[Efficacy analysis of chemotherapy and endocrine therapy combined with targeted drugs after progression on cyclin-dependent kinase 4/6 inhibitor treatment in hormone receptor positive/human epidermal growth factor receptor 2-low metastatic breast cancer]

Objective: To evaluate the efficacy of chemotherapy and endocrine therapy combined with targeted drugs after progression on cyclin-dependent kinase 4/6 (CDK4/6) inhibitor treatment in hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2)-low metastatic breast cancer. Methods: Patients with metastatic breast cancer diagnosed with HR positive/HER2 low expression at the Fifth Medical Center of PLA General Hospital from October 1, 2018 to September 30, 2023 were retrospectively included. All patients received sequential chemotherapy or sequential endocrine therapy combined with targeted drugs after progression on CDK4/6 inhibitor treatment.The median follow-up was 9 months, and the follow-up ended on October 31, 2023. The patients were divided into chemotherapy group (receiving sequential chemotherapy) and endocrine therapy group (receiving sequential endocrine therapy combined with targeted drugs), according to the treatment plan. Information on demographic data, clinical and pathological diagnosis, treatment regimen, and efficacy evaluation was collected. The basic conditions of patients who may affect the curative effect of different treatment schemes were preset as stratified subgroups, including age, progesterone receptor (PR) status, HER2 status, disease-free survival, number of previous endocrine therapy and chemotherapy, and visceral metastasis. The primary endpoint was progression-free survival (PFS), the secondary endpoints were objective response rate (ORR), clinical benefit rate(CBR) and PFS based on stratification factors. The survival curve was plotted by Kaplan-Meier method, the comparison of PFS between groups was performed by log-rank test, and the comparison of ORR and CBR between groups were performed by χ2 test. Results: A total of 188 patients were included, including 126 patients in the chemotherapy group [all females, aged 29-74 (51±10) years] and 62 patients in the endocrine therapy group [1 male and 61 female, aged 29-77 (51±12) years]. ORR of chemotherapy group was 23.0% (29/126), higher than that of endocrine treatment group [3.2% (2/62)] (P<0.001); The CBR of chemotherapy group and endocrine therapy group were 46.8% (59/126) and 33.9% (21/62), respectively, with no statistical significance (P=0.091). The median PFS of chemotherapy group and endocrine therapy group were 5.0 (95%CI: 4.3-5.7) and 4.0 (95%CI: 1.6-6.4) months, respectively, with no statistical significance (P=0.484). In the preset stratified subgroups, the median PFS of chemotherapy [6.0 (95%CI: 5.4-6.6) months] was longer than that of endocrine combined with targeted therapy [2.0 (95%CI: 1.8-2.2) months] (P<0.001) in PR negative patients; In patients who had progressed on over 2 previous endocrine treatments, the median PFS of chemotherapy [5.0 (95%CI: 3.8-6.2) months] was longer than that of endocrine combined with targeted therapy [2.0 (95%CI: 0.6-3.4) months] (P=0.045). Conclusions: After progression on treatment with CDK4/6 inhibitors for HR-positive/HER2-low expression metastatic breast cancer, both chemotherapy and endocrine therpy combined with targeted drugs are viable treatment options. However, for patients with PR negative or ≥2 lines of endocrine therapy previously, priority should be accorded to chemotherapy.

[Adjuvant therapy strategies for breast cancer based on the efficacy of neoadjuvant therapy]

With the advent of the precision cancer therapy era, neoadjuvant therapy has become the standard therapy for certain types of breast cancer. Neoadjuvant therapy is a fundamental treatment plan implemented at the time of disease diagnosis, and its efficacy can guide the formulation of subsequent adjuvant therapy strategies. Building on the efficacy of neoadjuvant therapy and medication regimens, in conjunction with evidence-based medicine and healthcare policy, developing adjuvant therapy strategies for breast cancer following neoadjuvant therapy has the benefit of providing more precise treatment options for patients.

[Expert consensus on endocrine therapy of breast cancer (2023 edition)]

Endocrine therapy is the primary systemic therapy for hormone receptor-positive breast cancer, which runs through the whole process of treatment for early and metastatic breast cancer. The development of new endocrine agents and targeted drugs such as cyclin-dependent kinases 4/6(CDK4/6)inhibitors has improved outcome of patients with hormone receptor-positive breast cancer and changed the treatment landscape. The update of clinical research data provides more treatment options, calling for treatment optimization. Experts had a deep discussion around the hot topics on endocrine therapy of breast cancer, and formulated the'Expert consensus on endocrine therapy of breast cancer (2023 edition)'.This consensus is based on research data worldwide and clinical practice experience, with the aims of standardizing clinical diagnosis and optimizing treatment in neoadjuvant, adjuvant and metastatic setting of hormone receptor-positive breast cancer.

