Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Quantifying tumor morphological complexity based on pretreatment MRI fractal analysis for predicting pathologic complete response and survival in breast cancer: a retrospective, multicenter study

BACKGROUND

The tumor morphological complexity is closely associated with treatment response and prognosis in patients with breast cancer. However, conveniently quantifiable tumor morphological complexity methods are currently lacking.

METHODS

Women with breast cancer who underwent NAC and pretreatment MRI were retrospectively enrolled at four centers from May 2010 to April 2023. MRI-based fractal analysis was used to calculate fractal dimensions (FDs), quantifying tumor morphological complexity. Features associated with pCR were identified using multivariable logistic regression analysis, upon which a nomogram model was developed, and assessed by the area under the receiver operating characteristic curve (AUC). Cox proportional hazards analysis was used to identify independent prognostic factors for disease-free survival (DFS) and overall survival (OS) and develop nomogram models.

RESULTS

A total of 1109 patients (median age, 49 years [IQR, 43-54 years]) were included. The training, external validation cohort 1, and cohort 2 included 435, 351, and 323 patients, respectively. HR status (odds ratio [OR], 0.234 [0.135, 0.406]; P < 0.001), HER2 status (OR, 3.320 [1.923, 5.729]; P < 0.001), and Global FD (OR, 0.352 [0.261, 0.480]; P < 0.001) were independent predictors of pCR. The nomogram model for predicting pCR achieved AUCs of 0.80 (95% CI: 0.75, 0.86) and 0.74 (95% CI: 0.68, 0.79) in the external validation cohorts. The nomogram model, which integrated global FD and clinicopathological variables can stratify prognosis into low-risk and high-risk groups (log-rank test, DFS: P = 0.04; OS: P < 0.001).

CONCLUSIONS

Global FD can quantify tumor morphological complexity and the model that combines global FD and clinicopathological variables showed good performance in predicting pCR to NAC and survival in patients with breast cancer.

Enrichment and Detection of HER2-Expressing Extracellular Vesicles Based on DNA Tetrahedral Nanostructures: A New Strategy for Liquid Biopsy in Breast Cancer

Extracellular vesicles (EVs) play a crucial role as important mediators of intercellular communication in the progression of tumors. The capture and analysis of tumor-derived EVs offer new possibilities for the application of cancer liquid biopsies. This study aims to construct a DNA tetrahedral nanostructure that specifically recognizes HER2 and CD63, enabling the effective enrichment and detection of HER2-expressing EVs (HEVs). We enriched HEVs from cell lines and 13 random clinical samples and validated their characteristics by dynamic light scattering, transmission electron microscopy, and Western blotting. Further, we detected HEVs levels in clinical samples. The HEVs levels in HER2-positive breast cancer patients were significantly higher than those in healthy/benign controls (mean, 4.737 vs 4.160 vs 4.144 U/μL, P < 0.0001), displaying a concentration gradient across different HER2 expression levels. This study establishes an approach for HEV detection, thus providing a new tool for the diagnosis of HER2-positive breast cancer.

The Role of PAX7 in Breast Cancer Prognosis and Its Mechanistic Involvement in the Wnt/β-Catenin Pathway

Breast cancer significantly affects women's lives globally. While PAX7 (Paired Box 7), a regulatory protein linked to muscle growth, has been connected to various cancers, its role in breast cancer is not well understood. This study explores PAX7's significance in breast cancer and its mechanisms. RNA-seq data from the TCGA database assessed PAX7 expression across cancer types. Prognostic value in breast cancer was evaluated using Kaplan-Meier and Cox regression analyses. Functional experiments, including high-throughput sequencing, cell growth analysis, colony formation, Transwell assays, and Western blot analysis, were conducted on PAX7 knockdown cell lines (MDA-MB-468 and MDA-MB-231). Results showed high PAX7 expression in breast cancer linked to lower survival rates. PAX7 knockdown affected over 2000 genes and inhibited cancer cell proliferation, migration, and invasion, involving the Wnt/β-catenin pathway. SKL2001 reversed these effects. PAX7 is a potential prognostic biomarker and therapeutic target, with elevated levels indicating a poor prognosis. Further research on PAX7-targeted therapies is needed.

Mapping immune cell dynamics and macrophage plasticity in breast cancer tumor microenvironment through single-cell analysis

Breast cancer (BRCA) is a complex disease influenced by the tumor microenvironment, where interactions between immune cells and cancer cells play a crucial role in tumor progression and response to therapy. Understanding the intricacies of these interactions requires detailed analysis at the single-cell level, enabling the identification of specific immune cell subpopulations and their functional roles within the tumor milieu. This study comprehensively analyzed immune cell subpopulations and macrophage subtypes in BRCA using single-cell RNA sequencing technology and various computational tools. Initially, Sc-Type software accurately identified and annotated immune cell subpopulations, followed by CNV analysis using infercnv software, revealing significant CNV variations in epithelial cells. Subsequently, macrophages were re-clustered into 5 clusters, and their biological significance and functional features were assessed. CellChat analysis elucidated potential interactions between macrophage subtypes and BRCA cells, primarily through SPP1-CD44 and LGALS9-CD44 signaling networks. Additionally, CytoTRACE and Monocle were employed to analyze cellular plasticity and differentiation trajectories of macrophage subtypes. Furthermore, efferocytosis-related gene set scoring, transcription factor analysis, and risk score development were conducted, followed by immune infiltration and tumor mutation burden analysis, revealing increased immune infiltration and higher TMB levels in the high-risk group. These findings offer crucial insights into the interaction mechanisms of immune cells and macrophage subtypes within the BRCA tumor microenvironment, aiding in the understanding of tumor progression and therapeutic interventions.

Exploring the revolutionary potential of MXene nanoparticles in breast Cancer therapy: A review of applications and future prospects

Breast cancer is a leading cause of cancer-related deaths in women worldwide. Early detection and accurate diagnosis are crucial for successful treatment and improving patient outcomes. Nanoparticles, such as MXenes, have emerged as a promising tool for various breast cancer applications due to their unique properties. MXenes possess a high surface area and excellent biocompatibility, and can be engineered to enhance targeting ability, as well as mechanical, electrochemical, and optical properties. This review article explores the potential of MXenes in breast cancer detection and treatment, including miRNA detection, MRI-guided photothermal therapy, combined therapy, and immunotherapy. MXenes can be used for miRNA detection, which has shown promise as a biomarker for breast cancer. MXenes can also be used for MRI-guided photothermal therapy, where they can absorb light and convert it into heat to destroy cancer cells. Additionally, MXenes can be used in combination therapy with other drugs to enhance their efficacy. MXenes can also be used for immunotherapy by enhancing the immune response against cancer cells. The article also discusses the future prospects of MXenes in breast cancer research and their cytotoxicity effects. The use of MXenes in breast cancer research is a novel approach with great potential for improving patient outcomes.

The Relationship Between Radiation History and Outcomes of Immediate Implant-Based Breast Reconstruction

BACKGROUND

Postmastectomy Radiotherapy (PMRT) has become standard of care for patients with breast cancer. However, local recurrence following breast conserving therapy is increasing in incidence due to increased survivorship. The relationship between prior radiation therapy, PMRT and immediate breast reconstruction (IBR) outcomes has not been widely studied. We aim to assess factors that correlate with post-IBR complications in the face of radiation therapy.

METHODS

An IRB approved retrospective cohort review of 262 patients was completed using our tumor registry to identify female patients age ≥ 18 with and without history of radiation who underwent mastectomy with IBR. Operative, clinical, and pathological data was collected, and univariate and multiple logistic regression analyses were conducted to evaluate the relationship between receipt of radiation and major and minor complications. Kaplan-Meier analysis was also conducted to assess the differences between the time to receipt of radiation and cancer recurrence amongst the 3 treatment groups.

RESULTS

There was no correlation between major or minor complications and a history of prior radiation. Patients with PMRT demonstrated a higher incidence of "other" minor complications (OR 2.8, CI 1.27-6.28, P = .01), such as erythema and edema. There was a higher incidence of implant exposure requiring reoperation (OR 5.7, CI 1.36-23.78, P = .01) and "other'' minor complications (OR 3.1, CI 1.32-7.35, P < .001) in patients with PMRT. Receipt of PMRT was associated with lower survival in compared to patients with no history of radiation treatment.

CONCLUSION

Our study found no significant associations between history of prior radiation and surgical complications after mastectomy and IBR. However, patients with PMRT were at increased risk of developing minor complications requiring reoperation. This suggests that we should discuss radiation concerns preoperatively and manage expectations regarding its effect on outcome.

GC-MS- and LC-TOF-MS/MS-based ginger volatile oil serum analysis and the potential mechanism of the anticancer effect of serum component citral on MCF-7 breast cancer cells

BACKGROUND

To explore the blood components of ginger volatile oil (GVO) after gastric perfusion in rats and its different metabolites from blank serum and the network pharmacological analysis and preliminary verification of the main components against breast cancer.

METHODS

A total of 20 male rats were randomly allocated to 10 control groups and 10 experimental groups. The administration group was given diluted GVO and the blank group was given the same amount of soybean oil (weigh 12 g of GVO diluted to 100 ml with soybean oil), the serum of rats in the given and blank groups was analyzed by gas chromatography-time-of-flight mass spectrometry, and the differential metabolites were screened and enriched, and the blood components were analyzed by ultra-high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS).

RESULTS

A total of 34 different metabolites were screened, and 31 original components were identified. The content of citral in volatile oil and serum is high, and the pathway of action is also closely related to the results of network pharmacology. Cell experiments showed that both drug-containing serum and citral significantly inhibited the proliferation and lateral transfer ability of breast cancer MCF-7 cells in a concentration and time-dependent manner, flow cytometry was used to measure apoptosis, and the experimental results showed that the proportion of early and late apoptosis was significantly increased in each group compared with the control group, and the proportion of total apoptosis showed a certain concentration-dependent trend.

