Efficacy and safety analysis of a docetaxel-plus-trastuzumab regimen in patients with early-stage HER2-positive breast cancer: a retrospective single-arm study

Background

A regimen of weekly paclitaxel and trastuzumab (WPH) is the standard treatment for patients with early-stage human epidermal growth factor receptor 2 (HER2)-positive breast cancer but has certain limitations. Weekly hospital visits are burdensome for patients and increase healthcare resource use. Docetaxel is currently used in several chemotherapy regimens for HER2-positive breast cancer, such as four cycles of docetaxel and cyclophosphamide plus trastuzumab (TC4H) or THP (paclitaxel, trastuzumab plus pertuzumab), and its safety and efficacy have been well established. Therefore, for patients who cannot visit the hospital for treatment every week, we have implemented a 3-week docetaxel regimen to replace the weekly paclitaxel schedule for these early-stage HER2-positive breast cancer patients. Our retrospective analysis conducted from 2014 to 2019 assessed the efficacy and safety of a docetaxel-and-trastuzumab (TH) regimen in patients with early-stage HER2-positive breast cancer, with the aim of establishing a more accessible and efficient treatment approach.

Methods

This is a single-arm retrospective study analysis of TH therapy for early-stage HER2-positive breast cancer conducted in The First Affiliated Hospital, School of Medicine, Zhejiang University between January 2015 and December 2019. Patients included were lymph node-negative, aged 50 years or older, and had received TH regimen after surgery, with comprehensive follow-up data available. Patients received six cycles of docetaxel (100 mg/m2) every 3 weeks and trastuzumab (8 mg/kg in cycle 1, followed by 6 mg/kg) every 3 weeks for 1 year. Disease-free survival (DFS), overall survival (OS), and adverse events were evaluated as prognosis outcomes of the TH regimen.

Results

A total of 144 breast cancer patients were enrolled. The median age of the patients was 61.5 years and 80 patients (55.6%) had hormone receptor-positive disease. In the entire study population, 34.7% of patients had tumors 1 cm or smaller. The median follow-up time of the included patients was 7.1 years, the 5-year DFS rate was 96.5%, and the OS rate was 98.6%. Among the five patients who experienced invasive disease events or death, three had local or regional recurrences. Three patients (2.1%) experienced at least one episode of grade 3 neuropathy, and five patients had a significant decrease in ejection fraction, leading to a 3.5% interruption of trastuzumab treatment. None of the patients experienced grade 3 or 4 hypersensitivity reactions to the study treatment.

Conclusions

The TH regimen demonstrated promise as a novel treatment alternative for patients with early-stage HER2-positive breast cancer. It offers a similar degree of efficacy and safety to those of the conventional WPH regimen while requiring fewer hospital visits, which could result in reduced healthcare costs and enhanced patient convenience.

Expression and clinical significance of CCN5 and the oestrogen receptor in advanced breast cancer

PURPOSE

The aim of this study was to investigate the expression and clinical implications of CCN family member 5 (CCN5) and the oestrogen receptor (ER) in advanced breast cancer (BC).

METHODS

A total of 130 patients with advanced BC were selected for the study. Samples of normal breast tissue, ductal carcinoma in situ (DCIS), and invasive carcinoma were collected. The expression levels of CCN5 and ER in these tissues were examined using immunohistochemical methods. The correlation between expression of CCN5 and ER in different tissues and also differences in expression in invasive carcinoma were analysed. In addition, the relationship between CCN5 expression in advanced BC tissues and clinical pathological features was examined.

RESULTS

CCN5 and ER had low expression in normal breast tissues and invasive carcinoma tissues, but high expression in DCIS, with this difference being statistically significant (X2 = 119.899, P < 0.001; X2 = 113.524, P < 0.001, respectively). The expression of CCN5 and ER in different tissues of patients with advanced BC showed a positive correlation. Significant differences were also observed in the positive and negative expression of CCN5 and ER (X2 = 56.358, P < 0.001). Moreover, the expression of CCN5 protein in advanced BC showed a statistically significant associations (P < 0.05) with the expression of the progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), Ki-67, and P53, tumor diameter, histological grade, lymph node metastasis, pathological molecular subtype, and clinical staging.

CONCLUSION

High expression of CCN5 and ER was observed in DCIS tissues of patients with advanced BC, with their expression being positively correlated. These findings suggest that CCN5 and ER may have a potential synergistic role in the progression of BC that influences the progression of advanced BC and can also be used to predict the effectiveness of endocrine therapy.

Clinical characteristics and therapeutic direction of HER2 low-expression breast cancer

Human epidermal growth factor receptor 2 (HER2) is one of the oncogenic drivers of breast cancer and is often used as a definitive therapeutic marker for breast cancer. This has led to significant improvements in both targeted therapy and prognosis for HER2-targeted breast cancer. Due to the differences in HER2 gene and protein expression levels, they are clinically classified into HER2 zero-expression breast cancer, low-expression breast cancer and high-expression breast cancer. Among them, HER2 low-expression is considered a special expression state, which is insensitive to conventional anti-HER2 therapy and has a poorer prognosis and thus has received attention from researchers. Some studies demonstrate that patients with HER2 low-expression can benefit from antibody-drug conjugates (ADC). Several studies are currently exploring the efficacy of various ADC drugs in breast cancer with HER2 low-expression, opening up new treatment avenues for patients with HER2 low-expression breast cancer. This review aims to summarize the clinical features of HER2 low-expression breast cancer and the recent advances in its therapeutic agents.

DNA Methylation and Demethylation in Triple-Negative Breast Cancer: Associations with Clinicopathological Characteristics and the Chemotherapy Response

Objectives: Triple-negative breast cancer (TNBC) is an aggressive cancer subtype with limited treatment options due to the absence of estrogen, progesterone receptors, and HER2 expression. This study examined the impact of DNA methylation and demethylation markers in tumor tissues on TNBC patients' response to neoadjuvant chemotherapy (NACT) and analyzed the correlation between 5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) and clinicopathological characteristics, offering new insights into the predictive value of these epigenetic markers. Methods: The study included 53 TNBC female patients, 19 of whom received neoadjuvant chemotherapy (NACT) before surgery. Global DNA methylation and demethylation levels were quantified using an ELISA-based method to measure 5-mC and 5-hmC content in DNA isolated from pre-treatment biopsy samples (in patients undergoing NACT) and postoperative tissues (in patients without NACT). Results: In patients who received NACT, those with disease progression had significantly higher pretreatment levels of 5-hmC (p = 0.028) and a trend toward higher 5-mC levels (p = 0.054) compared to those with pathological complete response, partial response, or stable disease. Higher 5-mC and 5-hmC levels were significantly associated with higher tumor grade (p = 0.039 and p = 0.017, respectively). Additionally, a positive correlation was observed between the Ki-67 proliferation marker and both 5-mC (rS = 0.340, p = 0.049) and 5-hmC (rS = 0.341, p = 0.048) levels in postoperative tissues. Conclusions: Our study highlights the potential of global DNA methylation and demethylation markers as predictors of tumor aggressiveness and chemotherapy response in TNBC. Further research in larger cohorts is necessary to validate these markers' prognostic and predictive value.

