrin-releasing peptide receptor antagonist with emerging diagnostic utility in low-grade breast cancer (BC) expressing estrogen receptors (ER). This systematic review and meta-analysis evaluates the current diagnostic utility of [68Ga]Ga-RM2 PET/CT and explores BC tumor uptake metrics in ER-positive BC lesions. A systematic search of PubMed, Scopus, and Web of Science databases was conducted using relevant keywords to extract, screen, and select eligible data for analysis. Out of 182 articles reviewed, only four studies were found eligible for inclusion. Qualitative data analysis was applied to four included papers meeting the eligibility criteria. Various promising utilities were identified, including [68Ga]Ga-RM2's ability to detect ER-positive primary BC lesions, lymph nodes, and distant metastatic lesions. Additionally, recent studies have addressed its potential for assessing therapy response following neoadjuvant chemotherapy. Importantly, [68Ga]Ga-RM2 has demonstrated clinical utility in improving and guiding proper management planning by detecting metastatic lesions that can alter overall staging and treatment strategies. The overall lesion detectability was 93% (95% CI: 87-98%) for ER-positive BC. ER-positive BC lesions showed significantly higher maximum standardized uptake values (SUVmax) compared to ER-negative lesions, with a weighted mean difference (WMD) of 10.6 (95% CI: 8.1-13.2; P < 0.00001). Furthermore, ER-positive BC lesions exhibited statistically significant higher SUVmax compared to normal background breast tissue SUVmean, with an overall WMD of 9.9 (95% CI: 7.5-12.2; P < 0.00001). Further studies utilizing this promising radiotracer should be encouraged, implementing prospective, large-scale designs in the near future.

Increasing survivors of anthracycline-related cardiomyopathy with breast cancer in trastuzumab era: thirty-one-year trends in a Japanese Community

BACKGROUND

Trastuzumab has improved breast cancer (BC) prognosis and reduced anthracycline use. However, the characteristic changes of anthracycline-related cardiomyopathy (ARCM) in patients with BC remain unclear. We aimed to update our understanding of ARCM in the trastuzumab era.

METHODS

This retrospective observational cohort study included 2959 patients with BC treated with anthracyclines at three regional cancer centers in Niigata City between 1990 and 2020. Seventy-five patients (2.5%) developed ARCM and were categorized into two groups: pre- 2007 (early phase) and post-2007 (late phase), corresponding to before and during the trastuzumab era in Japan.

RESULTS

ARCM incidence peaked at 6% in the 1990s, then decreased and stabilized at 2% until the 2010s. Survivors of anthracycline-treated BC increased more rapidly in the late phase, with four times as many patients with ARCM compared to the end of the early phase (26 and six, respectively). Although the rate of change in accumulation from the early phase to the late phase was slight in the anthracycline-treated BC group, it was more pronounced in the ARCM group (P < 0.001). Mean anthracycline use in the late phase was significantly lower than in the early phase (307 vs. 525 mg/m2, P < 0.001). Five-year survival rates in the late phase tended to be higher than early phase (45% and 28%, respectively. P = 0.058). Human epidermal growth factor receptor type 2 (HER2) positivity with trastuzumab therapy in the late phase was an independent predictor for mortality within 10 years (hazard ratio = 0.24, 95% confidence interval: 0.10-0.56; P = 0.001).

CONCLUSIONS

HER2-positive patients with ARCM receiving trastuzumab therapy had a better prognosis than HER2-positive and HER2-negative patients with ARCM not receiving trastuzumab therapy, and this trend has been increasing in the trastuzumab era. These findings highlight the importance of HER2-targeted treatments in improving prognosis for BC patients with ARCM.

Predicting Additional Metastases in Axillary Lymph Node Dissection After Neoadjuvant Chemotherapy: Ratio of Positive/Total Sentinel Nodes

BACKGROUND/OBJECTIVES

The aim of the study was to determine the clinical value of the sentinel lymph node ratio (SLN-R) in predicting additional positive lymph nodes during axillary lymph node dissection (ALND) in breast cancer patients following neoadjuvant chemotherapy (NAC).