CONCLUSIONS

A combination of serum metabolism, network pharmacology, and experiments was employed; this study offers a significant contribution to the clarification of the material basis and molecular mechanism of GVO- medicated serum against breast cancer.

Clinical Study of Post-Chemotherapy Cardiotoxicity in Breast Cancer Patients Based on Ultrasound Radiomics

PURPOSE

The aim of this study is to develop and validate a combined model based on ultrasound radiomics to detect cardiotoxicity after chemotherapy in patients with breast cancer.

METHODS

In this paper, we included 208 patients with breast cancer diagnosed pathologically and after chemotherapy, of whom had high-quality echocardiographic images; among them, 105 cases experienced cardiotoxicity, while 103 cases did not, which were divided into a training set and a validation set using a wholly randomized method according to a ratio of 7:3. Then, the left ventricular myocardium in the parasternal long-axis view of echocardiography was manually traced, the myocardial features of each image were extracted and filtered, and then a radiomics model was established; lastly, we plotted the receiver operating characteristic (ROC) curve; calculated the area under the curve (AUC); and assessed the diagnostic performance of the model.

RESULTS

The AUC of the combined model in the training set was 0.88 (95%CI,0.828-0.936), which was higher than the clinical model at 0.73 (95%CI,0.646-0.807) and the radiomics model at 0.84 (95%CI,0.774-0.903). In the validation set, the AUC of the combined model was 0.87 (95%CI,0.783-0.959), which was higher than the clinical model at 0.75 (95%CI,0.631-0.877) and the radiomics model at 0.81 (95%CI,0.698-0.917). The combined model of the training group and the validation group had statistical significance compared to both the clinical model and the radiomics model (Z = -4.066, p < 0.001; Z = -1.977, p = 0.048); (Z = -1.986, p = 0.047; Z = -2.142, p = 0.032). Meanwhile, the results of Hosmer-Lemeshow goodness-of-fit test were favorable (the training group: X2 = 6.776, p = 0.561; the validation group: X2 = 11.949, p = 0.154).

CONCLUSION

The combined model based on radiomics is an effective tool for the early diagnosis of cardiac toxicity in breast cancer patients after chemotherapy. It helps to detect cardiotoxicity of breast cancer patients during chemotherapy.

Imaging Microstructural Parameters of Breast Tumor in Patient Using Time-Dependent Diffusion: A Feasibility Study

Objectives: To explore the feasibility of time-dependent diffusion in clinical applications of breast MRI, as well as the capacity of quantitative microstructural mapping for characterizing the cellular properties in malignant and benign breast tumors. Methods: 38 patients with 45 lesions were enrolled. Diffusion MRI acquisition was conducted with a combination of pulsed gradient spin-echo sequences (PGSE) and oscillating gradient spin-echo (OGSE) on a 3T MRI scanner. The microstructural parameters including cellularity extracellular diffusivity (Dex), mean cell size, intracellular volume fraction (νin), and the apparent diffusion coefficient (ADC) values were calculated. Each parameter was compared using the unpaired t-test between malignant and benign tumors. The area under the receiver operating characteristic curve (AUC) values was used to evaluate the diagnostic performance of different indices. Results: The mean diameter, Dex, ADC0Hz, ADC25Hz, and ADC50Hz were significantly lower in the malignant group than in the benign group (p < 0.001), while νin and cellularity were significantly higher in the malignant group (p < 0.001). All the microstructural parameters and time-dependent ADC values achieved high accuracy in differentiating between malignant and benign tumors of the breast. For microstructural parameters, the AUC of the cellularity was greater than others (AUC = 0.936). In an immunohistochemical subgroup comparison, the PR-positive group had significantly lower νin and cellularity, and significantly elevated Dex and ADC0Hz compared to the negative groups (p < 0.05). When combining diffusion parameters (cellularity, diameter, and ADC25Hz), the highest diagnostic performance was obtained with an AUC of 0.969. Conclusions: DWI with a short diffusion time is capable of providing additional microstructural parameters in differentiating between benign and malignant breast tumors. The time-dependent diffusion MRI parameters have the potential to serve as a non-invasive tool to probe the differences in the internal structures of breast lesions.

Significance of phosphoinositide 3-kinase inhibitors in advanced breast cancer: a systematic review and meta-analysis

BACKGROUND

The Phosphoinositide 3-kinase (PI3K) inhibitors may be used in cancer progression and mortality along with standard therapy to improve therapeutic efficacy of Advanced Breast Cancer (ABC).

PURPOSE

This systematic review and meta- analysis were conducted to understand the therapeutic and toxicity profile of PI3K inhibitors in ABC.

METHODS

The electronic databases were searched for suitable trials as per the criteria. The outcomes assessed were Progression- Free Survival, Objective Response Rate and Disease Control Rate. The data were systematically reviewed and meta-analyzed by Mantele- Haenszel method.

RESULTS

Seven studies were included in the systematic review and meta- analysis. The co- administration of PI3K inhibitors with standard therapy improved the Progression- Free Survival significantly, while a marginal improvement was observed in Objective Response Rate, no difference in Disease Control Rate and toxicity significantly increased.

CONCLUSIONS

The addition of PI3K inhibitors decreased the risk of progression but increased the risk of toxicity.

A Multicenter Cohort Study on Ultrasound-based Deep Learning Nomogram for Predicting Post-Neoadjuvant Chemotherapy Axillary Lymph Node Status in Breast Cancer Patients

RATIONALE AND OBJECTIVES

The aim of this study was to evaluate the capability of an ultrasound (US)-based deep learning (DL) nomogram for predicting axillary lymph node (ALN) status after neoadjuvant chemotherapy (NAC) in breast cancer patients and its potential to assist radiologists in diagnosis.

METHODS

Two medical centers retrospectively recruited 535 node-positive breast cancer patients who had undergone NAC. Center 1 included 288 patients in the training cohort and 123 patients in the internal validation cohort, while center 2 enrolled 124 patients for the external validation cohort. Five DL models (ResNet 34, ResNet 50, VGG19, GoogLeNet, and DenseNet 121) were trained on pre- and post-NAC US images, and the best model was chosen. A US-based DL nomogram was constructed using DL predictive probabilities and clinicopathological characteristics. Furthermore, the performances of radiologists were compared with and without the assistance of the nomogram.

RESULT

ResNet 50 performed best among all DL models, achieving areas under the curve (AUCs) of 0.837 and 0.850 in the internal and external validation cohorts, respectively. The US-based DL nomogram demonstrated strong predictive ability for ALN status post-NAC, with AUCs of 0.890 and 0.870 in the internal and external validation cohorts, respectively, outperforming both the clinical model and the DL model (p all < 0.05, except p = 0.19 for DL model in external validation cohort). Moreover, the nomogram significantly improved radiologists' diagnostic ability.

CONCLUSION

The US-based DL nomogram is promising for predicting ALN status post-NAC and could assist radiologists for better diagnostic performance.

Evaluating Tumor Size to Ki67 Proliferation Index Ratio for Optimizing Surgical Axillary Treatment Decisions in Breast Cancer Patients

Despite advancements in breast cancer surgery, the decision-making process for axillary treatment remains complex, necessitating new predictors like the tumor size to Ki67 proliferation index ratio. Intraoperative examination of the sentinel lymph node is performed to reduce the risk of a secondary surgery. Several studies have demonstrated that even in the presence of moderate nodal involvement, local disease control can be achieved by omitting axillary lymph node dissection (ALND). The aim of our retrospective study is to compare patients subjected to sentinel lymph node biopsy (SNLB) with or without intraoperative evaluation. This study included patients with breast cancer who underwent breast-conserving surgery and SNLB. Of the 551 patients, 333 (60.4%) underwent an SNLB intraoperative evaluation (SLNB-IE), while 218 (39.6%) underwent sentinel lymph node dissection diagnostic evaluation (SLNB-DE). Our analysis revealed that the tumor size to Ki67 ratio is an independent predictive factor for axillary tumor burden, suggesting its utility in surgical decision-making. A secondary ALND was performed in 2 (0.6%) vs. 7 (2.8%), p = 0.032, and in 1 (0.4%) vs. 4 (2.1%), p = 0.171, excluding patients with T ≥ 2. Surgical time was significantly shorter (p > 0.001) in the SLNB-DE group. According to a multivariate analysis, lesion dimension (OR 1.678; 95%CI 1.019-2.145; WALD:7.588; p = 0.006) and the ratio of lesion dimension to the Ki67 proliferation index (OR 0.08; 95%CI 0.011-0.141; WALD:11.004 p = 0.001) were both predictive factors for a higher axillary tumor burden. A value of 0.425, which is the ratio of tumor dimension to the Ki67 proliferation index, was identified as a predictor of tumor burden in the axilla (sensitivity, 78%; specificity, 87.5%). Intraoperative evaluation of SNLB may be omitted but could be considered in potential candidates for cyclin inhibitor and cN0 therapy with a higher ratio of tumor dimension to the Ki67 proliferation index in order to avoid secondary surgery.

Triple-Negative Breast Cancer Systemic Treatment: Disruptive Early-Stage Developments for Overcoming Stagnation in the Advanced Pipeline

New breast cancer (BC) diagnoses will soon reach 2.5-3 million/year worldwide, with 15-25% of them being triple-negative breast cancer (TNBC), the most aggressive type, characterized for lacking the main pharmacological targets: estrogen and progesterone receptors (ERs and PRs), as well as HER2 overexpression. Therefore, chemotherapy remains the almost-unique systemic treatment for TNBC. However, some targeted therapies are recommended for use in combination with chemotherapy; namely, PARP inhibitors for BRCA-mutated TNBC, the immune checkpoint inhibitors pembrolizumab and atezolizumab, as well as the antibody-drug conjugates sacituzumab govitecan and trastuzumab deruxtecan, the latter for HER2low subtypes. Regardless of the limited benefits they provide, other treatments with similar mechanisms of action are being investigated in advanced clinical stages. Further, therapies that benefit other cancers, like PI3K/Akt/mTOR pathway and CDK4/6 inhibitors, are still being investigated for TNBC, although convincing results have not been obtained. Given this scenario, it might appear innovation for TNBC treatments has become stuck. However, the huge unmet medical need drives intense research into the biology of the disease. As a result, emerging disruptive therapies are being tested in early-stage trials, designed for novel targets and applying cutting-edge advances in immunotherapy and precision oncology.