Clinical factors influencing residual subcutaneous tissue after skin-sparing and nipple-sparing mastectomy with immediate breast reconstruction

Background

Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have emerged as increasingly preferred alternatives to traditional mastectomy, largely due to their enhanced cosmetic outcomes and elevated levels of patient satisfaction. Nonetheless, the oncological safety and implications associated with residual breast tissue in these surgical procedures continue to raise significant concerns. The objective of this study is to evaluate the influence of various clinical and surgical factors on residual subcutaneous tissue in patients undergoing SSM and NSM.

Methods

This retrospective cohort study encompassed breast cancer patients who underwent postoperative radiotherapy following SSM and NSM with immediate breast reconstruction from November 2020 to April 2024. Clinical and demographic data, including age, tumor size, axillary staging, molecular subtype, genetic analysis, and surgical details, were systematically collected. Additionally, radiation treatment planning CT scans were assessed to measure residual subcutaneous tissue thickness at multiple anatomical regions. The correlation between residual subcutaneous tissue thickness and clinical factors was subsequently analyzed.

Results

The median age was 45 years (range, 31-61). Among the total patients, 20 underwent SSM (52.63%), and 18 underwent NSM (47.37%). An acceptable residual subcutaneous tissue distance (≤5 mm) was observed in 21 breasts (55.26%), while 17 breasts (44.74%) did not meet this criterion. Analysis demonstrated a statistically significant but modest positive correlation between RFT thickness and age (r = 0.38, p = 0.02), minimal positive correlation was observed between RFT thickness and clinical tumor size (r = 0.08, p = 0.042). A significant effect of contralateral breast surgery on residual subcutaneous tissue thickness was noted (F = 8.38, p < 0.001). Additionally, the results also revealed a statistically significant inverse correlation between RFT thickness and axillary involvement (r = -0.18, p = 0.005), suggesting that thicker flaps are associated with reduced axillary involvement. There was no significant difference in RFT thickness between NSM and SSM groups (Chi² = 0.47, p = 0.491).

Conclusion

A significant proportion of patients undergoing SSM and NSM exhibit residual subcutaneous tissue thickness that exceeds acceptable limits, which may vary based on clinical and pathological factors. Further research involving larger cohorts and prospective designs is essential to identify additional contributing factors and optimize indications for postoperative radiotherapy.

Radiogenomic Landscape of Metastatic Endocrine-Positive Breast Cancer Resistant to Aromatase Inhibitors

Breast cancer poses a significant global health challenge and includes various subtypes, such as endocrine-positive, HER2-positive, and triple-negative. Endocrine-positive breast cancer, characterized by estrogen and progesterone receptors, is commonly treated with aromatase inhibitors. However, resistance to these inhibitors can hinder patient outcomes due to genetic and epigenetic alterations, mutations in the estrogen receptor 1 gene, and changes in signaling pathways. Radiogenomics combines imaging techniques like MRI and CT scans with genomic profiling methods to identify radiographic biomarkers associated with resistance. This approach enhances our understanding of resistance mechanisms and metastasis patterns, linking them to specific genomic profiles and common metastasis sites like the bone and brain. By integrating radiogenomic data, personalized treatment strategies can be developed, improving predictive and prognostic capabilities. Advancements in imaging and genomic technologies offer promising avenues for enhancing radiogenomic research. A thorough understanding of resistance mechanisms is crucial for developing effective treatment strategies, making radiogenomics a valuable integrative approach in personalized medicine that aims to improve clinical outcomes for patients with metastatic endocrine-positive breast cancer.

Innovations in the localization techniques for non-palpable breast lesions: Make invisible visible

Non-palpable breast cancer lesions pose a challenge for surgeons to resect cancer lesions. Making 'invisible' lesions 'visible' is the main strategy. Currently, multiple preoperative localization techniques have been applied in clinical. Among them, wire-guided localization (WGL) is the most common procedure due to its convenience and low cost. However, its limitations including discomfort, wire migration and the coupling of localization and operation procedures cause troubles for surgeons and patients. The desire for localization methods improvement, accompanied by the advance of emerging science and technology, leads to the development of a series of locating approaches for breast non-palpable lesions, aiming to improve locating accuracy while reducing adverse events. These emerging methods have undergone improvements from steel wire to functional particles, from radioactivity to non-radioactive, which help doctors and patients choose a more appropriate scheme. This review outlines the principles, procedures, advantages and disadvantages of these locating methods, and highlights the latest progress and related clinical data on innovative locating approaches. Finally, we briefly discuss the current challenges and future opportunities for the clinical application of these localization approaches.

Selective clearance of aberrant membrane proteins by TORC1-mediated micro-ER-phagy

Aberrant accumulation and clearance of membrane proteins is associated with disease. Membrane proteins are inserted first to the endoplasmic reticulum (ER). During normal growth, two quality control (QC) processes, ER-associated degradation and macro-ER-phagy, deliver misfolded and excess membrane proteins for degradation in the proteasome and lysosome, respectively. We show that in yeast during normal growth, ER-QC is constitutive, since none of the stress-induced signaling pathways-nutritional, proteotoxic, or heat-are involved. In mutant cells defective in ER-QC, misfolded or excess proteins accumulate and nutritional stress, but not proteotoxic or heat stress, can stimulate their clearance. Early during nutritional stress, clearance occurs in the lysosome through a selective micro-ER-phagy pathway dependent on the ubiquitin ligase Rsp5, its Ssh4 adaptor, and ESCRT. In contrast, only a fraction of normal membrane proteins is degraded much later via macro-autophagy. Because the pathways explored here are conserved, nutritional stress emerges as a possible way for clearing disease-associated membrane proteins.

Influence of histopathological changes after neoadjuvant chemotherapy on the survival of breast cancer patients

INTRODUCTION

Neoadjuvant chemotherapy (NACT) is an established form of therapy for early breast cancer (BC). The aim of our study was to analyze histopathological parameters before and after receiving NACT and to determine the influence of these changes on prognosis of BC patients.

MATERIAL AND METHODS

We retrospectively analyzed data of patients with primary early BC, diagnosed between January 2012 and December 2019, and NACT, followed by primary surgery. Patients achieving pathological complete response (pCR) were excluded. For the outcome analysis, disease-free survival (DFS) and overall survival (OS) were defined.

RESULTS

A total of 237 tumors were analyzed in the study. The conversion rates of tumor grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki67 status, and BC subtype were 34.6 %, 3.4 %, 14.3 %, 4.6 %, 30.0 %, and 28.7 %, respectively. After a median follow-up of 58.03 months, we found an association between consistently negative ER/PR with the worst prognosis (DFS and OS) (ER p < 0.0001 for both; PR p = 0.0003, p = 0.0004, respectively). The conversion from Ki67 ≥14 % to <14 % led to an improved outcome compared to a constant Ki67 ≥14 % (DFS p = 0.003, OS p = 0.001). Tumor residuals with a non-triple-negative (nTN) subtype (TN → nTN) showed a better prognosis than those with TN subtype (nTN → TN) (DFS and OS p < 0.0001).

CONCLUSIONS

After NACT, tumor grade and Ki67 showed the highest conversion rates between primary biopsy and tumor residual. Depending on changes in ER, PR, Ki67, and subtype, we found significant differences in the prognosis of the patients.