[Rediscussion on hot issues of endocrine therapy for breast cancer]

In the past decade, generated data of large-scale clinical research of endocrine therapy and the update of guidelines have changed clinical practice of breast cancer treatment. However, there are unresolved issues on endocrine therapy. Based on new evidences and clinical experience, we expounded our points on neoadjuvant endocrine therapy, CDK4/6 inhibitoradjuvant therapy, concepts of endocrine sensitivity and endocrine resistance, first-line treatment for metastatic breast cancer, treatment options after progression on CDK4/6 inhibitor and treatment ofvisceral crisis.

[Development in the last 20 years of anti-HER2 targeted therapy for breast cancer]

Since trastuzumab was listed and approved for breast cancer in 2002, China has entered a new epoch of targeted therapy. Over the past 20 years, anti-human epidermal growth factor receptor 2 (HER2) targeted therapy for breast cancer in China has experienced the era of single-target, tyrosine kinase inhibitors, double-target and anti-HER2 plus antibody-drug conjugate. Advancement in the anti-HER2 targeted therapy is continuously changing the treatment mode of patients with HER2 positive status and even HER2 low expression, significantly improved their prognosis. In the past 20 years, Chinese scholars have participated in international clinical researches, completed a series of registration studies of imported drugs, developed new drugs with proprietary intellectual property rights, enriched the evidence of clinical research on HER2-targeted therapy, and formed a treatment system with both international standards and Chinese characteristics. In particular, the formulation of the Chinese Society of Clinical Oncology Breast Cancer Guidelines and the Chinese expert consensus on anti-HER2 targeted treatment in breast cancer are the concentrated embodiments of Chinese wisdom.

[A real-world study on the efficacy and safety analysis of paclitaxel liposome in advanced breast cancer]

Objective: To explore the application and efficacy of paclitaxel liposome in the treatment of advanced breast cancer among Chinese population in the real world. Methods: The clinical characteristics of patients with advanced breast cancer who received paclitaxel liposome as salvage treatment from January 1, 2016 to August 31, 2019 in 11 hospitals were collected and retrospectively analyzed. The primary outcome was progression free survival (PFS), and the secondary outcome included objective response rate (ORR) and safety. The survival curve was drawn by Kaplan-Meier analysis and the Cox regression model were used for the multivariate analysis. Results: Among 647 patients with advanced breast cancer who received paclitaxel liposome, the first-line treatment accounted for 43.3% (280/647), the second-line treatment accounted for 27.7% (179/647), and the third-line and above treatment accounted for 29.1% (188/647). The median dose of first-line and second-line treatment was 260 mg per cycle, and 240 mg in third line and above treatment. The median period of paclitaxel liposome alone and combined chemotherapy or targeted therapy is 4 cycles and 6 cycles, respectively. In the whole group, 167 patients (25.8%) were treated with paclitaxel liposome combined with capecitabine±trastuzumab (TX±H), 123 patients (19.0%) were treated with paclitaxel liposome alone (T), and 119 patients (18.4%) were treated with paclitaxel liposome combined with platinum ± trastuzumab (TP±H), 108 patients (16.7%) were treated with paclitaxel liposome combined with trastuzumab ± pertuzumab (TH±P). The median PFS of first-line and second-line patients (5.5 and 5.5 months, respectively) were longer than that of patients treated with third line and above (4.9 months, P<0.05); The ORR of the first line, second line, third line and above patients were 46.7%, 36.8% and 28.2%, respectively. Multivariate analysis showed that event-free survival (EFS) and the number of treatment lines were independent prognostic factors for PFS. The common adverse events were myelosuppression, gastrointestinal reactions, hand foot syndrome and abnormal liver function. Conclusion: Paclitaxel liposomes is widely used and has promising efficacy in multi-subtype advanced breast cancer.

[Expert consensus on the management of adverse events of CDK4/6 inhibitors in breast cancer]

Cyclin-dependent kinases 4/6 (CDK4/6) inhibitors are anti-tumor agents for the treatment of hormone receptor-positive breast cancer. Palbociclib, abemaciclib and dalpiciclib have been approved for the treatment of breast cancer in China. Common adverse effects of CDK4/6 inhibitors include bone marrow suppression, gastrointestinal toxicities, liver dysfunction, and skin or subcutaneous tissue adverse reactions (AEs). The Breast Cancer Expert Group of Chinese Society of Clinical Oncology (CSCO) summarized the incidence, clinical manifestations, and grading of the AEs. This expert consensus reports measures of AE management on the basis of experience of clinical practice and the latest advances worldwide, aiming to guide clinical practice by the way of managing AE and help to choose the best treatment regimen.

[Cold thinking on ten hot issues in the treatment of early breast cancer]

With the development of new strategies like target therapy and immunotherapy, early breast cancer treatment has become more standardized, and the interval of disease free survival has been extended. Although guidelines and expert consensus have provided supports for clinical decision making, there are still some controversial issues in clinical practice, attributing to different treatment concepts, product indications and accessibility. These controversial issues would eventually affect the treatment of early breast cancer. This year in 2021, the approval of new indications of drugs like abemaciclib and the popularity of dual anti-human epidermal growth factor receptor 2 targeted drugs have promoted the change of treatment modalities for different types of early breast cancer. To this end, ten hot topics of early breast cancer are summarized according to their different molecular typing and treatment stages for discussion.