Impact of trastuzumab emtansine (T-DM1) on spleen volume in patients with HER2-positive metastatic breast cancer

BACKGROUND

Trastuzumab emtansine (T-DM1) is a novel therapy for human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer, combining the targeted action of trastuzumab with the cytotoxic effects of emtansine. Although T-DM1 has demonstrated greater efficacy and safety compared to traditional therapies, concerns about hepatotoxicity and spleen-related complications have arisen.

METHODS

We conducted a retrospective study of 64 HER2-positive metastatic breast cancer patients treated with T-DM1 at our institution. Patients underwent computed tomography or magnetic resonance imaging at baseline and during treatment cycles. Spleen volume, portal vein diameter, and laboratory values were compared between baseline and 12 months after T-DM1 treatment.

RESULTS

Median spleen volume significantly increased from 201 cm3 (IQR, 157-275) at baseline to 291 cm3 (IQR, 215-420) after 12 months of T-DM1 treatment (P < 0.001). Spleen enlargement was observed in 87.5% of patients, while no significant alteration was detected in portal vein diameter. The change in spleen volume was positively correlated with changes in serum globulin levels, liver enzymes, and bilirubin levels, but did not impact survival outcomes.

CONCLUSIONS

T-DM1 therapy in HER2-positive metastatic breast cancer leads to significant spleen enlargement and systemic biochemical changes. Future studies should focus on elucidating the long-term implications of these findings and optimizing monitoring strategies for spleen-related complications.

Diagnosis and Management of Cancers in Pregnancy: The Results of a Dual Battle Between Oncological Condition and Maternal Environment-Literature Review

Cancer during pregnancy presents considerable challenges that arise from various factors, including the diagnostic, prognostic and therapeutic implications of managing cancer in this unique patient population. There is a crucial need for an integrated approach that aligns medical interventions for both the pregnant patient and the developing embryo or fetus. Furthermore, the distinct characteristics associated with each stage of gestation may significantly influence the treatment protocols that can be proposed. Due to all of these factors, the importance of collaboration among healthcare professionals from different specialties (to ensure that both mother and child receive optimal care throughout the pregnancy) is often neglected. This review is designed to provide a thorough overview of the current standard procedures regarding the diagnosis and treatment options for cancer in pregnant patients in order to ensure the safety of mother and child. Furthermore, the review describes the feasibility of current fertility preservation methods, highlights the psychological effects of cancer during pregnancy and examines the risks and benefits of breastfeeding.

A deep learning approach for early prediction of breast cancer neoadjuvant chemotherapy response on multistage bimodal ultrasound images

Neoadjuvant chemotherapy (NAC) is a systemic and systematic chemotherapy regimen for breast cancer patients before surgery. However, NAC is not effective for everyone, and the process is excruciating. Therefore, accurate early prediction of the efficacy of NAC is essential for the clinical diagnosis and treatment of patients. In this study, a novel convolutional neural network model with bimodal layer-wise feature fusion module (BLFFM) and temporal hybrid attention module (THAM) is proposed, which uses multistage bimodal ultrasound images as input for early prediction of the efficacy of neoadjuvant chemotherapy in locally advanced breast cancer (LABC) patients. The BLFFM can effectively mine the highly complex correlation and complementary feature information between gray-scale ultrasound (GUS) and color Doppler blood flow imaging (CDFI). The THAM is able to focus on key features of lesion progression before and after one cycle of NAC. The GUS and CDFI videos of 101 patients collected from cooperative medical institutions were preprocessed to obtain 3000 sets of multistage bimodal ultrasound image combinations for experiments. The experimental results show that the proposed model is effective and outperforms the compared models. The code will be published on the https://github.com/jinzhuwei/BLTA-CNN .

The efficacy of screening with FDG-PET/CT for distant metastases in breast cancer patients scheduled for neoadjuvant systemic therapy

PURPOSE

This study aims to identify which breast cancer patients benefit from the routine use of FDG-PET/CT in a large cohort of patients scheduled for neoadjuvant systemic therapy (NST).

METHODS

A total of 1337 breast cancer patients eligible for NST were identified from a retrospective database between 2011 and 2020 at a single tertiary care hospital. All patients underwent staging with FDG-PET/CT prior to NST. The incidence and extent of asymptomatic distant metastases in different patient subgroups were determined, as well as the impact on treatment. Logistic regression analysis was used to identify prognostic patient and tumor characteristics.

RESULTS

FDG-PET/CT detected distant metastases in 109 patients (8%). Initial clinical stage was a prognostic factor for the presence of distant metastases, with a significantly higher risk for stage 2b and 3 as opposed to lower stages (p < 0.001). The incidence of distant metastases was 3% (4/125) for stage 1, 2% (8/534) for stage 2a, 7% (24/354) for stage 2b and 23% (73/324) for stage 3. Other characteristics such as age, tumor subtype, histological type and grade were not correlated with the risk of distant metastases. Among the subset of patients with distant metastases, 46% received palliative treatment, while the remaining 54% were diagnosed with oligometastatic breast cancer and were treated with curative intent.

CONCLUSION

The results of the current study support the routine use of FDG-PET/CT for the detection of distant metastases in breast cancer patients with initial clinical stage 2b and 3, regardless of tumor subtype.

Switching to a Fixed-dose Combined Pertuzumab and Trastuzumab With Recombinant Human Hyaluronidase Subcutaneous Injection to Treat Human Epidermal Growth Factor Receptor 2-positive Breast Cancer in Real-world UK Clinical Practice

Current standard of care for human epidermal growth factor receptor 2 (HER2)-positive breast cancer is first-line treatment with chemotherapy in combination with the HER2-targeting monoclonal antibodies, trastuzumab and pertuzumab. While this treatment approach is associated with improved clinical outcomes, there is a treatment burden associated with the invasive and time-consuming nature of separate intravenous (IV) administration of pertuzumab and trastuzumab. In 2020, a novel subcutaneous (SC) formulation of pertuzumab plus trastuzumab with recombinant human hyaluronidase, available as a fixed-dose combination vial that can be administered in 5-8 minutes, was approved for use by the US Food and Drug Administration and the European Medicines Agency.

AIM

A UK cancer centre set out to switch all patients currently receiving IV infusion of pertuzumab and trastuzumab over to the combined SC injection in a safe and timely manner and to initiate all future patients on the combined SC injection.

MATERIALS AND METHODS

Organisational governance approval was obtained before a novel project model approach was used to implement the treatment switch which incorporated aspects such as education and multidisciplinary team collaboration.

RESULTS

Of the 97 eligible patients, 99% were switched to the combined SC injection safely and effectively over a 4-week period. Between 1st April 2021 and 30th September 2022, 3062 hours of pharmacy aseptic preparation time and 6764 hours of day unit chair time were saved. The number of aseptic unit operation days above the maximum capacity was reduced post-switch.

CONCLUSION

This initiative demonstrated the ability to rapidly and effectively transition >95% of eligible breast cancer patients from separate IV trastuzumab and pertuzumab to a fixed combined SC formulation. Patient benefits included shorter administration appointments and a less invasive form of treatment, whereas healthcare system benefits included substantial savings in aseptic preparation time and chair time, and a meaningful increase in clinic capacity. The reported treatment-switch process provides a model that can be adopted by other centres wishing to implement similar treatment switches.

First-line carboplatin-based chemotherapy may be beneficial for HER2-low advanced breast cancer: A retrospective analysis

For patients with human epidermal growth factor receptor 2 (HER2)-low advanced breast cancer who had failed to meet with anthracycline or taxane, the application of HER2-targeted antibody-drug conjugates as second-line therapy could improve patients' outcomes, but it is unclear whether carboplatin-based first-line therapy will benefit these patients. This retrospective study was designed to explore whether carboplatin based first-line treatment could improve outcomes in HER2-low advanced breast cancer, and to analyze potential factors affecting efficacy and prognosis. 103 patients with HER2-negative metastatic breast cancer were treated with carboplatin based first-line therapy. The differences in progression-free survival (PFS), objective response rate (ORR), and adverse events were analyzed in different HER2 expression subgroups. The risk ratio (HR) and 95% confidence interval (CI) for PFS were estimated using Cox proportional risk models. The ORR for the whole group was 42.72% and the median PFS (mPFS) was 7.93 months (m). The ORR of HER2-low patients was significantly higher than HER2-zero patients (56.4% vs 27.1%, P = .003), and HER2-zero was an independent risk factor of ORR (OR 3.478, 95%CI 1.516-7.977, P = .003), especially in the HR-negative subgroup. The mPFS was significantly longer in patients with low neutrophil-to-lymphocyte ratio (NLR) scores than those with high NLR scores (P < .001). Multivariate analysis showed that young breast cancer (age < 40) (P = .006) and high NLR values (P = .001) were prognostic risk factors affecting mPFS. The main grade 3 to 4 adverse reactions were neutropenia (15.53%), anemia (15.53%), and leukopenia (11.65%). The first-line carboplatin-based chemotherapy is quite active and tolerable in patients with HER2-low advanced breast cancer, that higher response rates can be achieved. In cases where CDK4/6 inhibitors are inappropriate for use due to resistance to endocrine therapy or the urgent need for short-term clinical response, chemotherapy remains important. When it is necessary to consider the accessibility of antibody-drug conjugates and the economics of patients, carboplatin-based chemotherapy may be provided to HER2-low patients as a more convenient, cost-effective and efficient option on the front line. Forecasting the efficacy and prognosis via inflammatory index such as NLR before the commencement of the treatment could enhance the precision and efficiency of carboplatin-based regimens.