Plasma Proteomics and Metabolomics of Aromatase Inhibitors-Related Musculoskeletal Syndrome in Early Breast Cancer Patients

BACKGROUND

Aromatase inhibitors-related musculoskeletal syndrome (AIMSS) is a common side effect experienced by early breast cancer patients undergoing endocrine therapy. This condition can result in medication discontinuation and a diminished quality of life. The objective of this study was to characterize AIMSS, investigate its pathogenesis, and identify potential biomarkers at both the protein and metabolic levels.

METHODS

We collected peripheral blood samples from 60 women diagnosed with breast cancer undergoing aromatase inhibitor therapy, of whom 30 had AIMSS and 30 did not. The samples were analyzed using four-dimensional data-independent acquisition (DIA)-based proteomics and untargeted metabolomics, employing liquid chromatography-mass spectrometry (LC-MS) on the latest platform.

RESULTS

The mean age of participants was 49.2 (11.3) years in the AIMSS group and 50.1 (11.5) years in the non-AIMSS group. There were no statistically significant differences between the two groups in terms of age, BMI, education level, clinical stage, and treatment. In total, we identified 3473 proteins and 1247 metabolites in the samples. The chemokine signaling pathway (p = 0.015), cytokine-cytokine receptor interaction (p = 0.015), complement and coagulation cascades (p = 0.004), neuroactive ligand-receptor interaction (p = 0.004), and the estrogen signaling pathway (p = 0.004) were significant enriched in differentially expressed proteins (DEPs). GnRH secretion (p < 0.001), sphingolipid signaling pathways (p < 0.001), endocrine resistance (p < 0.001), the estrogen signaling pathway (p = 0.001), endocrine and other factor-regulated calcium reabsorption (p = 0.001), dopaminergic synapse (p = 0.003), regulation of lipolysis in adipocytes (p = 0.004), biosynthesis of cofactors (p = 0.004), thyroid hormone synthesis (p = 0.008), aldosterone synthesis and secretion (p = 0.001), taurine and hypotaurine metabolism (p = 0.011), ovarian steroidogenesis (p = 0.011), and the cAMP signaling pathway (p = 0.011) were significantly enriched in differentially expressed metabolites (DEMs). Complement C3 (p = 0.004), platelet factor 4 (p = 0.015), KRT10 (p = 0.004), KRT14 (p = 0.004), beta-estradiol (p = 0.019), testosterone (p = 0.023), sphingosine (p < 0.001), and 1-stearoyl-2-arachidonoyl-sn-glycerol (p = 0.039) could be the monitoring and therapeutic targets for AIMSS.

CONCLUSIONS

This study offered new insights into the mechanisms underlying musculoskeletal symptoms associated with aromatase inhibitors. It also highlighted potential biomarkers for predicting and addressing these symptoms in breast cancer patients, paving the way for improved intervention strategies.

Influence of Complete Lesion Removal During Vacuum-Assisted Breast Biopsy on the Upgrade Rate of B3 Lesions Presenting as Microcalcifications

Background: B3 lesions of the breast, for which vacuum-assisted biopsy (VABB) represents the standard tissue sampling approach, have different risks of upgrade to malignancy at surgery and/or follow-up. This study aimed to investigate if complete or partial lesion removal during VABB of B3 lesions presenting as microcalcifications influences their subsequent upgrade rate. Methods: For this retrospective single-center study, we retrieved 165 lesions diagnosed as B3 at VABB that presented solely as microcalcifications categorized as Breast Imaging Reporting & Data System (BI-RADS) 4 or 5 at mammography between January 2016 and December 2020. Surgical pathology or at least 3-year follow-up were obtained to determine potential lesion upgrade to malignancy. χ2, Fisher's, and Mantel-Haenszel tests were performed to assess if complete lesion removal influenced upgrade rates overall and among different B3 subtypes. Results: Complete lesion removal was achieved in 99/165 cases (60.0%) and did not differ among B3 subtypes (p = 0.092). The overall upgrade rate was 8.5% (95% confidence interval [CI] 5.1-13.7%, 14/165), without statistically significant differences among B3 subtypes (p = 0.562). Conversely, completely removed lesions (4.0%, 95% CI 1.6-9.9%) had a statistically significant lower upgrade rate compared to partially removed lesions (15.2%, 95% CI 8.4-25.7%, p = 0.019). According to stratified analysis according to B3 subtypes, the odds ratio of upgrade among completely and partially removed flat epithelial atypia (0.13, 95% CI 0.00-1.45) was lower (Mantel-Haenszel test p = 0.016) than those of atypical ductal hyperplasia (0.31, 95% CI 0.02-3.17) and of lobular neoplasia (0.73, 95% CI 0.01-60.62). Conclusions: The upgrade rate of B3 lesions is significantly influenced by complete lesion removal, both overall and among different B3 subtypes.

A comparative study on the short-term and long-term efficacy of endoscopic lipolysis, liposuction, and traditional open excision in gynecomastia treatment

OBJECTIVE

This study investigates the comparative short-term and long-term efficacy of endoscopic lipolysis and liposuction versus traditional open excision in the treatment of gynecomastia.

METHODS

A total of 140 male patients diagnosed with gynecomastia and admitted to our hospital from April 2021 to May 2022 were enrolled in this study. Patients were randomly assigned to two groups based on the surgical treatment method: the control group (traditional open excision, n = 70) and the observation group (liposuction under endoscope, n = 70). Comprehensive demographic and clinical data were collected for both groups. Surgical indicators, postoperative complication rates, and pain levels measured using the Visual Analog Scale (VAS) one month post-surgery were observed and compared. Additionally, recurrence rates and patient satisfaction scores were evaluated one year after the procedure.

RESULTS

There were no significant differences in demographic and clinical characteristics between the two groups (P > 0.05). The observation group exhibited shorter incision lengths, reduced operation times, and decreased hospital stays compared to the control group (P < 0.05), alongside less intraoperative bleeding (P < 0.05). The incidence of postoperative complications was significantly lower in the observation group (P < 0.05). At one and three weeks post-surgery, the observation group reported lower VAS scores for pain compared to the control group (P < 0.05). There were no significant differences in recurrence rates between the groups one year post-surgery (P > 0.05). However, the observation group achieved higher scores in terms of chest appearance, wound scarring, nipple and areola aesthetics, and overall satisfaction (P < 0.05).

CONCLUSION

Endoscopic lipolysis and liposuction not only demonstrate advantages such as lower complication rates and expedited recovery in the treatment of gynecomastia but also provide long-term efficacy comparable to traditional surgical methods. This approach significantly enhances patient satisfaction, establishing it as a preferred treatment option due to its safety profile and ability to deliver superior cosmetic outcomes.

Docetaxel rechallenge in HER2-negative metastatic breast cancer: a real-world study of previously discontinued patients for non-progression reasons

PURPOSE

This study aimed to evaluate the efficacy and safety of docetaxel rechallenge in HER2-negative metastatic breast cancer (MBC) patients who discontinued docetaxel for reasons other than disease progression.

PATIENTS AND METHODS

We retrospectively analyzed HER2-negative MBC patients treated with docetaxel-based therapy (DBT) at our institution from 2010 to 2020. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were assessed. Multivariate Cox regression and propensity score matching analysis (PSMA) were used to minimize bias.