[Chinese Society of Clinical Oncology Breast Cancer Guideline version 2021: updates and interpretations]

Objective: Since the first publication in 2017, the Chinese society of clinical oncology breast cancer guidelines have been updated in four editions, and nearly 300 000 volumes have been published, which has been widely recognized by scholars at home and abroad. The important updates from pathological diagnosis to therapies in the newest guideline has been updated in accordance with evidence, drug accessibility and expert opinions. Meanwhile, more chapters, like drug adverse reaction management, real-world research, biosimilar drugs, have been added, making a comprehensive guideline in guiding breast cancer standardized diagnosis and treatment.

[Phase Ⅲ randomized controlled, multicenter, prospective study of recombinant anti-HER2 humanized monoclonal antibody (Cipterbin) combined with vinorelbine in patients with HER2 positive metastatic breast cancer: the HOPES Study]

Objective: To evaluate the clinical efficacy and safety of recombinant anti-HER2 humanized monoclonal antibody (Cipterbin) combined with vinorelbine in patients with HER2 positive metastatic breast cancer. Methods: Patients were randomized 2∶1 to test group and control group. Patients in test group received Cipterbin (4 mg/kg loading dose and 2 mg/kg maintenance dose each week, IV) combined with vinorelbine (25 mg/m(2) on days 1,8 and 15 of each 28 days, IV). Patients in control group received vinorelbine (25 mg/m(2) on days 1,8 and 15 of each 28 days, IV).The primary end point was progression free survival (PFS). Results: A total of 315 patients were enrolled from Jan 2009 to Jan 2013 (212 in test group and 103 in control group). The median PFS of test group was significantly longer than that of control group, 39.1 weeks vs 14.0 weeks (HR=0.24; 95%CI, 0.16-0.36; P<0.000 1). The objective response rate (ORR) and disease control rate (DCR) in test group were significantly higher than those in control group, ORR was 46.7% vs 18.45% (P<0.000 1) and DCR was 79.72% vs 45.63% (P<0.000 1). The incidence of neutropenia, leucopenia and erythrocytopenia were higher in both groups, but there was no significant difference between two groups.The most common adverse events associated with Cipterbin were infusion reactions. Left ventricular ejection fraction reduced to less than 50% in 5 patients, which were recovered. No serious cardiotoxicity. Conclusion: The recombinant anti-HER2 humanized monoclonal antibody (Cipterbin) combined with vinorelbine has significant efficacy and good safety. It is the optimized therapy regime for patients with taxane-pretreated HER2 positive metastatic breast cancer, which provides more targeted therapy opportunities for HER2 positive breast cancer patients in China.

[Development of guidelines and clinical practice for breast cancer]

In the past two decades, with the introduction of NCCN guidelines, the establishment of a standardized diagnosis and treatment system for breast cancer had begun. The Chinese version of the NCCN guidelines, which combines international standards and Chinese characteristics, was then developed to guide clinical practice. Since 2011, Chinese experts have entered St. Gallen International Expert Consensus Group, and to introduce the latest therapy concepts. On this basis, the Chinese Society of Clinical Oncology has developed guidelines for diagnosis and treatment in line with product accessibility and expert opinions to help clinicians choose the best treatment option. The latest Chinese Society of Clinical Oncology Breast Cancer Guideline will further contribute to the establishment of a standardized diagnosis and treatment system for breast cancer.

[The present situation and future of real world research in diagnosis and treatment of breast cancer]

Real-world study is increasingly becoming an important source of evidence for changing clinical practice, especially for clinical problems that can't be randomized. In recent years, real-world research in the field of breast cancer has gradually became a boom. Existing research results have begun to assist in the epidemiological analysis of breast cancer, promote the approval of rare diseases diagnosis and indication, and promote the analysis of real-world treatment status and evaluation of curative effects. Chinese scholars have also established databases and carried out relevant real-world research, providing real-world evidence for clinical practice in China. But domestic research is still in its infancy. The number of real-world research literature published by domestic scholars is relatively small, and there is a lack of pragmatic randomized clinical trial and real-world research for decision-making. In the future, we need to take advantage of the abundant diagnosis and treatment resources, further improve the database, and carry out real-world study on drug development based on population data in China.

