Clinicopathological characteristics and prognostic analysis of breast cancer with a hormone receptor status of ER(-)/PR(+)

Comparing survival outcomes between neoadjuvant and adjuvant chemotherapy within hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer among young women (≤35): a retrospective cohort study based on SEER database and TJMUCH registry

Breast cancer is a leading cause of cancer morbidity and mortality among young women, who often experience more aggressive disease, which may impact their treatment responses and long-term prognoses. Understanding the effectiveness of neoadjuvant chemotherapy (NAC) versus adjuvant chemotherapy (AC) in this specific population is critical for optimizing treatment strategies and improving prognoses. This research was conducted to compare the prognoses of young women (≤35 years old) with early-stage hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer, who were treated with NAC versus those treated with AC. This study retrospectively analyzed data from young women with HR+/HER2- breast cancer, with complete follow-up information, sourced from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2018) and the Tianjin Medical University Cancer Institute and Hospital (TJMUCH) (2014-2018). Patients from both cohorts were allocated to NAC and AC groups based on their treatment regimens. Categorical variables were compared using chi-square, whereas the Kaplan-Meier method was utilized to generate survival curves; additionally, the log-rank test was employed for survival analysis. Propensity score matching (PSM) was employed to control baseline differences. Analysis of the SEER and TJMUCH cohorts revealed that patients treated with NAC had significantly worse overall survival (OS) compared to those treated with AC, as indicated by Kaplan-Meier curves both before and after PSM. The disease-free survival analysis of the TJMUCH cohort yielded similar results, indicating that patients treated with AC experienced longer periods without disease recurrence compared to their counterparts receiving NAC. Statistically significant differences were observed across both survival metrics, reinforcing the robustness of our findings. Overall, among young women (≤35 years old) with early-stage HR+/HER2- breast cancer, patients treated with AC exhibited a more favorable prognosis and improved survival outcomes compared to those treated with NAC. These findings could potentially influence clinical decision-making and treatment guidelines, advocating for a more tailored approach in managing young women with HR+/HER2- breast cancer.

Synchronous bilateral breast cancer with heterogeneous hormone receptor status: a case report

The expression of estrogen, progesterone, and HER2 receptors in breast cancer cells helps guide treatment and predict outcomes. When the status of these receptors is heterogeneous, it makes treatment planning more complex. We present the case of a 72-year-old woman with bilateral breast cancer with heterogenous receptor status and subsequent challenges in management.

Autophagy and senescence facilitate the development of antiestrogen resistance in ER positive breast cancer

Estrogen receptor positive (ER+) breast cancer is the most common breast cancer diagnosed annually in the US with endocrine-based therapy as standard-of-care for this breast cancer subtype. Endocrine therapy includes treatment with antiestrogens, such as selective estrogen receptor modulators (SERMs), selective estrogen receptor downregulators (SERDs), and aromatase inhibitors (AIs). Despite the appreciable remission achievable with these treatments, a substantial cohort of women will experience primary tumor recurrence, subsequent metastasis, and eventual death due to their disease. In these cases, the breast cancer cells have become resistant to endocrine therapy, with endocrine resistance identified as the major obstacle to the medical oncologist and patient. To combat the development of endocrine resistance, the treatment options for ER+, HER2 negative breast cancer now include CDK4/6 inhibitors used as adjuvants to antiestrogen treatment. In addition to the dysregulated activity of CDK4/6, a plethora of genetic and biochemical mechanisms have been identified that contribute to endocrine resistance. These mechanisms, which have been identified by lab-based studies utilizing appropriate cell and animal models of breast cancer, and by clinical studies in which gene expression profiles identify candidate endocrine resistance genes, are the subject of this review. In addition, we will discuss molecular targeting strategies now utilized in conjunction with endocrine therapy to combat the development of resistance or target resistant breast cancer cells. Of approaches currently being explored to improve endocrine treatment efficacy and patient outcome, two adaptive cell survival mechanisms, autophagy, and "reversible" senescence, are considered molecular targets. Autophagy and/or senescence induction have been identified in response to most antiestrogen treatments currently being used for the treatment of ER+ breast cancer and are often induced in response to CDK4/6 inhibitors. Unfortunately, effective strategies to target these cell survival pathways have not yet been successfully developed. Thus, there is an urgent need for the continued interrogation of autophagy and "reversible" senescence in clinically relevant breast cancer models with the long-term goal of identifying new molecular targets for improved treatment of ER+ breast cancer.