Co-Inhibition of tGLI1 and GP130 Using FDA-Approved Ketoconazole and Bazedoxifene Is Synergistic Against the Growth and Metastasis of HER2-Enriched and Triple-Negative Breast Cancers

Breast cancer stem cells (CSCs) are resistant to most cancer therapeutics and contribute to tumor recurrence and metastasis. Two breast CSC-promoting transcription factors, truncated glioma-associated oncogene homolog 1 (tGLI1) and signal transducer and activator of transcription 3 (STAT3), have been reported to be frequently co-expressed in HER2-enriched breast cancer and triple-negative breast cancer (TNBC), undergo protein-protein interactions for gene regulation and activation, and functionally cooperate to promote breast CSCs. STAT3 can be activated by activated interleukin-6 receptor/glycoprotein-130 (IL-6R/GP130). Co-targeting of tGLI1 and IL-6R/GP130 has not been investigated in breast cancer or any tumor type. Here, we report that tGLI1 and GP130 are co-overexpressed in the majority of HER2-enriched breast cancers and TNBCs at 53.8% and 44.4%, respectively. tGLI1+IL-6/IL-6R/GP130 signaling is frequently co-enriched and co-activated in HER2-enriched breast cancer and TNBC when compared to luminal subtypes. tGLI1+GP130 co-overexpression strongly promotes CSCs of HER2-enriched breast cancer and TNBC. FDA-approved tGLI1 inhibitor Ketoconazole and GP130 inhibitor Bazedoxifene synergize against breast cancer proliferation and CSC phenotypes in vitro and reduce TNBC tumor growth and metastatic burden in vivo. Our study demonstrates, for the first time, that co-targeting tGLI1 and IL-6R/GP130/STAT3 signaling pathways is synergistic against HER2-enriched breast cancer and TNBC, warranting future clinical investigations.

Synthesis and biological assessment of chalcone and pyrazoline derivatives as novel inhibitor for ELF3-MED23 interaction

HER2 overexpression significantly contributes to the aggressive nature and recurrent patterns observed in various solid tumors, notably gastric cancers. Trastuzumab, HER2-targeting monoclonal antibody drug, has shown considerable clinical success; however, readily emerging drug resistance emphasizes the pressing need for improved interventions in HER2-overexpressing cancers. To address this, we proposed targeting the protein-protein interaction (PPI) between ELF3 and MED23 as an alternative therapeutic approach to trastuzumab. In this study, we synthesized a total of 26 compounds consisting of 10 chalcones, 7 pyrazoline acetyl, and 9 pyrazoline propionyl derivatives, and evaluated their biological activity as potential ELF3-MED23 PPI inhibitors. Upon systematic analysis, candidate compound 10 was selected due to its potency in downregulating reporter gene activity of ERBB2 promoter confirmed by SEAP activity and its effect on HER2 protein and mRNA levels. Compound 10 effectively disrupted the binding interface between the ELF3 TAD domain and the 391-582 amino acid region of MED23, resulting in successful inhibition of the ELF3-MED23 PPI. This intervention led to a substantial reduction in HER2 levels and its downstream signals in the HER2-positive gastric cancer cell line. Subsequently, compound 10 induced significant apoptosis and anti-proliferative effects, demonstrating superior in vitro and in vivo anticancer activity overall. We found that the anticancer activity of compound 10 was not only restricted to trastuzumab-sensitive cases, but was also valid for trastuzumab-refractory clones. This suggests its potential as a viable therapeutic option for trastuzumab-resistant gastric cancers. In summary, compound 10 could be a novel alternative therapeutic strategy for HER2-overexpressing cancers, overcoming the limitations of trastuzumab.

Monitoring concentration and lipid signature of plasma extracellular vesicles from HR+ metastatic breast cancer patients under CDK4/6 inhibitors treatment

Extracellular vesicles (EVs) are cell-derived small membrane structures that transport various molecules. They have emerged as potential circulating biomarkers for monitoring responses to cancer therapies. This study aimed to comprehensively characterize plasma-carried EVs in hormone receptor-positive (HR+) metastatic breast cancer (MBC) patients treated with first-line CDK4/6 inhibitors (iCDK4/6) combined with endocrine therapy. MBC patients were classified into three groups based on their response to therapy: resistant, intermediate or sensitive. In a prospective cohort, we monitored the concentration of circulating EVs, analyzed their lipid signature and correlated these factors with treatment response. To facilitate the translation of EV research to clinical practice, we established a three-step procedure: (1) EVs were isolated from plasma using semi-automatized size exclusion chromatography (SEC); (2) EV concentration, termed vesiclemia, was determined by drop counting via interferometric light microscopy (ILM); and (3) EV lipid composition was analyzed by mass spectrometry. ILM-based vesiclemia values were highly fluctuating upon iCDK4/6 treatment, while early increase associated with accelerated progression. Of note, vesiclemia remained a steady parameter over a 1-year period in age-matched healthy women. Additionally, analysis of the EV cargo unveiled a distinct sphingolipid profile, characterized by increased levels of ceramides and sphingomyelins in resistant patients within the first 2 months of treatment. Based on 16 sphingolipid species, sensitive and resistant patients were correctly classified with an overall accuracy of 82%. This specific sphingolipid pattern was exclusively discernible within EVs, and not in plasma, highlighting the significance of EVs in the early prediction of individual responses to iCDK4/6 and disease progression. Overall, this study provides insights of the longitudinal characterization of plasma-borne EVs in both a healthy group and HR+ MBC patients under iCDK4/6 therapies. Combined vesiclemia and EV sphingolipid profile emphasize the promising potential of EVs as non-invasive biomarkers for monitoring early treatment response.

Perspectives on Death and Dying by the Bereaved Designated Personal Representatives of Women Diagnosed With Metastatic Breast Cancer

Metastatic breast cancer (MBC) is a complex disease with variability in disease subtype, length of survival, treatment selection, symptom burden, and, ultimately, end-of-life (EOL) care. Influencing factors that contribute to the complexity of this disease are socioeconomic factors, provider differences, and patient and family preferences. Because of this variability, it is challenging for health care providers to know when treatments are no longer helpful but contribute to a poor quality of end-of-life care and a poor death experience for both patients and their families. Determining the unique point, based on their own values and goals, at which patients and their family members feel that MBC treatment becomes unhelpful and unwanted, is difficult to ascertain. Of the 25 individuals who participated in the Quality of Death and Dying survey, 16 individuals participated in an interview to provide a reflection of the patient's EOL experience and its congruence with their wishes. Four major categories emerged as primary priorities essential to high quality end-of-life care, that is, resilience, communication, support, and knowledge. Without tailored and precise care, patients with MBC will continue to receive prolonged, inappropriate, and costly treatment, resulting in a potentially unacceptable poor-quality EOL and death experience.

Real-world application of disitamab vedotin (RC48-ADC) in patients with breast cancer with different HER2 expression levels: efficacy and safety analysis

BACKGROUND

Disitamab vedotin (RC48-ADC), an antibody-drug conjugate (ADC), combines specific antibody disitamab with cytotoxicity monomethyl auristatin E to effectively target the human epidermal growth factor receptor 2 (HER2) protein on tumor cells for precise elimination. Recent studies have demonstrated that RC48-ADC offers therapeutic benefits for patients with HER2-positive and HER2-low-expression breast cancer (BC). However, a thorough exploration of its efficacy and safety in real-world settings for patients with metastatic breast cancer (mBC) is currently lacking.

METHODS

This retrospective, multicenter, real-world study included patients with mBC who received RC48-ADC from September 2021 to March 2024. These patients include HER2-positive BC and HER2-low-expression BC. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), restricted mean survival time, objective response rate (ORR), and disease control rate (DCR). Factors affecting efficacy and the occurrence of treatment-related adverse events (TRAE) were evaluated.

RESULTS

The study included a cohort of 89 patients with mBC, with 48 of those being identified as HER2-positive. As of March 2024, 22 deaths were recorded, with an immature median OS. Total PFS varied from 1.0 to 31.2 months, with a median of 5.5 months (95% CI, 4.368-6.632). HER2-positive patients exhibited prolonged PFS compared with HER2-low-expression patients (6.6 months vs 4.1 months, P = .023). The overall ORR stood at 25.8% (95% CI, 0.178-0.358), with higher rates observed in HER2-positive patients compared with HER2-low-expression patients (31.3% vs 19.5%). Similarly, the overall DCR was 78.7% (95% CI, 0.691-0.859), with HER2-positive patients demonstrating superior DCR compared with HER2-low-expression patients (83.3% vs 73.2%). Notably, HER2 expression emerged as the primary determinant of RC48-ADC efficacy. The most prevalent TRAE among all patients included leukopenia (21.3%) and alopecia (20.2%).

CONCLUSION

RC48-ADC showcases promising efficacy and manageable safety in patients with both HER2-positive and HER2-low-expression mBC.

Predicting ipsilateral supraclavicular lymph node pathological complete response: nomogram based on the inflammatory markers

Background

The prediction of ISLN pCR after neoadjuvant chemotherapy (NAC) based on inflammatory markers and its prognostic value have rarely been investigated.

Methods

Patients diagnosed with ISLN-involved breast cancer who received NAC in West China Hospital between September 2009 and December 2020 were enrolled in the derivation cohort for model construction and survival analysis, and patients with the same criteria between January 2021 and July 2024 were involved in validation cohort for external validation. After randomly dividing patients into training and testing groups at 7:3 ratio, a nomogram predicting ISLN pCR was constructed based on logistic regression in training group. Internal validation was performed in the testing group and external validation was performed in the independent validation cohort. The ROC curves were applied to validate the accuracy of the model. Survival analysis was performed using Kaplan-Meier plots.