METHODS

A cross-sectional study was performed at a single institution evaluating data from 1521 BC patients. Inclusion criteria comprised cT1/cT4, cN0/cN1 status with positive post-NAC axillary staging by SLN/TAD, respectively, and subsequent ALND.

RESULTS

The study included 118 patients, divided into two groups based on the presence or absence of additional node metastasis at ALND: 39 in the residual disease group (RD) and 79 in the non-residual disease group (nRD). Univariate logistic regression analysis of SLN-R was conducted to assess its predictive value, yielding an odds ratio (OR) of 7.79 (CI 1.92-29.5, p = 0.003). An SLN-R cut-off point of <0.35 was identified using ROC curve analysis, with a false-negative rate of 10.2%, as a predictor for no additional metastasis at ALND following post-NAC SLN/TAD positivity.

CONCLUSIONS

The study concludes that SLN-R is a valuable predictor for determining the omission of ALND in cases where SLN/TAD is positive after NAC. This metric, in combination with other clinical variables, could help develop a nomogram to spare patients from ALND.

Prognosis prediction with the IHC3 score in patients with node-negative, hormone receptor-positive, HER2-negative early breast cancer

BACKGROUND

Prognostication has been used to identify patient populations that could potentially benefit from treatment de-escalation. In patients with hormone receptor-positive (HRpos), human epidermal growth factor receptor 2-negative (HER2neg) early breast cancer (eBC), treatment de-escalation classically involved omitting chemotherapy. With recently developed specialized therapies that require hands-on side-effect management, the therapeutic landscape is changing and therapy decisions are no longer based only on prognosis, but also consider potential side-effects. Therefore, identification of patient groups based on prognostication has gained importance.

MATERIALS AND METHODS

In this retrospective analysis, a population of 2359 node-negative HRpos/HER2neg eBC patients was selected from all patients treated at the University Breast Center of Franconia, Germany between 2002 and 2021. The prognostic value of the IHC3 score (incorporating immunohistochemical measurements of the estrogen and progesterone receptor status and Ki-67) with clinical parameters (lymph node status, tumor stage, grading) regarding invasive disease-free survival (iDFS) and overall survival (OS) was assessed.

RESULTS

IHC3 positively correlated with Ki-67 expression and inversely correlated with hormone receptor expression. IHC3 categorized into quartiles identified patients with a more unfavorable prognosis: 5-year and 10-year iDFS rates for patients in the highest versus the lowest quartile were 84% versus 95% and 70% versus 88%, respectively. A sensitivity analysis of distant disease-free survival showed similar results to those of iDFS. Five-year and 10-year OS rates for patients in the highest versus the lowest quartile were, respectively, 92% versus 97% and 81% versus 92%.

CONCLUSIONS

IHC3 is able to define prognostic groups in patients with node-negative, HRpos/HER2neg eBC. Node-negative patients with a high IHC3 score had the worst prognosis, which was comparable to that of node-positive patients described in recent trials. This simple and cost-effective tool could thus potentially aid in identifying patient groups for innovative therapeutic approaches.

Genes Related to Motility in an Ionizing Radiation and Estrogen Breast Cancer Model

Breast cancer is a major global health concern as it is the primary cause of cancer death for women. Environmental radiation exposure and endogenous factors such as hormones increase breast cancer risk, and its development and spread depend on cell motility and migration. The expression of genes associated with cell motility, such as ADAM12, CYR61, FLRT2, SLIT2, VNN1, MYLK, MAP1B, and TUBA1A, was analyzed in an experimental breast cancer model induced by radiation and estrogen. The results showed that TUBA1A, SLIT2, MAP1B, MYLK, and ADAM12 gene expression increased in the irradiated Alpha3 cell line but not in the control or the malignant Tumor2 cell line. Bioinformatic analysis indicated that FLERT2, SLIT2, VNN1, MAP1B, MYLK, and TUBA1A gene expressions were found to be higher in normal tissue than in tumor tissue of breast cancer patients. However, ADAM12 and CYR61 expressions were found to be higher in tumors than in normal tissues, and they had a negative correlation with ESR1 gene expression. Concerning ESR2 gene expression, there was a negative correlation with CYR61, but there was a positive correlation with FLRT2, MYLK, MAP1B, and VNN1. Finally, a decreased survival rate was observed in patients exhibiting high expression levels of TUBA1A and MAP1B. These genes also showed a negative ER status, an important parameter for endocrine therapy. The genes related to motility were affected by ionizing radiation, confirming its role in the initiation process of breast carcinogenesis. In conclusion, the relationship between the patient's expression of hormone receptors and genes associated with cell motility presents a novel prospect for exploring therapeutic strategies.