[Study of bioequiavailability of paclitaxel for Injection (Albumin Bound) and abraxane and the efficacy of extension treatments in patients with metastatic breast cancer]

Objective: To compare the bioequiavailability of paclitaxel for injection (albumin bound) (PAB) and reference listed drug abraxane in the patients with metastatic breast cancer, and to investigate the safety and efficacy in the extension treatments of PAB. Methods: This study was random, two cycles, self-crossover control study in the bioequiavailability stage. PAB was the investigational drug T and Abraxane was the reference drug R. Patients were randomly assigned to two cycles therapy of either R→T or T→R(260 mg/m(2)/21d). Non-PD patients entered in the extension treatments of the investigational drug PAB(260 mg/m(2)/21d) until the disease progression or the intolerance toxicity. Results: From Mar 1, 2016 to May 24, 2016, we enrolled 40 patients. The blood concentration-time curve and the parameters of pharmacokinetics indicated the two drugs were the bioequivalent drug products in the initial two cycles crossover-therapy.The incidence of adverse drug reactions were 89.7% vs 97.4% in investigational drug vs reference drug and grade 3/4 toxicities were 20.5% vs 21.1%(P=1.000). Patients received a median of 7 treatment cycles(range 1-23) and a median of 260mg/m(2) actual drug dose (range 220-260 mg/m(2)). Seven patients (17.5%) had dose reductions because of toxicities (260 mg/m(2) reduce to 220 mg/m(2)). Twenty-two patients (55%) discontinued treatment prematurely because of toxicity.Overall response rates (ORR) were 40% (95% CI, 24.8%-55.2%). For patients who received PAB as first-line vs non-first-line therapy, the ORR were 43.8% vs 25%. For patients who taxane-naïve vs taxane-pretreated, the ORR were 45.5% vs 37.9%. Median PFS was 49 weeks(95% CI, 30weeks-NA). Conclusion: The paclitaxel for injection (albumin bound) (PAB) and reference listed drug abraxane are the bioequivalent drug products.The toxicity and efficacy of the PAB are similar with abraxane.The more therapy chances for Chinese patients will come by the research and development of domestic drugs.

Cisplatin as a Radiosensitizer in Clinical Practice: A Pilot Study

Fifty-four patients with Inoperable cancers were treated with a combination of cisplatin and radiotherapy from May 1984 to February 1989. Cisplatin was administered at a dose of 40 mg/week, for a total dose of 160-320 mg, during radiation therapy. In 4 cases with brain metastases, the cisplatin dose was 40 mg/m2. Cisplatin concentration in blood was measured using the flameless atomic absorption spectrophotometric method. Radiation therapy was delivered by a 6 MV X-ray or a cobalt-60 unit up to a total dose of 50-70 Gy. Among the 54 patients, 89% (48) responded to the treatment regimen; complete responses (CR) and partial responses (PR) were 56% and 33%, respectively. Six patients were stable in their disease. Among the 30 patients who had CR's, the 1-year survival rate was 88% (21/24). Two patients (7%) had local relapse. However, among PRs, the 1-year survival rate was 33% (4/12) and local failure (61%) (11/18). Objective tumor response was observed in 4 cases with brain metastasis, 2 of the 4 patients were alive for more than 6 months. Toxic effects were moderate and consisted of emesis and myelosuppression. Grade III bone marrow suppression amounted to 11%, and the interval of recovery was relatively long compared with that reported in the literature. Further prospective controlled studies are recommended.

[Ten hot issues of breast cancer in diagnosis and therapy in 2018]

The rigorous randomized clinical trials and qualified real world evidence have improved the domestic standardized diagnosis and therapy. Meanwhile, the recent consensus and guideline integrated with Chinese realities have also promoted the breast cancer therapy. To expound our views and to provide suggestions for the revision of breast cancer guideline of Chinese Society of Clinical Oncology, we select ten hot issues to discuss with our experience.

Thymidine kinase 1 combined with CEA, CYFRA21-1 and NSE improved its diagnostic value for lung cancer

AIMS

Thymidine kinase 1 (TK1) is a tumor biomarker in human malignancies. The purpose of this study was to evaluate the diagnostic efficiency of this marker for lung cancer using the combined analysis of carcinoembryonic antigen (CEA), cytokeratin-19 fragment (CYFRA21-1), neuron specific enolase (NSE) and TK1.

MAIN METHODS

From 2013 to 2014, 147 patients with lung cancer and 228 patients with lung benign diseases who were admitted to our hospital were reviewed. Peripheral blood samples were collected for the detection of TK1, CEA, CYFRA21-1 and NSE. The diagnostic value of each marker was analyzed using receiver operating characteristic (ROC) curves and logistic regression equations.

KEY FINDINGS

The serum levels of TK1, CEA, CYFRA21-1 and NSE were significantly higher than those in patients with lung benign diseases (all P<0.05). The TK1 concentration was dependent on TNM stage (P=0.005). The ROC curve analyses showed that the diagnostic value of TK1 combined with CEA, CYFRA21-1 and NSE in lung cancer was significantly higher than that of each biomarker alone (all P<0.0001). In addition, TK1 combined with CEA, CYFRA21-1, or NSE could also improve the diagnosis of the squamous cell carcinoma, adenocarcinoma and small cell lung cancer subtypes, respectively.

SIGNIFICANCE

The combined detection of TK1 and the other three markers significantly improved the diagnosis of lung cancer. Furthermore, the detection of TK1 combined with that of CYFRA21-1, CEA or NSE increased the diagnostic value of TK1 for lung squamous cell carcinoma, adenocarcinoma and SCLC, respectively.