RESULTS

Among 600 patients, 369 only received docetaxel once (control group), while 231 (38.5%) received docetaxel rechallenge as second or later-line therapy (rechallenge group). In the second-line rechallenge subset (143 patients), ORR was 51.0%, and PFS was 6.7 months. Multivariate analysis showed that a response to initial DBT (stable disease [SD] vs. complete response/partial response [CR/PR]: odds ratio [OR] 2.615, 95% confidence interval [CI] 1.373-4.981; p = 0.03) independently predicted the ORR. Beyond second-line rechallenge, the ORR and PFS were 37.5% and 5.6 months, respectively. After PSMA, the rechallenge group demonstrated significantly improved OS compared to the control group: 50.5 months vs. 46.0 months (Hazard Ratio [HR] 0.632; 95% CI 0.455-0.878; p = 0.006). The toxicities reported were manageable, primarily hematologic, with grade 3-4 events occurring in 19.5% of cases.

CONCLUSION

This study suggests that docetaxel rechallenge may be an effective and tolerable later-line treatment option for patients with HER2-negative MBC, particularly those who responded to initial DBT. However, further prospective, randomized controlled research is needed to fully evaluate its impact on disease response in this patient population.

DeepWalk-Based Graph Embeddings for miRNA-Disease Association Prediction Using Deep Neural Network

Background: In recent years, micro ribonucleic acids (miRNAs) have been recognized as key regulators in numerous biological processes, particularly in the development and progression of diseases. As a result, extensive research has focused on uncovering the critical involvement of miRNAs in disease mechanisms to better comprehend the underlying causes of human diseases. Despite these efforts, relying solely on biological experiments to identify miRNA-disease associations is both time-consuming and costly, making it an impractical approach for large-scale studies. Methods: In this paper, we propose a novel DeepWalk-based graph embedding method for predicting miRNA-disease association (DWMDA). Using DeepWalk, we extracted meaningful low-dimensional vectors from the miRNA and disease networks. Then, we applied a deep neural network to identify miRNA-disease associations using the low-dimensional vectors of miRNAs and diseases extracted via DeepWalk. Results: An ablation study was conducted to assess the proposed graph embedding modules. Furthermore, DWMDA demonstrates exceptional performance in two major cancer case studies (breast and lung), with results based on statistically robust measures, further emphasizing its reliability as a method for identifying associations between miRNAs and diseases. Conclusions: We expect that our model will not only facilitate the accurate prediction of disease-associated miRNAs but also serve as a generalizable framework for exploring interactions among various biological entities.

Comprehensive Analysis of Predictors and Outcomes in Breast Cancer Screening in Romania: Insights from Demographic, Clinical, and Lifestyle Factors

Background/Objectives: The primary purpose of this study is to provide a more in-depth insight into various demographic, clinical, and lifestyle factors in relation to breast cancer and to predict the extent to which certain variables described as "predictors" might lead to further investigation. By analyzing a large cohort, we are able to provide valuable and up-to-date information on breast cancer screening, support breast specialists, and further enhance international screening guidelines. Methods: We screened for breast cancer in a population of women aged 50 to 69 years by using the standardized breast cancer imaging screening method (breast mammography) and ultrasonography as a complementary imagistic tool, and we compared the results with the gold standard, breast biopsy. For this, 58,760 women with no known history of breast cancer coming from 4 major regions of Romania (North-East, North-West, South-East, and West) were first evaluated through mammography. Out of these, 3197 women with positive mammograms subsequently underwent a breast ultrasound examination. The remaining 688 patients with positive breast ultrasound were further referred for a breast biopsy. Results: The statistical analysis revealed several predictors such as the body mass index (BMI), positive family medical history of breast cancer, age at first birth, and age at menopause that influenced the progression from mammography (first stage of the screening program) towards echography (additional imaging modality). Furthermore, we established that age, age at first birth, and BMI are significant predictors of progression from echography towards biopsy (the last stage of the screening program). Furthermore, by analyzing the number of positive biopsies (688) out of the total number of patients in the study (58,760), we calculated a total breast cancer detection rate of 8 per 1000 patients. Lastly, by studying the patient demographics in the context of breast cancer (BC) screening, we observed that participants coming from an urban environment presented a higher rate of positive mammographic results as compared to ones of rural provenience. Conclusions: Our study analyzed a large cohort of patients and offers real world data which shows that multiple factors were positively associated with an increased risk of BC. Older age, older age at first birth, and an older menopausal age are all estrogen-dependent risk factors that were linked with an increased breast cancer risk in our study. Furthermore, our findings concerning the rural/urban disparities and regional differences highlight the need for region-specific interventions to address lifestyle risk factors, improve healthcare access, and enhance breast cancer screening and follow-up protocols, particularly in underserved areas like the North-East and South-East regions.

Association of social support and religiosity with survival among women with breast cancer in a low-income population in the Southeastern United States

BACKGROUND

Large social networks have been associated with better overall survival after a breast cancer diagnosis in some but not all study populations. This study evaluated associations of social support and religiosity/spirituality with survival among Black and White women with breast cancer of largely low socioeconomic status in the United States (US).

METHODS

The study used data from the prospective Southern Community Cohort Study, which enrolled approximately 86,000 adults in the southeastern US during 2002-2009. A total of 1,347 Black and White women with incident breast cancer were identified in the cohort and followed through December 2020 for mortality via linkage with the National Death Index. Exposures of interest were social support and religiosity obtained via baseline questionnaire, including number of close friends/relatives who can provide instrumental and emotional support, and frequency of attendance at religious services. Multivariable Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality in association with social support and religiosity. The models were tested for proportional hazards assumption using Schoenfeld residuals.

RESULTS

Among the 1,347 women with breast cancer, 365 (27.1%) died during follow up. The participants were followed up for 17 years with a median follow-up time of 5 years. In all-cause mortality analyses, women who reported having 2 + relatives/friends for emotional support had a 20% reduced hazard of death compared to women with ≤ 1 relative/friend (HR = 0.80, 95% CI: 0.67-0.96) after adjusting for age at breast cancer diagnosis, race, time from cohort enrollment to diagnosis, income, education, marital status, insurance, and tumor hormone receptor status. Similarly, women reporting having 2 + people able to provide instrumental support (render assistance in an emergency or lend money) had a 25% (HR = 0.75, 95% CI: 0.59-0.95) reduced hazard of death compared to those who had ≤ 1. Frequent attendance at religious services/meetings was associated with reduced hazard of death compared to those who did not attend (HR = 0.60, CI: 0.41-0.89); addition of cancer stage in the models attenuated this association.

CONCLUSIONS

A large social support network and regular attendance at faith-based services were associated with better survival among women with breast cancer. This calls for incorporating appropriate interventions to cancer care such as social support groups to improve survival.