Results

A total of 120 eligible patients were involved in the derivation cohort to establish the nomogram (84 patients in training group and 36 patients in testing group), and 45 patients were involved in the independent validation cohort for external validation of the nomogram. Pretreatment NLR and hormone receptor (HR) status, as well as preoperative SII, CEA, CA15-3 and anti-HER2 therapy were included in the nomogram predicting ISLN pCR. The AUC were 0.906 (95% CI 0.837-0.975, P<0.001), 0.888 (95% CI 0.751-1.000, P<0.001) and 0.828 (95% CI 0.703-0.953, P< 0.001) in training, testing groups and the validation cohort respectively. ISLN pCR was significantly associated with better prognosis (all P<0.05).

Conclusion

Inflammatory factors combined with tumor makers, hormone receptor status and anti-HER2 therapy could predict ISLN pCR effectively, which was significantly associated with improved survival outcomes.

Intramammary Tumor Location and Ipsilateral Lymphatic Spread in Early Breast Cancer Patients Using One-Step Nucleic Acid Amplification (OSNA) Assay

Establishing an accurate prognosis for women diagnosed with breast cancer (BC) is extremely challenging. Axillary lymph node (ALN) evaluation is considered of major prognostic value. The one-step nucleic acid amplification (OSNA) assay is currently used for assessing axillary sentinel lymph node (SLN) status in BC. Additionally, total tumor load (TTL) may help predict further metastatic axillary involvement beyond the SLN. The prognostic value of primary BC location remains controversial due to lack of consensus on the biological differences among tumors at various sites. Evidence suggests that tumors in the internal quadrants (INLs) have worse prognosis compared to those in the external quadrants. Furthermore, ALN involvement is believed to be mainly associated with external quadrant tumors, mainly due to the lymphatic drainage system of the breast. This pilot observational study, despite lacking a control group and having a relatively small sample size, is the first to evaluate the potential relationship between primary BC location and ALN metastasis using the OSNA assay. A sample of consecutive BC patients undergoing axillary staging with the OSNA assay were included. Tumors were categorized into three groups based on primary location: external quadrants and axillary tail (EXL), INLs, and nipple and areola location (NAL). Although not statistically significant, the INL group exhibited a higher mean TTL. Additionally, no significant differences were observed between groups concerning SLN detection techniques, SLN status, number of metastatic SLN, or mean TTL. These findings support the use of the innovative tracer superparamagnetic iron oxide regardless of tumor site. This study underscores the importance of understanding the relationship between BC location and ALN status, which may improve prognostic stratification and targeted therapies based on tumor site. If these observations are confirmed in larger, multicentric studies, the potential conclusions may shift the paradigm of INL tumor treatment, significantly impacting clinical practice and research.

An explainable longitudinal multi-modal fusion model for predicting neoadjuvant therapy response in women with breast cancer

Multi-modal image analysis using deep learning (DL) lays the foundation for neoadjuvant treatment (NAT) response monitoring. However, existing methods prioritize extracting multi-modal features to enhance predictive performance, with limited consideration on real-world clinical applicability, particularly in longitudinal NAT scenarios with multi-modal data. Here, we propose the Multi-modal Response Prediction (MRP) system, designed to mimic real-world physician assessments of NAT responses in breast cancer. To enhance feasibility, MRP integrates cross-modal knowledge mining and temporal information embedding strategy to handle missing modalities and remain less affected by different NAT settings. We validated MRP through multi-center studies and multinational reader studies. MRP exhibited comparable robustness to breast radiologists, outperforming humans in predicting pathological complete response in the Pre-NAT phase (ΔAUROC 14% and 10% on in-house and external datasets, respectively). Furthermore, we assessed MRP's clinical utility impact on treatment decision-making. MRP may have profound implications for enrolment into NAT trials and determining surgery extensiveness.

Sexuality after breast cancer treatment: A physician's survey of current clinical practice

BACKGROUND

Side effects of breast cancer treatment (BCT) impact patients' general and sexual wellbeing. Sexuality related complaints are reported by 70% of breast cancer survivors mainly due to the genitourinary syndrome of menopause (GSM). In clinical care, sexual side effects are often un(der)detected because physicians as well as patients experience barriers to discuss sexuality-related issues.

MATERIALS AND METHODS

We composed an online survey ourselves using known definitions about sexuality and menopause and known factors for not discussing sexuality. We used multiple-choice questions with a Likert scale to optimize interpretation of the statements. 64 practitioners completed the survey. With this online survey, we examined physicians' knowledge of -and attitude towards- sexual wellbeing and detection and treatment of GSM in breast cancer survivors (BCS).

RESULTS

Vaginal dryness and dyspareunia were the symptoms most associated with menopause (n = 63/64 (98 %) and n = 56/64 (87 %)) and sexuality (n = 63/64 (98 %) and n = 61/64 (95 %)). These 2 complaints were also the most discussed symptoms of menopause (vaginal dryness n = 51/64 (80 %) and dyspareunia n = 45/64 (70 %)). The main reason to not discuss these issues were absence of reporting GSM (n = 40/64 (62 %)) and absence of a direct cause to discuss GSM (n = 35/64 (55 %). 64 % (n = 41/64) of practitioners don't feel sufficiently educated to discuss and treat GSM. They proposed vaginal estrogens to treat GSM as first or second line respectively in 12 % (n = 8/64) and 46 % (n = 30/64) of symptomatic BCS.

DISCUSSION

Although sexuality related complaints are common in BCS, 64% of all participating physicians feel they are not adequately trained to handle them. More attention towards training of physicians is needed to discuss GSM related complaints also when they are not spontaneously reported by a patient and with clear guidance towards the medical treatment of GSM in BCS.

Differences in axillary response and treatment implications in HER2 positive node positive breast cancer during neoadjuvant HER2 targeted dual therapy

Explore whether the axillary outcomes differ among HER2 positive subgroups receiving standard dual-targeted therapy, aiming to identify subgroups exhibiting enhanced sensitivity to NAT among HER2-positive/node-positive breast cancer patients. HER2 positive female patients with biopsy-proven node-positive disease from April 2020 to May 2023 were included. All patients underwent standard Neoadjuvant HER2-targeted dual therapy and axillary lymph node dissection (ALND) at Breast Surgery Center of Sichuan Cancer Hospital. Univariate and multivariate analyses were used to identify factors associate with axillary pathological complete response (ApCR). Statistical analysis and graphing were performed using SPSS 24.0 and GraphPad Prism 9.0 software. This study enrolled 215 HER2 positive patients with a total ApCR rate of 76.7%, which included 49 HER2 2+/FISH + and 166 HER2 3 + cases with approximate ApCR rates of 63.3% and 80.7% (P = 0.011). Univariate and multivariate analysis indicated that HER2 3 + disease (OR = 2.43, 95% CI 1.21-4.88, P = 0.012), Ki-67 ≥ 20% disease (OR = 3.00, 95% CI 1.26-7.13, P = 0.013) and NAC regimen of TCb (OR = 2.71, 95% CI 1.39-5.38, P = 0.004) were more likely to achieve ApCR. Further subgroup analysis revealed that HER2 3 + patients receiving TCb regimen showed the highest ApCR rate of 88% compared to other subgroups. HER2 3 + breast cancer had a higher ApCR rate than HER2 2+/FISH + breast cancer during Neoadjuvant HER2-targeted dual therapy. HER2 positive patients could benefit from NAC regimen of TCb in axillary response.

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

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

Development and Validation of a Prognostic Nomogram for Breast Cancer Patients With Multi-Organ Metastases: An Analysis of the Surveillance, Epidemiology, and End Results Program Database

BACKGROUND

Multi-organ metastases represent a substantial life-threatening risk for breast cancer (BC) patients. Nonetheless, the current dearth of assessment tools for patients with multi-organ metastatic BC adversely impacts their evaluation.

METHODS

We conducted a retrospective analysis of BC patients with multi-organ metastases using data from the SEER database from 2010 to 2019. The patients were randomly allocated into a training cohort and a validation cohort in a 7:3 ratio. Univariate COX regression analysis, the LASSO, and multivariate Cox regression analyses were performed to identify independent prognostic factors in the training set. Based on these factors, a nomogram was constructed to estimate overall survival (OS) probability for BC patients with multi-organ metastases. The performance of the nomogram was evaluated using C-indexes, ROC curves, calibration curves, decision curve analysis (DCA) curves, and the risk classification system for validation.

RESULTS

A total of 3626 BC patients with multi-organ metastases were included in the study, with 2538 patients in the training cohort and 1088 patients in the validation cohort. Age, grade, metastasis location, surgery, chemotherapy, and subtype were identified as significant independent prognostic factors for OS in BC patients with multi-organ metastases. A nomogram for predicting 1-year, 3-year, and 5-year OS was constructed. The evaluation metrics, including C-indexes, ROC curves, calibration curves, and DCA curves, demonstrated the excellent predictive performance of the nomogram. Additionally, the risk grouping system effectively stratified BC patients with multi-organ metastases into distinct prognostic categories.

CONCLUSION

The developed nomogram showed high accuracy in predicting the survival probability of BC patients with multi-organ metastases, providing valuable information for patient counseling and treatment decision making.

Knowledge, attitude, and willingness toward breast magnetic resonance imaging screening among women at high risk of breast cancer in Beijing, China

BACKGROUND

Annual breast magnetic resonance imaging (MRI) is highly recommended to assist mammography for women at high risk of breast cancer (BC). This study explored the knowledge, attitude, and willingness toward breast MRI screening among women at high risk of BC.

METHODS

This cross-sectional study enrolled women at high risk of BC between August 2022 and January 2023 in Beijing, China. A structural equation model (SEM) was used to analyze the relationships among knowledge, attitude, and willingness.

RESULTS

A total of 596 questionnaires were collected, and 412 questionnaires (69.13%) were valid. The women's knowledge and attitude scores were 7.75 ± 2.79 (possible range: 0-12) and 48.53 ± 6.31 (possible range: 13-65). Among the women, 297 (72.09%) were willing to undergo regular breast MRI screening. The SEM showed that knowledge had direct effect on attitude [β = 0.77, 95% CI: (0.57, 0.98), P < 0.001], the attitude had direct effect on willingness [β = 0.02, 95% CI: (0.01, 0.02), P < 0.001], knowledge had an indirect effect on willingness through attitude [β = 0.01, 95% CI: (0.01,0.02), P < 0.001], and the direct effect of knowledge on practice was not significant.