[A study on the correlation between Neo-Bioscoresystem and disease-free survival of breast cancer patients with neoadjuvant chemotherapy]

Obiective: To explorethe correlation between Neo-Bioscore and disease-free survival (DFS) after neoadjuvant therapy in patients with breast cancer in China. Methods: The clinical and pathological data of 429 patients with early or locally advanced breast cancer who received neoadjuvant therapy at the No.307 Hospital of PLA from January 1, 2005 to December 31, 2015 were analyzed and we followed up their DFS. Results: Neo-Bioscore were closely related to DFS (χ(2)=47.662, P<0.001). When the groups were divided by Neo-Bioscore 3, they weremore relevantto DFS (HR=5.093 vs HR=2.044), equivalent tothe role of traditional recurrence risk grouping in guiding the choice of adjuvantendocrine regimen for hormone receptor (HR) positive patients who were premenopausalafter neoadjuvant chemotherapy, andmore relevantto DFS than whetherthe pathologic complete response (pCR)grouping in the same molecular pathology subgroup of HR positive/human epidermal growth factor receptor 2 (HER-2)negative (P<0.001 vs P=0.166), HER-2 positive (P<0.001 vs P=0.166), HRnegative/HER-2 negative (P<0.001 vs P=0.166). Conclusions: Neo-Bioscore could be used as an early indicator of predicting DFS for breast cancer patients after neoadjuvant therapy.When the groups were divided by Neo-Bioscore 3, they were more relevant to DFS, equivalent to the role of traditional recurrence risk grouping in guiding the choice of adjuvantendocrine regimen for premenopausal HR positive patients, andmore relevantto DFS than whetherthe pCRgrouping in the same molecular pathology subgroup.

Geometric decoherence of valley excitons in monolayer transition metal dichachogenides

We study the effects of the Berry phases of the valley excitons in the monolayer transition metal dichalcogenides (TMDs) when the valley excitons are manipulated by an external terahertz field. We find that the decoherence of the valley degree of freedom of the valley excitons is spontaneously induced because of the different Berry phases of valley excitons accumulated along the opposite trajectories under the manipulation of the external field. It is called the geometric decoherence because it completely results from the geometric phases. The obvious phenomenon related to such spontaneous decoherence is the gradual decrement of the dipole moment matrix element of the valley exciton and consequently the decrement of the emitted signals after the valley excitons are recombined. Moreover, another effect due to the Berry phases is the giant Faraday rotation of the polarization of the emitted photons. Such imperfection of the valley degree of freedom is supposed to provide the potential limits of the valleytronics based on the TMDs optoelecronic devices.

[Research progress of circulating tumor cells: the way from counting to subtyping]

Although circulating tumor cells(CTCs) have long been identified, it was not until the approval of CellSearch^® system that CTCs are current lyunder in-depth investigation.The CTCs technology has advanced from simple cell counting into era of molecular subtyping. The development of sequencing technologies and liquid biopsy has made it possible to sequence single cell genomes. In the recent years, how to take advantage of CTCs as a useful tool to clarify the mechanisms of carcinogenesis and cancer development and to predict the patient survival have become a hot issue.

[The progression of tumor liquid biopsy and its applications in precision medicine]

Malignant tumor is the most heterogeneous human disease, and it has been gradually reached the consensus in clinical oncology that the personalized treatment of tumor patients should be directed by molecular diagnostics. However, the ever-changing characteristic of tumor in heterogeneity and the fact that tissue samples are usually unavailable highlight the function and significant of liquid biopsy. The material that could be used in liquid biopsy are mainly the circulating tumor DNA, circulating tumor cells and extracellular vesicles, which though have their own advantages and disadvantages, but could complement to each other, thus accurately and comprehensively reflecting the characteristic of the tumor and gave the best direction for patient's individualized therapy. This article reviewed the recent advances of liquid biopsy and explained its importance in tumor precision medicine.

[Calm thinking for precision medicine of breast cancer in the boom]

In the past two years, researchers have been exploring the precision medicine. Thanks to the development of sequence industry and clinical study, the big data about the precision medicine have been more and more sufficient. However, how to deal with the precision data is still a question for clinicians. We focus on the hot issues that disturb clinicians most, wanting to help them to make suitable decisions between the traditional and precision medicine of breast cancer. We believe the precision medicine is on the way.

[Predictive values of pathologic complete response for patient outcome in different molecular subtypes of breast cancer]