EGFR-to-Src family tyrosine kinase switching in proliferating-DTP TNBC cells creates a hyperphosphorylation-dependent vulnerability to EGFR TKI

Triple-Negative Breast Cancer (TNBC) is the most aggressive type of breast malignancy, with chemotherapy as the only mainstay treatment. TNBC patients have the worst prognoses as a large fraction of them do not achieve complete pathological response post-treatment and develop drug-resistant residual disease. Molecular mechanisms that trigger proliferation in drug-resistant chemo-residual TNBC cells are poorly understood due to the lack of investigations using clinically relevant cellular models. In this study, we have established TNBC subtype-specific cellular models of proliferating drug-tolerant persister (PDTP) cells using different classes of chemotherapeutic agents that recapitulate clinical residual disease with molecular heterogeneity. Analysis of total phospho-tyrosine signals in TNBC PDTPs showed an enhanced phospho-tyrosine content compared to the parental cells (PC). Interestingly, using mass-spectrometry analysis, we identified a dramatic decrease in epidermal growth factor receptor (EGFR) expression in the PDTPs, while the presence of hyper-activated tyrosine phosphorylation of EGFR compared to PC. Further, we show that EGFR has enhanced lysosomal trafficking in PDTPs with a concomitant increase in N-Myc Downstream Regulated-1 (NDRG1) expression that co-localizes with EGFR to mediate receptor degradation. More surprisingly, we found that reduced protein levels of EGFR are coupled with a robust increase in Src family kinases, including Lyn and Fyn kinases, that creates a hyper-phosphorylation state of EGFR-Src tyrosine kinases axis in PDTPs and mediates downstream over-activation of STAT3, AKT and MAP kinases. Moreover, paclitaxel-derived PDTPs show increased sensitivity to EGFR TKI Gefitinib and its combination with paclitaxel selectively induced cell death in Paclitaxel-derived PDTP (PDTP-P) TNBC cells and 3D spheroids by strongly downregulating phosphorylation of EGFR-Src with concomitant downregulation of Lyn and Fyn tyrosine kinases. Collectively, this study identifies a unique hyper-phosphorylation cellular state of TNBC PDTPs established by switching of EGFR-Src family tyrosine kinases, creating a vulnerability to EGFR TKI.

Canine, Feline, and Murine Mammary Tumors as a Model for Translational Research in Breast Cancer

In veterinary medicine, mammary tumors are the most common neoplasms in female dogs and the third most frequent in cats, representing a significant challenge. Efforts have been directed toward adopting standardized diagnostic criteria to better understand tumor behavior and progression in these species. Meanwhile, the use of animal models has substantially advanced the understanding of comparative mammary carcinogenesis. These models provide critical insights into factors responsible for the disease in humans, with the expectation that such factors can be identified and controlled. In this context, this review presents a work based mainly on articles published by a research group specializing in mammary pathology (Laboratory of Comparative Pathology-Department of General Pathology-ICB/UFMG) and its collaborators, complementing their results with literature findings. The publications were categorized into animal research, experimental research, and human research. These studies addressed topics such as diagnosis, prognostic and predictive factors, tumor microenvironment, inflammation associated with tumors, treatment approaches, and factors influencing tumor growth. The conceptual network analysis underscores the importance of in vivo breast cancer models, both experimental and spontaneous, for understanding tumor progression mechanisms and therapeutic responses, offering valuable contributions to veterinary and human oncology.

Lymphovascular Invasion Is Associated With Doxorubicin Resistance in Breast Cancer

Lymphovascular invasion (LVI), the invasion of tumor cells into the lymphatic or vascular space, is an early indicator of potential metastasis, with its presence in breast cancer independently predicting poorer outcomes even after neoadjuvant chemotherapy. However, a major limitation is that LVI detection currently relies on postsurgical evaluation. To address this, we determined whether LVI+ breast tumors contain a unique gene signature that could facilitate earlier detection. Here, we conducted an integrative analysis of the gene profile between LVI+ and LVI- primary breast tumors from various sources, including published data and our own research, using both microarray and RNA-seq data. Our analysis revealed protein binding and vesicle-related genes to be the most enriched categories in LVI+ vs LVI- tumors. Furthermore, LVI+ tumors showed enrichment for xenobiotic metabolism genes, particularly drug metabolism enzymes, such as cytochrome P450 and uridine 5'-diphospho-glucuronosyltransferases. An elastic net regression model containing 13 of these uridine 5'-diphospho-glucuronosyltransferases and cytochrome P450 genes can predict LVI status with 92% accuracy. This suggests a potential link to drug resistance, which was further confirmed by the finding that patients with LVI+ tumors had a significantly lower clinical response rate than individuals with LVI- tumors. We also observed this resistance in patient-derived organoids, with LVI+ organoids exhibiting lower sensitivity to doxorubicin, implying that doxorubicin might be less effective for LVI+ breast cancer, potentially contributing to poorer outcomes. Overall, our study unlocked an exciting opportunity for personalized medicine, in that, therapy efficacy and patient outcomes can be improved by incorporating the LVI-associated gene signature into treatment plans.

Comparative Study of Mastectomy Surgical Techniques Followed by Reconstruction: Hydrodissection and Electrical Plasma Surgery

Background/Objectives: Mastectomy is a surgical option for breast cancer when conservative treatment is unsuitable, and it is also performed prophylactically in high-risk women. Various surgical techniques can be used for mastectomy, including electrosurgery, which can cause thermal damage to tissues, reducing surgical precision and delaying wound healing. This study aims to compare electrical plasma surgery and hydrodissection, which appear to be the least traumatic methods, to determine the better option for performing mastectomy with immediate reconstruction. Methods: Conducted at the "Breast Unit" of AO "OrdineMauriziano Umberto I", this study analyzed 56 patients undergoing 65 mastectomies (9 bilateral, 47 unilateral). A total of 16 were prophylactic, and 49 were oncologic. All patients received immediate subpectoral reconstruction. Data collected included preoperative medical history, pain, drain flow, blood transfusions, hemoglobin levels, and hospital stay duration. Complications were graded using the Clavien-Dindo classification. Results: Both groups were similar in age, body mass index (BMI), smoking habits, and comorbidities. Patients who underwent hydrodissection reported more pain on the first and second postoperative day and had longer hospital stays. The drop in hemoglobin from pre- to postoperative and the volume of surgical drains on the day of surgery and the first and second postoperative days were comparable between groups. Early complications and reintervention rates (Clavien-Dindo grade 3) were similar between techniques. Conclusions: Electrical plasma surgery offers better early postoperative outcomes in terms of pain and hospital stay, although overall complication and reintervention rates are unaffected by the technique used. Larger randomized studies are needed to confirm these findings and optimize patient management.

Is the information about occupational health and safety on YouTube reliable for users?

Companies provide employees with occupational health and safety (OHS) training through videos on YouTube. In this study, the reliability of 118 YouTube videos related to OHS was evaluated by two experts using Journal of the American Medical Association (JAMA) and global quality score (GQS) scales. Six video variables - video duration, number of subscribers, likes, views, publication time and comments - were evaluated based on video source (five groups) and type (seven groups). The correlation analysis found a positive significant relationship between all variables except publication time-number of comments. Scores according to video source and type were 1.9 out of 4 on the JAMA scale and 2.3 out of 5 on the GQS scale. These scores show that the videos are inadequate and of poor quality. There was a statistically significant difference between video durations according to video type. Moreover, video sources differ depending on the number of subscribers and comments.