CONCLUSIONS

The women at high risk of BC had insufficient knowledge and a relatively positive attitude toward breast MRI screening. Most of them were willing to undergo regular breast MRI screening. Advertising and public health education programs should be designed to improve their knowledge and attitude, therefore improving their willingness and practice.

Effects of Inc parameter on quality of VMAT radiotherapy plans for right breast cancer based on dosimetric study

This study aimed to investigate the influence of gantry angle increment (Inc) parameters on the Monaco treatment planning system for volumetric modulated arc therapy (VMAT) in right breast cancer, and to determine the optimal Inc parameters. Twenty-three patients with right breast cancer at the Sir Run Run Shaw Hospital from August 2022 to August 2023 were retrospectively selected. Four VMAT plans were generated for each patient incorporating Inc of 10°, 20° (control group), 30°, and 40°, while the other optimization parameters and constraint functions remained constant. The D98 and conformity index were lower in the Inc30 and Inc40 groups than in the Inc20 group. As Inc increased from 10° to 30°, the irradiated dose to the ipsilateral lung, including the V20, V5, and Dmax, mean dose, gradually increased. There were no statistically significant differences in the irradiated dose to the contralateral breast, contralateral lung, heart, esophagus, and brachial plexus. The number of monitor units and control points decreased with increasing Inc. Smaller Inc values can achieve higher target coverage and lower irradiated dose to the ipsilateral lung, but will reduce delivery efficiency. Considering the plan quality and delivery efficiency, an Inc of 10° or 20° is recommended for right breast cancer VMAT plans.

Impact of ALDH1A1 and NQO1 gene polymorphisms on the response and toxicity of chemotherapy in Bangladeshi breast cancer patients

PURPOSE

Cyclophosphamide, Epirubicin/Doxorubicin, 5-fluorouracil (CEF or CAF) chemotherapy has long been a standard first-line treatment for breast cancer. The genetic variations of enzymes that are responsible for the metabolism of these drugs have been linked to altered treatment response and toxicity. Two drug-metabolizing enzymes ALDH1A1 and NQO1 are critically involved in the pathways of CEF/CAF metabolism. This study aimed to evaluate the effect of ALDH1A1 (rs13959) and NQO1 (rs1800566) polymorphisms on treatment response and toxicities caused by adjuvant (ACT) and neoadjuvant chemotherapy (NACT) where CEF/CAF combination was used to treat Bangladeshi breast cancer patients.

METHODS

A total of 330 patients were recruited from various hospitals, with 150 receiving neoadjuvant chemotherapy and 180 receiving adjuvant chemotherapy. To extract genomic DNA, a non-enzymatic simple salting out approach was adopted. The polymerase chain reaction-restriction fragment length polymorphism method was used to detect genetic polymorphisms. Unconditional logistic regression was used to derive odds ratios (ORs) with 95% confidence intervals (CIs) to study the association between genetic polymorphisms and clinical outcome and toxicity.

RESULTS

A statistically significant association was observed between ALDH1A1 (rs13959) polymorphism and treatment response (TT vs. CC: aOR = 6.40, p = 0.007; recessive model: aOR = 6.38, p = 0.002; allele model: p = 0.032). Patients with the genotypes TT and CT + TT of the NQO1 (rs1800566) polymorphism had a significantly higher risk of toxicities such as anemia (aOR = 0.34, p = 0.006 and aOR = 0.58, p = 0.021), neutropenia (aOR = 0.42, p = 0.044 and aOR = 0.57, p = 0.027), leukopenia (aOR = 0.33, p = 0.010 and aOR = 0.46, p = 0.005), and gastrointestinal toxicity (aOR = 0.30, p = 0.02 and aOR = 0.38, p = 0.006) when compared to the wild CC genotype, while patients with the genotype CT had a significant association with gastrointestinal toxicity (aOR = 0.42, p = 0.02) and leukopenia (aOR = 0.52, p = 0.010). The TT and CT + TT genotypes of rs13959 had a significantly higher risk of anemia (aOR = 2.00, p = 0.037 and aOR = 1.68, p = 0.029). There was no significant association between rs1800566 polymorphism and treatment response.

CONCLUSION

Polymorphisms in ALDH1A1 (rs13959) and NQO1 (rs1800566) may be useful in predicting the probability of treatment response and adverse effects from CEF or CAF-based chemotherapy in breast cancer patients.

Cost-effectiveness of CDK4/6 inhibitors in HR+/HER2- metastatic breast cancer: a systematic review and meta-analysis

BACKGROUND

Cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors have emerged as a significant advancement in the treatment of HR+/HER2- metastatic breast cancer (MBC). Despite the clinical efficacy of CDK 4/6 inhibitors in HR+/HER2- metastatic breast cancer, there remains a significant gap in understanding their cost-effectiveness, particularly regarding the long-term economic impact and the key drivers of costs, when used in combination with endocrine therapy. This study aims to systematically review and conduct a meta-analysis of cost-effectiveness studies evaluating CDK4/6 inhibitors in treatment of HR+/HER2- advanced breast cancer and identify key drivers of costs of CDK4/6 inhibitors in combination with endocrine therapy.

METHODS

A comprehensive search of PubMed and Embase was conducted to identify peer-reviewed studies from February 2015 to March 2022 reporting cost-effectiveness of CDK4/6 inhibitors in MBC treatment. Incremental net benefits (INBs) were estimated, and meta-analysis was conducted. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

We identified 120 articles, of which 18 were eligible for systematic review and 16 for meta-analysis. None of the three CDK4/6 inhibitors had positive INB compared to endocrine/aromatase inhibitors therapy alone. The pooled INB was estimated at -$149,266.87 (95% Confidence Interval (CI) = -$196,961.54, -$101,572.20).

CONCLUSION

The combination of CDK4/6 inhibitors and letrozole/endocrine therapy for the treatment of postmenopausal patients with advanced HR+/HER2 - MBC was not cost-effective.

Receptor Discordance in Metastatic Breast Cancer; a review of clinical and genetic subtype alterations from primary to metastatic disease

PURPOSE

Receptor and subtype discordance between primary breast tumours and metastases is a frequently reported phenomenon. The aim of this article is to review the current evidence on receptor discordance in metastatic breast cancer and to explore the benefit of performing a repeat biopsy in this context.

METHODS

Searches were undertaken on PubMed and Clinicaltrials.gov for relevant publications and trials.

CONCLUSION

The current guidelines recommend offering to perform a biopsy of a metastatic lesion to evaluate receptor status. The choice of systemic therapy in metastatic disease is often based on the receptor status of the primary lesion. As therapeutic decision making is guided by subtype, biopsy of the metastatic lesion to determine receptor status may alter treatment. This article discusses discordance rates, the mechanisms of receptor discordance, the effect of discordance on treatment and survival outcomes, as well as highlighting some ongoing clinical trials in patients with metastatic breast cancer.

Early Identification of Pathologic Complete Response to Neoadjuvant Chemotherapy Using Multiphase DCE-MRI by Siamese Network in Breast Cancer: A Longitudinal Multicenter Study

BACKGROUND

Siamese network (SN) using longitudinal DCE-MRI for pathologic complete response (pCR) identification lack a unified approach to phases selection.

PURPOSE

To identify pCR in early-stage NAC, using SN with longitudinal DCE-MRI and introducing IPS for phases selection.

STUDY TYPE

Multicenter, longitudinal.

POPULATION

Center A: 162 female patients (50.63 ± 8.41 years) divided 7:3 into training and internal validation cohorts. Center B: 61 female patients (50.08 ± 7.82 years) were used as an external validation cohort.

FIELD STRENGTH/SEQUENCE

Center A: single vendor 3.0 T with a compressed-sensing volume interpolated breath-hold examination sequence. Center B: single vendor 1.5 T with volume interpolated breath-hold examination sequence.

ASSESSMENT

Patients underwent DCE-MRI before and after two NAC cycles, with tumor regions of interest (ROI) manually delineated. Histopathology was the reference for pCR identification. Models developed included a clinical one, four SN models based on IPS-selected phases, and integrated models combining clinical and SN features.

STATISTICAL TESTS

Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). The DeLong test was used to compare AUCs. Net reclassification improvement and integrated discrimination improvement (IDI) tests were employed for performance comparison. P < 0.05 was considered significant.

RESULTS

In internal and external validation cohorts, the clinical model showed AUCs of 0.760 and 0.718. SN and integrated models, with increasing phases via IPS, achieved AUCs ranging from 0.813 to 0.951 and 0.818 to 0.922. Notably, SN-3 and integrated-3 and integrated-4 outperformed the clinical model. However, input phases beyond 20% did not significantly enhance performance (IDI test: SN-4 vs. SN-3, P = 0.314 and 0.630; integrated-4 vs. integrated-3, P = 0.785 and 0.709).

DATA CONCLUSION

The longitudinal multiphase DCE-MRI based on the SN demonstrates promise for identifying pCR in breast cancer.

EVIDENCE LEVEL

1 TECHNICAL EFFICACY: Stage 4.

Role of textural and radiomic analysis parameters in predicting histopathological parameters of the tumor in breast cancer patients

INTRODUCTION

Texture and radiomic analysis characterizes the tumor's phenotype and evaluates its microenvironment in quantitative terms. This study aims to investigate the role of textural and radiomic analysis parameters in predicting histopathological factors in breast cancer patients.