Comparison of neoadjuvant single-agent treatment and dual-HER2 blockade for breast-conserving surgery conversion in HER2-positive breast cancer: a meta-analysis

BACKGROUND

Neoadjuvant targeted therapy has shown that improve pathologic complete response and facilitate breast-conserving surgery, but the difference between single-agent treatment or dual-HER2 blockade to the conversion of breast-conserving surgery has not been well described.

METHODS

Via the systematic literature search of PubMed, Web of Science and Cochrane Library databases, 5 eligible studies used to perform this meta-analysis, which was carried out using RevMan version 5.4.

RESULTS

A total of 1306 patients from five randomized controlled trials were included in the analysis, revealing a significant increase in the conversion rate to breast-conserving surgery with neoadjuvant targeted therapy (OR 0.30, 95% CI 0.15-0.57; p = 0.0003). The odds ratio (OR) for single-agent treatment compared to dual-HER2 blockade was 1.04 (95% CI 0.73-1.48; p = 0.82). For pathological complete response (pCR), the OR for single-HER2 blockade versus dual-HER2 blockade was 0.43 (95% CI 0.34-0.55; p = 0.01), and for clinical response, it was 0.81 (95% CI 0.59-1.10; p = 0.17). The OR for serious adverse events between single-HER2 and dual-HER2 blockade was 0.72 (95% CI 0.55-0.95; p = 0.02). The risk ratio (RR) for pCR and the shift from mastectomy to BCS was 1.16 (95% CI 0.78-1.72; p = 0.47), while for clinical response and the shift from mastectomy to BCS, it was 2.40 (95% CI 1.44-4.01; p = 0.0008).

CONCLUSION

Neoadjuvant targeted treatment obviously promote the actual implementation rate of breast-conserving surgery, nevertheless, there was no statistically significant increase in single-agent treatment versus dual-HER2 blockade.

Role of Immunotherapy in Conjunction With the Surgical Treatment of Breast Cancer: Preoperative and Postoperative Applications

Breast cancer is one of the most common cancers in the world. Since the appearance of molecular medicine, the perspective of breast cancer treatment has changed, making it more successful in comparison with the treatment during previous years. Numerous ongoing trials are exploring the capacity of immunotherapy, mainly in immune checkpoint inhibitors (ICIs), in conjunction with conventional therapies or with antibody-drug conjugates (ADCs). The current narrative review discusses the advantages and limitations of immunotherapy in breast cancer treatment in conjunction with the surgical options available. Going through the modern capacity of surgery treatment and how the use of immunotherapy in conjunction with it has emerged as a transformative approach to breast cancer and listing the main complications and adverse effects caused by ICIs. We searched Google Scholar, PubMed, MEDLINE, and EMBASS. Fourteen different articles showed that the use of cytokines and cancer vaccines revealed new possibilities to treat breast cancer with antibodies against PD-1/PD-L1 (pembrolizumab), PI3K/Akt/mTOR (alpelisib and everolimus), CAR T-cell (chimeric antigen receptor), PARP (poly ADP-ribose polymerase), and CTLA4 (cytotoxic T-lymphocyte-associated protein 4), and with representative relevance of changing in tumor microenvironment. Immunotherapy made it possible to reduce recurrences, after radiotherapy and surgery. Estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) targets show also a high effectivity. In recent years, the release of new strategies has become promising, for changing the microenvironment and de-escalation of therapy based on tumor biology, novel biomarkers, and tumor spread.