Adiponectin Influences the Behavior of Stem Cells in Hormone-Resistant Breast Cancer

In the breast tumor microenvironment (TME), adipocytes exert a selective pressure on the behavior of breast cancer stem cells (BCSCs), which are involved in endocrine therapy resistance. In obesity, adipocytes secrete reduced levels of adiponectin, which promotes the growth and progression of ERα-positive breast cancer (BC). Here, we examined how low adiponectin levels affect the enrichment of the BCSC subpopulation and the mechanisms contributing to the maintenance of endocrine therapy resistance in BC. Flow cytometry, qRT-PCR, and Western blotting analysis were performed to assess stemness, the cell cycle, and apoptosis markers in MCF-7 wild-type (WT) and tamoxifen-resistant (TR) mammospheres. nLC-MS/MS was employed to profile and compare the proteome of BCSCs. Differentially expressed proteins were intersected with data from the MetacoreTM dataset. Our study demonstrated that adiponectin increased the percentage of CD44+/CD24-/ALDH1+ stem-like cells in TR MCF-7 mammospheres. Specifically, adiponectin contributed to the maintenance of BCSC bulk in TR MCF-7 cells through a slow cycling rate, supported by decreased levels of Cyclin D1 and Ki67 and increased p21 and p27 expression, and through escape from apoptosis, sustained by reduced ROS production and preserved maintenance of mitochondrial membrane potential. Our results provide new insights into the contribution of adiponectin to poor ERα-positive BC outcomes. Deeply understanding adiponectin's role in stemness may disclose novel therapeutic approaches to treat hormone-resistant obese BC patients.

Two-dimensional speckle tracking imaging and tissue Doppler imaging can predict subclinical left ventricular systolic and diastolic dysfunctions after chemotherapy for breast cancer

OBJECTIVE

This research primarily analyzes the clinical application of two-dimensional speckle tracking imaging (2D-STI), real-time 3-dimensional echocardiography (RT-3DE), and tissue Doppler imaging (TDI) in evaluating left ventricular dysfunction associated with breast cancer (BC) chemotherapy-related cardiotoxicity.

METHODS

First, we selected 106 BC patients who received treatment in The Affiliated Hospital of Chengde Medical University as the research group, all of whom underwent anthracycline-based chemotherapy; another 100 healthy subjects were chosen as the control group. Conventional ultrasound was employed to detect the mitral annular plane systolic excursion (MAPSE), mitral valve orifice early diastolic blood flow velocity (E), and left atrial volume index (LAVI) in the study subjects. 2D-STI was utilized to measure the global longitudinal strain (GLS) of the left ventricle, RT-3DE to measure left ventricular ejection fraction (LVEF), and TDI to measure the ratio of E to the average early diastolic mitral annulus velocity (E/e'), as well as systolic and early diastolic tissue velocities at the lateral wall of the mitral annulus and the ventricular septum (lateral s', septal s', lateral e', and septal e'). Left ventricular dysfunction was analyzed in both groups, and potential influencing factors were discussed.

RESULTS

The data revealed markedly lower GLS, MAPSE, E, lateral e', and septal e' in the research group compared to the control group. GLS<15.02% and LVEF<53% were defined as left ventricular systolic dysfunction. In comparison with the control group, the GLS and LVEF abnormality rates were evidently higher in the research group. No left ventricular diastolic dysfunction was observed in patients in both groups. Additionally, the dose of anthracyclines was a potential influencing factor for left ventricular dysfunction.

CONCLUSIONS

2D-STI and TDI have certain predictive implications for the occurrence of subclinical left ventricular systolic and diastolic dysfunctions after BC chemotherapy. Furthermore, high-dose anthracyclines might lead to left ventricular dysfunction.

Bibliometric and visual analysis of breast cancer-related lymphedema: Knowledge structure, research status, and future trends

BACKGROUND

As the survival rate of breast cancer patients increases, breast cancer-related lymphedema (BCRL) has gradually received attention from researchers. This study aims to sort out and summarize the relevant studies on BCRL using bibliometric analysis and to explore future research trends.

METHODS

In this study, we searched the Web of Science Core Collection for publications related to BCRL, analyzed the publication trends by applying Microsoft Excel 2019, and analyzed authors, cited journals, journal mapping overlays, cited references, and keywords by applying CiteSpace (v.6.1.R3 Advanced). SCImago Graphica (v.1.0.39) was applied to analyze countries/regions, institutions, and published journals.

RESULTS

We finally included 1000 publications published between 2003 and July 4, 2024. Publications showed an upward trend, with the largest number of publications in 2023. USA is the most published country, Harvard University is the most published institution, Taghian AG is the most published author, and DiSipio T is the most cited author. Lymphatic Research and Biology is the most published journal, and Cancer-American Cancer Society is the most cited journal. "Breast cancer," "arm lymphedema," and "quality of life" were the most frequent keywords. Current research focuses on risk factors, treatment strategies, and patients' quality of life with BCRL. Future research will mainly focus on establishing BCRL evaluation protocols, improving treatment techniques, and early prevention and detection of BCRL.

CONCLUSION

Our study sorts out the current knowledge structure in the field and highlights the current state of research and future research directions. These findings inform researchers and clinicians.

Cell signaling in Ehrlichia infection and cancer: Parallels in pathogenesis

Ehrlichia chaffeensis (E. chaffeensis) has recently emerged as an intracellular bacterial pathogen with sophisticated survival mechanisms that include repurposing evolutionarily conserved eukaryotic cell signaling pathways for immune evasion. E. chaffeensis exploits four major developmental signaling pathways (Wnt, Notch, Hedgehog, and Hippo) using short linear motif (SLiM) ligand mimicry to initiate signaling cascades. Dysregulation of these major signaling pathways leading to unchecked cell survival is implicated in various diseases, most notably cancer. E. chaffeensis exploits Wnt, Notch, Hedgehog and Hippo signaling pathways to inhibit apoptosis and co-opt other cellular functions to promote infection. This review will explore the signaling pathways exploited during Ehrlichia infection and the new discoveries that have illuminated this interesting example of the cell signaling convergence in cellular infection and cancer biology.

Reactive Oxygen Species Inducing Triazolylpyridine-Based Ru(II)/Ir(III) Complexes for Therapeutically Enhanced Triple-Negative Breast Cancer Treatment

The effectiveness of existing systemic and targeted therapies remains limited in triple-negative breast cancer (TNBC) treatment. Much research has been conducted on reactive oxygen species (ROS)-mediated cancer cell death to overcome the shortcomings of the currently applied chemotherapeutic treatments. Herein, we have developed novel Ru(II)/Ir(III)-mediated triazolylpyridine complexes as ROS inducers. Upon entering the TNBC cells, the Ru(II) complex effectively accumulated in mitochondria and triggered the creation of ROS, facilitating dysfunction of mitochondria and oxidative DNA damage, ultimately causing death of cells through G2/M phase cell cycle arrest. Eventually, this complex induced the upregulation of BAX (pro-apoptotic protein) and downregulation of BCL-2 (antiapoptotic protein) and triggered the caspase 3/9 pathway and released cytochrome c in the cytosol for apoptosis. The complex JRu (RuII triazolylpyridine) significantly reduced the integrity and viability of TNBC 3D spheroids.

Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals

BackgroundThe Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders.MethodsCANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive-compulsive and post-traumatic stress disorders (January 2013-October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations.ResultsThe guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided.ConclusionsThis guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.