MATERIALS AND METHODS

Two hundred and twelve primary breast cancer patients underwent 18 F-FDG PET/computed tomography for staging. The images were processed in a commercially available textural analysis software. ROI was drawn over the primary tumor with a 40% threshold and was processed further to derive textural and radiomic parameters. These parameters were then compared with histopathological factors of tumor. Receiver-operating characteristic analysis was performed with a P -value <0.05 for statistical significance. The significant parameters were subsequently utilized in various machine learning models to assess their predictive accuracy.

RESULTS

A retrospective study of 212 primary breast cancer patients was done. Among all the significant parameters, SUVmin, SUVmean, SUVstd, SUVmax, discretized HISTO_Entropy, and gray level co-occurrence matrix_Contrast were found to be significantly associated with ductal carcinoma type. Four parameters (SUVmin, SUVmean, SUVstd, and SUVmax) were significant in differentiating the luminal subtypes of the tumor. Five parameters (SUVmin, SUVmean, SUVstd, SUVmax, and SUV kurtosis) were significant in predicting the grade of the tumor. These parameters showcased robust capabilities in predicting multiple histopathological parameters when tested using machine learning algorithms.

CONCLUSION

Though textural analysis could not predict hormonal receptor status, lymphovascular invasion status, perineural invasion status, microcalcification status of tumor, and all the molecular subtypes of the tumor, it could predict the tumor's histologic type, triple-negative subtype, and score of the tumor noninvasively.

Predicting Prognosis of Phyllodes Tumors Using a Mammography- and Magnetic Resonance Imaging-Based Radiomics Model: A Preliminary Study

PURPOSE

To investigate whether a radiomics model based on mammography (MG) and magnetic resonance imaging (MRI) can be used to predict disease-free survival (DFS) after phyllodes tumor (PT) surgery.

METHOD

About 131 PT patients who underwent MG and MRI before surgery between January 2010 and December 2020 were retrospectively enrolled, including 15 patients with recurrence and metastasis and 116 without recurrence. 884 and 3138 radiomic features were extracted from MG and MR images, respectively. Then, multiple radiomics models were established to predict the recurrence risk of the patients by applying a support vector machine classifier. The area under the ROC curve (AUC) was calculated to evaluate model performance. After dividing the patients into high- and low-risk groups based on the predicted radiomics scores, survival analysis was conducted to compare differences between the groups.

RESULTS

In total, 3 MG-related and 5 MRI-related radiomic models were established; the prediction performance of the T1WI feature fusion model was the best, with an AUC value of 0.93. After combining the features of MG and MRI, the AUC increased to 0.95. Furthermore, the MG, MRI and all-image radiomic models had statistically significant differences in survival between the high- and low-risk groups (P < .001). All-image radiomics model showed higher survival performance than the MG and MRI radiomics models alone.

CONCLUSIONS

Radiomics features based on preoperative MG and MR images can predict DFS after PT surgery, and the prediction score of the image radiomics model can be used as a potential indicator of recurrence risk.

Implementation of Choosing Wisely® Recommendations for Lymph Node Surgery in Male Breast Cancer

BACKGROUND

The Choosing Wisely® (CW) campaign recommended de-implementation of surgical management of axillary nodes in specified patients. This study aimed to assess trends in the application of CW guidelines for lymph node (LN) surgery in males with breast cancer.

METHODS

The National Cancer Database was queried for males diagnosed with breast cancer from 2017 to 2020. Patients were categorized into two cohorts based on CW criteria. Cohort 1 included all T1-2, clinically node-negative patients who underwent breast-conserving therapy and with ≤ 2 positive nodes, and Cohort 2 included all T1-2, node-negative, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative patients aged ≥ 70 years. In Cohort 1, patients who underwent sentinel LN biopsy (SLNB) alone were compared with axillary LN dissection (ALND) or no LN surgery, while in Cohort 2, patients who underwent LN surgery were compared with those with no LN surgery.

RESULTS

Of 617 patients who met the criteria for Cohort 1, 73.1% underwent SLNB alone compared with ALND (11.8%) or no LN surgery (15.1%). Those who received SLNB alone were younger (65 vs. 68 vs. 73 years; p < 0.001). The annual proportion of males who underwent SLNB alone remained stable from 2017 to 2020. Overall, 1565 patients met the criteria for Cohort 2, and 84.9% received LN surgery. LN surgery was omitted in older patients (81 vs. 77; p < 0.001). The proportion of elderly males with early-stage breast cancer who underwent LN surgery increased from 2017 to 2020.

CONCLUSION

This study demonstrates that CW recommendations are not being routinely applied to males. These findings reinforce the need for additional studies and subsequent recommendations for optimal application of axillary surgery de-implementation for males diagnosed with breast cancer.

Review on effects and mechanisms of plant-derived natural products against breast cancer bone metastasis

Bone metastasis is the prevalent form of metastasis in breast cancer, resulting in severe pain, pathological fractures, nerve compression, hypercalcemia, and other complications that significantly impair patients' quality of life. The infiltration and colonization of breast cancer (BC) cells in bone tissue disrupt the delicate balance between osteoblasts and osteoclasts within the bone microenvironment, initiating a vicious cycle of bone metastasis. Once bone metastasis occurs, conventional medical therapy with bone-modifying agents is commonly used to alleviate bone-related complications and improve patients' quality of life. However, the utilization of bone-modifying agents may cause severe drug-related adverse effects. Plant-derived natural products such as terpenoids, alkaloids, coumarins, and phenols have anti-tumor, anti-inflammatory, and anti-angiogenic pharmacological properties with minimal side effects. Certain natural products that exhibit both anti-breast cancer and anti-bone metastasis effects are potential therapeutic agents for breast cancer bone metastasis (BCBM). This article reviewed the effects of plant-derived natural products against BCBM and their mechanisms to provide a reference for the research and development of drugs related to BCBM.

Prevalence and associated factors of psychological distress among patients with breast cancer: a systematic review and meta-analysis

OBJECTIVE

This paper aims to evaluate the literature on the prevalence of psychological distress and its associated factors in patients with breast cancer.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure and Wanfang were searched from inception to 11 June 2024.

ELIGIBILITY CRITERIA

Studies reported data on the prevalence and correlates of psychological distress were included. Review, letter, conference abstracts and articles not available in English and Chinese were excluded.

DATA EXTRACTION AND SYNTHESIS

Two researchers independently conducted literature screening, data extraction and bias risk assessment. Meta-analysis was employed to estimate the prevalence and correlates of psychological distress in patients with breast cancer. The Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale were used for quality assessment. Meta-analysis was performed by using the R V.4.1.1 software.

RESULTS

In total, 34 studies representing 13 828 patients with breast cancer were included in the study. Most of the studies were cross-sectional study (n=25, 73.53%%). The pooled prevalence of psychological distress was 50% (95% CI 42% to 58%, I2=98%). Results showed that psychological distress was positively correlated with younger age (z=0.13, 95% CI 0.07 to 0.20), having children (z=0.39, 95% CI 0.11 to 0.61), poor financial situation (z=0.12, 95% CI -0.03 to 0.26), short time since diagnosis (z=0.19, 95% CI 0.01 to 0.36), previous treatment (z=0.15, 95% CI 0.03 to 0.27), distant metastasis (z=0.31, 95% CI 0.07 to 0.52), chemotherapy (z=0.22, 95% CI 0.05 to 0.38), prior emotional status (z=0.40, 95% CI 0.29 to 0.50), body image damaged (z=0.10, 95% CI -0.01 to 0.21), negative coping (z=0.12, 95% CI -0.11 to 0.34), communication avoidance (z=0.32, 95% CI 0.24 to 0.39) and negatively correlated with married (z=-0.25, 95% CI 0.45 to -0.02), high education level (z=-0.19, 95% CI -0.40 to 0.05), having insured (z=-0.04, 95% CI -0.15 to 0.08), full employment (z=-0.40, 95% CI -0.61 to -0.14), time of completion of treatment (z=-0.12, 95% CI -0.30 to -0.06), surgery (z=-0.05, 95% CI -0.53 to 0.45), social support (z=-0.18, 95% CI -0.29 to -0.06), post-traumatic growth (z=-0.19, 95% CI -0.34 to -0.03), good physical conditions (z=-0.17, 95% CI -0.29 to -0.04), positive coping (z=-0.22, 95% CI -0.53 to 0.15).

CONCLUSION

Our findings indicated that the prevalence of psychological distress in patients with breast cancers was 50% and 21 correlates of psychological distress. Screening and evidence-based interventions are urgent and essential to address this public concern and promote the health of patients with breast cancer.

PROSPERO REGISTRATION NUMBER

CRD42023397109.

Engineered Platelet for In Situ Natural Killer Cell Activation to Inhibit Tumor Recurrence

Natural killer (NK) cells offer profound advantages against tumor recurrence due to their unique immunological behavior. NK cell therapies associated with the antibody-dependent cell-mediated cytotoxicity (ADCC) effect have made remarkable progress while being limited by insufficient antibody binding and the exhausted state of NK cells in the postsurgical immunosuppressive microenvironment. Leveraging the adherence of PLT to tumor cells, we developed an exogenously implanted platelet (PLT)-based NK cell-driven system (PLT-IgG-IL15) to improve the identifiability of residual tumors with IgG antibody labeling for NK cells catching and engaging, which consequently restored the ADCC effect and promoted the recovery of their killing function. Furthermore, interleukin-15 (IL-15) participated in the augmentation of NK cell function. Collectively, PLT-IgG-IL15 served as an NK cell tumor cell engager as well as an NK cell charger, achieving a <40% recurrence rate in mouse tumor models.

Community Pharmacists' Readiness for Breast Cancer Mammogram Promotion: A National Survey from Jordan

Purpose

Mammography is the gold standard screening technique for early detection of breast cancer. This study aimed to assess the knowledge of community pharmacists of different aspects emphasized by the JBCP programs. This study also identifies the attitudes and barriers towards promoting early detection services.