Objective: To analyze the predict values of pathologic complete response (pCR) rates for patient outcome according to breast cancer (BC) molecular subtypes. Methods: Four hundred and sixteen patients with confirmed BC who received neoadjuvant chemotherapy (NCT) in The Affiliated Hospital of Military Medical Science Academy of the PLA were enrolled.The clinical and pathological characteristics of patients were collected. The primary endpoint was pCR rate and the secondary endpoint was disease free survival (DFS). We analyzed the predict values of pCR rate for patient outcome, and the predict factors for DFS by univariate and multivariate Analysis. Results: A total of 416 BC patients confirmed by pathology were enrolled and received treatment and assessment in this study. The overall pCR rate was 23.1% (96/416). The pCR rate was 6.9% (14/204) in patients of HR+ /HER2- Subtype, 41.5% (27/65) in HR-/HER2+ Subtype, 30.9% (17/55) in HR+ /HER2+ Subtype, and 41.1% (37/91) in HR-/HER2- Subtype. The correlation of the pathological status and the patient outcome was analyzed in all patients. Compared with no pCR group, pCR group had significant higher DFS rates. In HER2+ Subtype and HR-/HER2- Subtype, DFS rates of patients who achieved pCR was higher than that of who didn't achieved pCR. In HR+ /HER2- Subtype, DFS rates of patients who achieved pCR was higher than that of who didn't achievced pCR, but without statistics difference. The Cox proportional hazards regression analysis revealed that ER status, T stage, pCR affected the patient outcome of BC. Conclusion: So far, pCR was an established prognostic factor: reaching a pCR could predicte improved survival in HER2-enriched BC and triple-negative breast cancer (TNBC) subgroup, while data remain controversial for the luminal subtypes. Our results do not support the use of pCR as a surrogate end point of treatment efficacy in unselected patients with BC submitted to neoadjuvant systemic therapy.

Clinical manifestations and radiological features may contribute to the early diagnosis of radiation-induced sarcoma after breast cancer

AIM

To describe the clinical manifestations and radiological features contributing to the early diagnosis of radiation-induced sarcoma (RIS) after radiotherapy for breast cancer.

MATERIALS AND METHODS

This retrospective analysis included four typical cases of RIS diagnosed at Affiliated Hospital of Academy of Military Medical Sciences between 1980 and 2013. Patient and imaging characteristics, treatment modalities, and outcomes were extracted from patients' medical records. Two pathologists reviewed all histological slides.

RESULTS

All four cases were misdiagnosed and treated for several months as cases of breast cancer relapse. CT using the bone-window setting and three-dimensional reconstructions clearly displayed bone tumours of RIS in three cases. Skin alterations were observed in all cases. At the time of RIS diagnosis, three patients were free of breast cancer. In one patient with bilateral breast cancer and lung metastasis, chemotherapy resulted in complete remission of the metastasis, but RIS progression. No RIS in this series responded to chemotherapy or endocrine therapy.

CONCLUSIONS

Abnormalities appearing in the radiation field long after RT should alert clinicians to the potential development of RIS. Careful physical examination and follow-up imaging studies are necessary. The presence of skin alterations, bone tumours at CT or radiography, and poor response to anti-cancer drugs may contribute to the early detection of RIS. Biopsy should be performed immediately when RIS is suspected.

Coherent combining technology of master oscillator power amplifier fiber arrays

Coherent beam combination of fiber laser array is an important technology of realize high-power, high-radiance fiber laser system. In this paper, Master Oscillator-Power Amplifier scheme is used to realize phase controlling of three ytterbium fiber amplifiers, the experiment results of both two and three fiber amplifiers are given and compared. Far-field patterns with different fill factor are studied experimentally. We perform optical phase-noise measurements of a commercial 1-W ytterbium fiber amplifier using our phase control electronics, the dominant phase noises of the 1-W fiber amplifier are at frequencies below one kilohertz.

Neoadjuvant chemotherapy in inoperable, locally advanced, and inflammatory breast carcinoma: a pilot study of MTT assay in vitro and outcome analysis of 10 patients

Patients with inoperable, locally advanced, and inflammatory breast carcinoma (LAIBC), whether with supraclavicular lymph nodes (SLN) or not (stage IIIB and IV), usually carry an overall poor prognosis. The current treatment for these patients is by means of combined modality, including preoperative chemotherapy. This strategy has led to a substantial improvement in clinical response, making some patients operable, and even making breast conservative surgery possible. However, the long-term results still are not promising. The aim of this pilot study was to determine the efficacy of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay in vitro in directing chemotherapy (including preoperative adjuvant chemotherapy and postoperative adjuvant chemotherapy) for these patients. Between June 1994 and March 1997, 10 patients with inoperable LAIBC, whether with SLN or not, were enrolled. During the period of the combined therapy modalities, the neoadjuvant chemotherapy was adopted for three cycles according to the results of chemosensitivity in vitro by MTT assay. Then a modified radical or radical mastectomy was performed, which was followed by radiotherapy and further postoperative adjuvant chemotherapy with the same regimen as that of neoadjuvant chemotherapy. All patients had been followed up from the beginning of neoadjuvant chemotherapy to the end of October 1999. Two patients had clinical complete response (CRs), with one having pathologic CR in both breast tumor and axillary lymph node, and the other having pathologic CR in axillary lymph node. The other eight patients had partial response. By the time of analysis, six patients had been dead of relapse or progression. Among the four patients who were still alive, one had local relapse, one had distant metastatic disease, and the other two had no evident disease. By retrieving from MEDLINE before 1999, the authors learned that this is the first pilot study of neoadjuvant chemotherapy for inoperable LAIBC using MTT assay to predict the chemosensitivity in vitro. Compared with conventional chemotherapy, the clinical response and long-term results seem to be more encouraging.