Neutrophil-to-lymphocyte ratio is associated with accelerometer-measured physical activity levels in breast cancer survivors

INTRODUCTION

Physical activity (PA) has been associated with remarkable benefits in breast cancer (BC) survivors. However, the physiological mechanisms that underlie these benefits are not well understood and the published results are inconsistent and weak. Some authors suggest that some biomarkers, particularly those related with inflammation, insulin resistance, or sexual hormones may account for some of these benefits. Most studies have used self-reported tools to assess PA.

OBJECTIVE

To explore the association between objectively assessed PA and potentially related biomarkers.

METHODS

A cross-sectional study was performed in a single hospital in Madrid, Spain. Candidates were BC survivors older than 18, who had finished their treatments. PA was assessed through accelerometers. Biomarkers related with insulin resistance (glucose, insulin, IGF-1, IGFBP-3), inflammation (C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), interleukin (IL) 1, IL-6, IL-8, IL-10, TNF, sexual hormones (progesterone, testosterone, estrogens, androsterone), hypothalamic-pituitary axis (HPA) (cortisol), autonomic nervous system (ANS) (noradrenaline), and oxidative stress (8-hydroxy-2'-deoxyguanosine, 8-OHdG) were assessed.

RESULTS

Data of 91 women (mean age: 51.4 ± 8.1 years, mean BMI (kg/m2): 25.9 ± 4.5) were analyzed. Sedentary time (β (SE): - 0.001 (0.001), p-value 0.040) and vigorous PA time (β (SE): 0.010 (0.004), p-value 0.026) were significantly associated with NLR, but not with other biomarkers.

CONCLUSIONS

PA was not associated with biomarkers related to insulin resistance, sexual hormones, HPA, ANS, and oxidative stress. Neither was it associated with typical biomarkers of inflammation. An unexpected but consistent direct association with NLR was found. This relationship deserves further confirmation.

A Case of Sarcoid Uveitis Diagnosed With Mammography Two Months After Normal Chest Imaging

Purpose: Sarcoidosis is a systemic inflammatory disease associated with ocular involvement in 20%-30% of cases. The current gold standard for detecting sarcoidosis is computed tomography of the thorax, which is 73% sensitive. Definitive diagnosis necessitates biopsy, with Schaumann bodies and non-necrotizing granulomas serving as key pathological hallmarks. Observations: Our patient, a 44-year-old White female, presented for a second opinion on her bilateral chronic intermediate uveitis with intractable chronic cystoid macular edema of the left eye. Our clinical suspicion for sarcoidosis was high, but the computed tomography thorax scan did not show any abnormal findings. A routine mammogram completed 4 weeks prior to our initial evaluation showed axillary lymph node enlargement with calcifications. Subsequent biopsy was consistent with sarcoidosis. Treatment with mycophenolate mofetil resolved the uveitis and macular edema. Conclusions and Importance: The diagnosis of sarcoidosis can be challenging due to nonspecific ocular signs and the potential for falsely negative findings on imaging. This case highlights the importance of patient education and self-surveillance regarding the characteristic systemic symptoms of sarcoidosis, which commonly involve the lungs, eyes, skin, joints, etc. Our report demonstrates the significance of maintaining a high level of suspicion for sarcoidosis in patients with characteristic ocular findings, even when initial imaging results are negative or inconclusive.

Desmoid-type fibromatosis of the breast: a case report and literature review

Breast desmoid-type fibromatosis (BDF) is a rare tumor predominated by mesenchymal cells. It has a high recurrence rate, although distal metastasis is uncommon. It resembles breast cancer clinically, and histological pathology is the only approach to a confirmed diagnosis. Comprehensive and individualized treatments were recommended for BDF patients. Here, we presented a case of BDF secondary to primary breast carcinoma in our center. A 47-year-old female complained of a large mass in her left breast for 2.5 months. She has a past history of left breast carcinoma with a failure of surgical and systemic intervention. Despite an active re-operation, she still suffered from disease progression with a bad prognosis. After our report, the clinicopathological traits, differential diagnosis of BDF and current recommendation of management were discussed. This case report aimed to make a clear recognition of this rare and aggressive disease and elaborate up-to-date treatment recommendations. More effective drugs and larger sample clinical studies are encouraged for better management of refractory and progressive BDF.

Addition of Bevacizumab to Vinorelbine-Platinum combination is efficacious in Heavily Pretreated HER2-Negative Metastatic Breast Cancer

Introduction: Despite rapidly improving therapeutics, challenges remain in the treatment of advanced breast cancer. Vinorelbine, a semisynthetic vinca alkaloid, is effective and well-tolerated in breast cancer treatment. The combination of vinorelbine and platinum-combination is a well-tolerated but underreported chemotherapy regimen. Bevacizumab, a VEGF-neutralizing antibody, has shown efficacy in HER2-negative metastatic breast cancer (mBC) when combined with chemotherapy. In this study we aimed to investigate the clinical and molecular effects of vinorelbine-platinum in heavily pretreated HER2-negative mBC, as well as the impact of adding bevacizumab. Material and methods: We conducted a retrospective study at Taipei Veterans General Hospital to evaluate the effectiveness of the vinorelbine-platinum regimen in heavily pretreated HER2-negative mBC patients from 2016 to 2020, with a portion of patients receiving additional bevacizumab. To model the molecular perturbations at a cellular level, transcriptional profiling of a triple negative breast cancer cell line treated with cisplatin-vinorelbine was done by RNA-sequencing. Results: The cohort included 54 patients. 50% of the patients received ≥ 5 lines of systemic treatment in the metastatic setting. All the patients had received anthracyclines and taxane. In patients treated with vinorelbine-platinum combination, the median progression-free survival (PFS) and overall survival (OS) were 2.3 and 7.3 months, respectively. With bevacizumab, median PFS improved to 4.1 months. Objective response rate (ORR) and disease control rate (DCR) without bevacizumab were 11.1% and 27.7%, respectively, improving to 25% and 83.3% with bevacizumab. Adverse events occurred in 37.0% of patients, with no grade IV events reported. Transcriptional profiling revealed significant downregulation of MAPK pathway, angiogenesis, and growth factor signaling related genes. Conclusion: The vinorelbine-platinum regimen, particularly with bevacizumab, shows potential efficacy even in heavily pretreated HER2-negative metastatic breast cancer patients. Molecular analyses of treated cells highlight potential targets and mechanisms of action, providing a basis for future therapeutic strategies.

Chitosan-Functionalized Fluorescent Calcium Carbonate Nanoparticle Loaded with Methotrexate: Future Theranostics for Triple Negative Breast Cancer

Herein, fluorescent calcium carbonate nanoclusters encapsulated with methotrexate (Mtx) and surface functionalized with chitosan (25 nm) (@Calmat) have been developed for the imaging and treatment of triple-negative breast cancer (TNBC). These biocompatible, pH-sensitive nanoparticles demonstrate significant potential for targeted therapy and diagnostic applications. The efficacy of nanoparticles (NPs) was evaluated in MDA-MB-231 TNBC cell lines. The enhanced permeability and retention effect facilitated the accumulation of NPs, in tumor-bearing rats, as confirmed by in vivo fluorescence imaging. Treatment with @Calmat resulted in a marked reduction in pro-inflammatory cytokines, with levels of IL-6 (1225 ± 67 pg/mL), IL-1β (379 ± 69 pg/mL), and TNF-α (14.1 ± 2 pg/mL), in contrast to the diseased control group (IL-6: 2223 ± 99; IL-1β: 1632 ± 90; TNF-α: 40 ± 3 pg/mL). A similar trend was observed for liver and kidney function biomarkers. Mechanistic studies revealed that @Calmat treatment activates the Bax/Bcl-2 signaling pathway, leading to cell cycle arrest in the G1 phase and subsequent late-phase apoptosis. As a result, the tumor inhibition rate reached 88%, with 80% of treated rats surviving beyond 100 days. These findings highlight the strong potential of @Calmat as a dual-function theranostic agent for the management of TNBC.