Patients and Methods

This study was a cross-sectional survey of community pharmacists in Jordan. Pharmacists were randomly selected and asked to complete an electronic questionnaire. Inclusion criteria: a pharmacist with a bachelor's degree or higher and registered at the JPA working in a community pharmacy. The questionnaire included demographic and socioeconomic information, knowledge, attitudes towards breast cancer screening mammography services, and barriers towards participation in the promotion of these services.

Results

A total of 1,088 community pharmacists were approached, 1,000 (91.8%) completed the questionnaire. Participants had an average age of 34 years ± 10.8 and average experience of 9.1 ± 9.5 years. Only 48 (37.8%) of the female pharmacists aged 40 years or older underwent a mammogram. Knowledge of symptoms of breast cancer was the highest with a score of 755, followed by knowledge of risk factors (670) and finally early detection of breast cancer (540). Many barriers were reported by the community pharmacists including lack of educational materials and time constraints. Pharmacists with higher educational levels (p<0.001), of female gender (p<0.001), attended continuous cancer-related education (p<0.001), encountered a higher percentage of female customers (p<0.001), in a certain geographic location (p=0.003), underwent mammography (p=0.014), and encountered high frequency of inquiries on mammogram by the customers (p<0.001) were all associated with higher knowledge scores.

Conclusion

Despite the reported barriers and insufficient knowledge in certain aspects of early detection of breast cancer, community pharmacists have positive attitudes and can be a valuable asset for awareness-raising efforts.

Pan-cancer exploration of PNO1: A prospective prognostic biomarker with ties to immune infiltration

The partner of NOB1 homolog (PNO1) is an RNA-binding protein that participates in ribosome biogenesis and protein modification. The functions of this molecule are largely unknown in cancers, particularly breast cancer. We employed bioinformatics methods to probe the putative oncogenic functions of PNO1 based on expression profiles and clinical data from the cancer genome atlas (TCGA), genotype-tissue expression project (GTEx), human protein atlas (HPA), cancer cell line encyclopedia (CCLE), UALCAN, drug sensitivity in cancer (GDSC) and UCSC XENA databases. Our analyses revealed that PNO1 was overexpressed in 31 malignancies, which excluded kidney chromophobe (KICH) and acute myeloid leukemia (LAML). Prognostic assessments have demonstrated that high PNO1 expression was significantly correlated with poor overall and disease-specific survival in various cancers. The promoter methylation level of PNO1 is significantly decreased in breast invasive carcinoma (BRCA), head and neck squamous cell carcinoma (HNSC), kidney renal papillary cell carcinoma (KIRP), prostate adenocarcinoma (PRAD), thyroid carcinoma (THCA) and uterine corpus endometrial carcinoma (UCEC). Furthermore, inhibition of PNO1 decreased the viability, migration and invasion of breast cancer cells, and these results were confirmed by mouse xenograft models of breast cancer. In addition, we discovered that tumor microenvironment (TME), immune infiltration, and chemotherapy sensitivity were influenced by PNO1 expression. Concordantly, our analyses revealed a significant positive correlation between PNO1 and programmed cell death ligand 1 (PD-L1) expression across breast carcinoma samples. In conclusion, these findings indicate that PNO1 could act as a promising prognostic biomarker and adjunct diagnostic indicator, because it affects tumor growth and invasion. Our study offers valuable new perspectives on the oncogenic role of PNO1 in various types of cancers.

Scalp Cooling in Preventing Persistent Chemotherapy-Induced Alopecia: A Randomized Controlled Trial

PURPOSE

Current studies of the efficacy of scalp cooling are limited by short-term duration. Therefore, we conducted a randomized controlled trial to evaluate the efficacy of scalp cooling in reducing persistent chemotherapy-induced alopecia (PCIA) 6 months after chemotherapy.

METHODS

We conducted an open-label randomized controlled trial comparing scalp cooling versus control in newly diagnosed patients with breast cancer stages I-III scheduled to receive neoadjuvant or adjuvant chemotherapy with curative intent between December 2020 and August 2021. Patients were randomly assigned (2:1 ratio) to scalp cooling or usual clinical practice. The primary outcome was PCIA 6 months after chemotherapy. Hair thickness and density were measured using Folliscope 5.0. CIA-related distress was assessed using the CIA distress scale (CADS), with a higher score reflecting higher stress.

RESULTS

The proportion of patients with PCIA at 6 months was 13.5% (12/89) in the scalp-cooling group and 52.0% (26/50) in the control group. The average difference in the change in hair thickness from baseline between the scalp-cooling and control groups was 9.0 μm in favor of the intervention group. The average difference in the change in hair density between intervention and control at the end of the study was -3.3 hairs/cm2. At 6 months after chemotherapy, the average difference in the change in CADS score between the intervention and control groups was -3.2 points, reflecting reduced CIA-related stress in the intervention group.

CONCLUSION

Scalp cooling reduced the incidence of PCIA, primarily by increasing hair thickness compared with control. Scalp cooling is helpful in promoting qualitative hair regrowth. Yet, further research is necessary to observe longer-term benefits of scalp cooling.

Multiregional dynamic contrast-enhanced MRI-based integrated system for predicting pathological complete response of axillary lymph node to neoadjuvant chemotherapy in breast cancer: multicentre study

BACKGROUND

The accurate evaluation of axillary lymph node (ALN) response to neoadjuvant chemotherapy (NAC) in breast cancer holds great value. This study aimed to develop an artificial intelligence system utilising multiregional dynamic contrast-enhanced MRI (DCE-MRI) and clinicopathological characteristics to predict axillary pathological complete response (pCR) after NAC in breast cancer.

METHODS

This study included retrospective and prospective datasets from six medical centres in China between May 2018 and December 2023. A fully automated integrated system based on deep learning (FAIS-DL) was built to perform tumour and ALN segmentation and axillary pCR prediction sequentially. The predictive performance of FAIS-DL was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. RNA sequencing analysis were conducted on 45 patients to explore the biological basis of FAIS-DL.

FINDINGS

1145 patients (mean age, 50 years ±10 [SD]) were evaluated. Among these patients, 506 were in the training and validation sets (axillary pCR rate of 40.3%), 127 in the internal test set (axillary pCR rate of 37.8%), 414 in the pooled external test set (axillary pCR rate of 48.8%), and 98 in the prospective test set (axillary pCR rate of 43.9%). For predicting axillary pCR, FAIS-DL achieved AUCs of 0.95, 0.93, and 0.94 in the internal test set, pooled external test set, and prospective test set, respectively, which were also significantly higher than those of the clinical model and deep learning models based on single-regional DCE-MRI (all P < 0.05, DeLong test). In the pooled external and prospective test sets, the FAIS-DL decreased the unnecessary axillary lymph node dissection rate from 47.9% to 6.8%, and increased the benefit rate from 52.2% to 86.5%. RNA sequencing analysis revealed that high FAIS-DL scores were associated with the upregulation of immune-mediated genes and pathways.

INTERPRETATION

FAIS-DL has demonstrated satisfactory performance in predicting axillary pCR, which may guide the formulation of personalised treatment regimens for patients with breast cancer in clinical practice.

FUNDING

This study was supported by the National Natural Science Foundation of China (82371933), National Natural Science Foundation of Shandong Province of China (ZR2021MH120), Mount Taishan Scholars and Young Experts Program (tsqn202211378), Key Projects of China Medicine Education Association (2022KTM030), China Postdoctoral Science Foundation (314730), and Beijing Postdoctoral Research Foundation (2023-zz-012).

Lipid-coated gold nanorods for photoimmunotherapy of primary breast cancer and the prevention of metastasis

Nanomedicines hold promise for the treatment of various diseases. However, treating cancer metastasis remains highly challenging. In this study, we synthesized gold nanorods (AuNRs) containing (α-GC), an immune stimulator, for the treatment of primary cancer, metastasis, and recurrence of the cancer. Therefore, the AuNR were coated with lipid bilayers loaded with α-GC (α-LA). Upon irradiation with 808 nm light, α-LA showed a temperature increase. Intra-tumoral injection of α-LA in mice and local irradiation of the 4T1 breast cancer tumor effectively eliminated tumor growth. We found that the presence of α-GC in α-LA activated dendritic cells and T cells in the spleen, which completely blocked the development of lung metastasis. In mice injected with α-LA for primary breast cancer treatment, we observed antigen-specific T cell responses and increased cytotoxicity against 4T1 cells. We conclude that α-LA is promising for the treatment of both primary breast cancer and its metastasis.

The prognostic potential of mammographic growth rate of invasive breast cancer in the Nijmegen breast cancer screening cohort

OBJECTIVES

Insight into the aggressiveness of potential breast cancers found in screening may optimize recall decisions. Specific growth rate (SGR), measured on mammograms, may provide valuable prognostic information. This study addresses the association of SGR with prognostic factors and overall survival in patients with invasive carcinoma of no special type (NST) from a screened population.

METHODS

In this historic cohort study, 293 women with NST were identified from all participants in the Nijmegen screening program (2003-2007). Information on clinicopathological factors was retrieved from patient files and follow-up on vital status through municipalities. On consecutive mammograms, tumor volumes were estimated. After comparing five growth functions, SGR was calculated using the best-fitting function. Regression and multivariable survival analyses described associations between SGR and prognostic factors as well as overall survival.

RESULTS

Each one standard deviation increase in SGR was associated with an increase in the Nottingham prognostic index by 0.34 [95% confidence interval (CI): 0.21-0.46]. Each one standard deviation increase in SGR increased the odds of a tumor with an unfavorable subtype (based on histologic grade and hormone receptors; odds ratio 2.14 [95% CI: 1.45-3.15]) and increased the odds of diagnosis as an interval cancer (versus screen-detected; odds ratio 1.57 [95% CI: 1.20-2.06]). After a median of 12.4 years of follow-up, 78 deaths occurred. SGR was not associated with overall survival (hazard ratio 1.12 [95% CI: 0.87-1.43]).

CONCLUSIONS

SGR may indicate prognostically relevant differences in tumor aggressiveness if serial mammograms are available. A potential association with cause-specific survival could not be determined and is of interest for future research.