Nuclear apoptosis induced by isolated mitochondria

We isolated and purified mitochondria from mouse livers and spinach leaves. When added into egg extracts of Xenopus laevis, they caused nuclei of mouse liver to undergo apoptotic changes. Chromatin condensation, margination and DNA ladder were observed. After incubating isolated mitochondria in some hypotonic solutions, and centrifuging these mixtures at high speed, we got mitochondrial supernatants. It was found that in the absence of cytosolic factor, the supernatant alone was able to induce apoptotic changes in nuclei. The effective components were partly of protein. DNA fragmentation was partly inhibited by caspase inhibitors AC-DEVD-CHO and AC-YVAD-CHO. Meanwhile, caspase inhibitors fully blocked chromatin condensation. Primary characterization of the nuclear endonuclease(s) induced by mitochondrial supernatants was also conducted. It was found that this endonuclease is different from endonuclease G, cytochrome c-induced nuclease, or Ca2+-activated endonuclease.

Physiologic-pathologic correlation in Guillain-Barré syndrome in children

OBJECTIVE

To correlate electrophysiologic patterns with sural nerve pathology in children with Guillain-Barré syndrome (GBS).

BACKGROUND

Based on electrophysiologic and pathologic observations, GBS has been divided into demyelinating and axonal subtypes. The acute motor axonal neuropathy (AMAN) involves predominantly motor nerve fibers with a physiologic pattern suggesting axonal damage, whereas the acute inflammatory demyelinating polyneuropathy (AIDP) involves both motor and sensory nerve fibers with a physiologic pattern suggesting demyelination. In this study, we sought to confirm these observations by correlating sural nerve pathology with electrophysiologic findings in GBS patients.

METHODS

Biopsies of sural nerve from 29 of 50 prospectively studied GBS patients were obtained. Nerves were examined by light and electron microscopy, and with immunocytochemistry for macrophages, lymphocytes, and complement activation products.

RESULTS

Sural nerves from AMAN patients were normal or had only a few (0.1% to 0.7%) degenerating fibers without lymphocytic infiltration or complement activation. One patient with reduced sural sensory nerve action potential classified as acute motor sensory axonal neuropathy (AMSAN) had many degenerating fibers (2.3%) in the sural nerve. All three AIDP patients displayed active demyelination, and in two patients, lymphocytic infiltration and complement activation products were observed on the abaxonal Schwann cell surface.

CONCLUSION

Classification of Guillain-Barré syndrome subtypes based on motor conduction studies correlates closely with pathologic changes seen in sural nerve. In acute motor axonal neuropathy cases, the sural nerve is almost completely spared pathologically. In acute inflammatory demyelinating polyneuropathy cases, macrophage-mediated demyelination and lymphocytic infiltration are common in the biopsies of sural nerves.

Induction of apoptosis in purified animal and plant nuclei by Xenopus egg extracts

We have developed a cell-free system that can trigger the nuclei purified from mouse liver and suspension-cultured carrot cells to undergo apoptosis as defined by the formation of apoptotic bodies and nucleosomal DNA fragments. The effects of different divalent cations and cycloheximide on DNA cleavage in this system were assessed. The fact that nuclei of plant cells can be induced to undergo apoptosis in a cell-free animal system suggests that animals and plants share a common signal transduction pathway triggering in the initiation stage of apoptosis.

Apoptosis of mouse liver nuclei induced in the cytosol of carrot cells

We report here the apoptosis of mouse liver nuclei induced in the cytosol of carrot cells by cytochrome c. Several typical characteristics of apoptosis, such as chromatin condensation, margination and apoptotic bodies, were detected. The result of DNA gel electrophoresis showed that DNA was degraded into nucleosomal fragments. The terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end labelling procedure was also performed to detect the breakage of 3'-OH ends of a DNA strand. Furthermore, we found that nuclear lamins were degraded from 88 kDa and 66 kDa to 37 kDa and 47 kDa fragments. The DNA fragmentation could be inhibited by AC-DEVD-CHO and AC-YVAD-CHO. The results indicate that the apoptosis in plant cells may share some similar pathways to apoptosis in animal cells.

Predictive chemotherapy of advanced breast cancer directed by MTT assay in vitro

In order to investigate the predictive value of in vitro MTT assay for directing chemotherapy of breast cancer patients, from 1992 to 1995, 156 advanced breast cancer patients who had evaluable lesions were recruited for a prospective study. Of them 83 had MTT assay before chemotherapy; the 73 patients in the MTT sensitive group received chemotherapy according to the result of the MTT assay. The other 10 patients in the MTT resistant group and 73 patients in the control group were given chemotherapy according to clinicians' discretion. The response rate in the MTT sensitive group was 76.7% (56/73). There was statistically significant difference as compared with 0 (0/10) in the MTT resistant group and 43.8% (32/73) in the control group. Between in vitro and in vivo, the overall coincident rate was 79.5% [(56 + 10)/83]. In the MTT sensitive group, the response rate of the subgroups of lesions and the chemotherapy regiments tended to be higher than that in the control group. Patients in the MTT sensitive group had longer response and survival than those in the control group. However, there was no statistical difference in the median response duration and the median survival between the two groups. Further exploration of in vitro chemosensitivity testing by MTT assay for patients with advanced breast cancer is warranted.

Evaluation of in vitro chemosensitivity of antitumor drugs using the MTT assay in fresh human breast cancer

Practical criteria were developed in this paper for the purpose of evaluating chemosensitivity of fresh human breast cancer by the MTT assay. The survival rates at maximum inhibition (Imax %) and the concentrations of drugs which caused fifty percent reduction in absorbance compared to baseline values (IC50) of 175 samples of 10 anti-tumor drugs were evaluated by logistic analyses of the dose-response curves. Distributions of Imax% appeared as normal curves, while those of the IC50 significantly deviated from normal distribution (p < 0.0001). We assessed the in vitro chemosensitivity by comparing the Imax % of each drug on individual samples with the mean Imax % + SD which was obtained from the Imax% of 175 samples. If the individual Imax % > mean Imax % + SD. we thought the tumor sample was resistant to this drug. If the Imax % < or = mean Imax % + SD, we would compare its IC50 with Q50 which was used as a cutoff point for in vitro chemosensitivity of anti-tumor drugs. The in vitro chemosensitivity could be graded as sensitive (Q1-Q25), intermediate (Q26-Q75), and resistant (Q76-Q100) by means of percentile method. If the individual IC50 > or = Q76, the tumor sample would be defined as resistant. If the individual IC50 < or = Q25, it would be defined as sensitive. In the range of Q26-Q75, we used Q50 as a cutoff point between relative sensitivity and relative resistance. Preliminary results showed that the in vitro chemosensitivity to different anti-tumor drugs determined by these criteria were consistent with the clinical response in 83 advanced breast cancer patients.

[Nuclear reconstitution around purified E. coli DNA in cell-free extracts of Xenopus laevis eggs]

In recent years we have succeeded in inducing various exogenous DNA to assembly typical nuclei in cell-free Xenopus egg extracts. However, it is not clear if prokaryotic chromosomal DNA can also form the nucleus in this eukaryotic system. In our experiment, we used the purified E. coli. chromosomal DNA to reconstitute the nucleus in the nuclear reconstitution extracts and found that typical nuclei can also be assembled around added DNA. We observed the process of nuclear reconstitution by using light microscopy and electronic microscopy. The scanning results of chromatin-like materials and assembled nuclei by microspectrophotometer showed that E. coli, chromosal DNA underwent obvious change from condensation to decondensation during nuclear reconstitution. Incorporation of alpha-32P-dCTP into DNA suggested that the reconstituted nuclei were capable of DNA replication.

Abuse of antibiotics in China and its potential interference in determining the etiology of pediatric bacterial diseases

There is scant information about the etiology and epidemiology of bacterial diseases of infants and children in China because of very little success with bacterial culture. This study describes the severity of abuse of antibiotics among Chinese pediatricians and this abuse's potential interference in determining the etiology of bacterial diseases. According to a survey in Beijing Children's Hospital more than 98% of the patients in the Outpatient Department who were diagnosed with common cold were given antibiotics by physicians. More than one-third of the patients had been taking antibiotics before coming to the hospital. Using a sensitive Staphylococcus aureus assay we found that 70% of blood samples and 43% of cerebrospinal fluid samples from the patients with bacterial meningitis and pneumonia contained antibacterial activity. Bacteria were recovered significantly less often from the samples with antibacterial activity than from those who did not from which antibiotic was not recovered, both in blood (5.3% vs. 12.5%) and in cerebrospinal fluid (2.5% vs. 14.8%). This study indicates that antibiotic abuse is a severe problem in China and that judicious use of antibiotics is urgently needed.

Countercurrent immunoelectrophoresis for diagnosis of acute bacterial pneumonia in Chinese children

Countercurrent immunoelectrophoresis (CIE) with H. influenzal type b(Hib) and Pneumococci Omni antisera was performed on serum and concentrated urine and pleural fluid samples from 100 patients with acute pneumonia in Beijing Children's Hospital. Thirty-one patients were investigated by bacteriologic techniques (blood culture and pleural fluid culture). CIE was positive in 29/100 (29%) of cases of Hib, 13/100 (13%) of cases for pneumococci. Overall, bacterial causes of pneumonia were diagnosed by CIE in 41/100 (41%) cases. Antigens were detected in 5/90 (5.6%) serum samples, in 36/87 (41.5%) concentrated urine samples, and in 1/2 (50%) samples of pleural fluid. Only one Hib strain was found by pleural fluid culture. The contamination rate of bacterial culture in this group was high (5/31 cases, 16.1%). Therefore, traditional bacteriologic techniques are of very limited value for diagnosing pneumonia in Chinese children. The results showed that bacterial pathogen, especially Hib and Pneumococci, are very common and important causes of pediatric pneumonia in China.