Decoding gene expression profiles of Hippo signaling pathway components in breast cancer

INTRODUCTION

The Hippo signaling pathway is an evolutionarily conserved, tumor suppressor, stem cell pathway. This is the very less explored pathway in Breast Cancer. It is a crucial regulator of several biological processes, such as organ size, differentiation, tissue homeostasis, cellular proliferation, and stemness. Interestingly, deregulation of this pathway leads to tumorigenesis. Hence, the present study aims to identify the role of the Hippo signaling pathway in Breast Cancer.

MATERIALS AND METHODS

The mRNA expression of the Hippo signaling pathway molecules was evaluated in 120 pre-therapeutic patients by quantitative real-time PCR. Statistical analysis was carried out using SPSS 23. The association between the gene expression and clinicopathological parameters was analyzed by the paired sample t-test, and Pearson chi-square test. ROC curve analysis was carried out using Med Cal. A p-value of ≤ 0.05 was considered statistically significant.

RESULTS

The hippo signaling pathway contains 10 core components i.e.SAV1, MOB1A, MOB1B, MST1, MST2, LATS1, LATS2, YAP, TAZ, and TEAD1 which were downregulated in malignant tissues as compared to adjacent normal tissue in breast cancer. In the correlation of hippo signaling pathway molecules with clinico pathological parameters, only LATS1, MST1, and SAV1 were found to be significantly negatively associated with stages of Breast Cancer. MOB1B was found to be significantly positively correlated with stages of Breast Cancer. ROC curve analysis of YAP, TAZ, LATS2, and TEAD showed significant discrimination between adjacent normal and malignant tissue.

CONCLUSION

In the current study, all the molecules of the hippo signaling pathway i.e. YAP, TAZ, LATS1, LATS2, MST1, MST2, SAV1, MOB1, MOB1B, TEAD1 were downregulated in BC suggesting the activation of hippo pathway which played a significant role in tumor suppression.

Machine learning prediction of breast cancer local recurrence localization, and distant metastasis after local recurrences

Local recurrences (LR) can occur within residual breast tissue, chest wall, skin, or newly formed scar tissue. Artificial intelligence (AI) technologies can extract a wide range of tumor features from large datasets helping in oncological decision-making. Recently, machine learning (ML) models have been developed to predict breast cancer recurrence or distant metastasis (DM). However, there is still a lack of models that consider the localization of LR as a tumor feature. To address this gap, here, we analysed data from 154 patients including pathological, clinical, and follow-up data (with an average follow-up of 133.16 months) on both primary tumors (PT) and recurrences. By using ML methods we predicted the localization of LR and the occurrence of DM after LR. The performance (ROC AUC) of the best ML models was 0.75, and 0.69 for predicting LR in breast parenchyma, and surgical scar tissue, respectively, and 0.74 for predicting DM after LR. We identified recurrence localization, and the time elapsed between the detection of primary breast carcinoma and the recurrence, and adjuvant chemotherapy as the most important features associated with further DM. We conclude that combining traditional prognostic factors with ML may provide important tools in the risk assessment of patients with breast LR.

Magnetic surgical marker navigation for excision of non-palpable ultrasound visible breast lesions: first 200 cases in a French cancer center

Wire guided localization is widely used as the standard method of pre-operative localization of breast lesions. The aim was to assess outcomes following the introduction of a novel non-wire guided, magnetic surgical marker navigation system. A prospective study between May 2022 and June 2023 established a data base of the first 200 procedures performed using the Sirius Pintuition GPS Detect magnetic marker. The primary outcome measures were the successful excision of the target lesion and retrieval of the magnetic marker. The primary lesion was excised and the magnetic marker was retrieved in all 200 procedures. In 17 procedures (8.5% of the total sample), the magnetic marker was dislodged during surgery; however, the primary lesion was still effectively excised with clear margins without the need for an additional procedure or radiologic assistance. The re-excision rate to achieve margin clearance was 9%. Insertion of the marker was classified as "easy" and "in contact with the target" by the radiologist in all cases (100%). This study has shown that surgical marker navigation reliably localizes lesions and is associated with low re-excision rates. We also perceived improvement in theater planning.

Simultaneous Symmetrizing Surgery on the Contralateral Breast in Unilateral Autologous Breast Reconstruction Is Cost-Effective

BACKGROUND

 Simultaneous symmetrizing surgery (SSS) at the time of unilateral free flap reconstruction has been described as a method to facilitate single-stage breast reconstruction. However, the impact on cost and number of additional procedures is not well described.

METHODS

 Patients with unilateral free flap reconstruction were identified in national administrative data from 2017 to 2021 and followed for one year. Patients were stratified by immediate and delayed reconstruction, then further stratified into groups with and without SSS. Thirty-day complications included transfusion, wound dehiscence, surgical site infection, hematoma/seroma, and thromboembolism. The costs of initial hospitalization and subsequent surgeries were determined. Deferred symmetrizing surgeries within one year were identified. Chi-squared and Fisher exact tests and Wilcoxon tests were used for statistical analysis.

RESULTS

 A total of 1,136 patients were identified, out of which 638 were delayed reconstructions: 75 with SSS and 563 without. There were no significant differences in patient characteristics or 30-day complications. Within one year of index reconstruction, fewer patients with SSS underwent revision surgery (29% vs. 51%, [p = 0.001]) or at least one additional procedure (36% vs. 57%, p < 0.001). Patients with SSS had lower total costs ($35,897 vs. $50,521, p = 0.005). There were 498 immediate reconstructions: 63 with SSS and 435 without. There were no significant differences in patient characteristics, 30-day complications, subsequent surgeries, or total costs.

CONCLUSION

 Symmetrizing procedures at the time of unilateral reconstruction may decrease the cost and number of subsequent surgeries without increasing complications.

Breast Diffusion-weighted MR Imaging: Current Applications, Insights from Screening, and Future Directions

Breast diffusion weighted MR imaging (DWI) is increasingly used, because it is fast and easy to be added in clinical protocol without contrast agent and provides information of cellularity or tissue microstructure. This review article explores the principles of breast DWI, the standardization of acquisition techniques, and its current clinical applications. We emphasize its role in differentiating benign from malignant lesions, reducing unnecessary biopsies, and discuss the evidence supporting DWI as a potential standalone screening tool. Prognostic indicators derived from DWI parameters and its utility in monitoring treatment responses are discussed. Finally, we look to the future, discussing emerging techniques. This review provides a comprehensive overview of breast DWI's current status and future potential.

Caught in the Crossfire: A Case of Splenic Infarction Amid G-CSF therapy in Chronic Myelomonocytic Leukaemia

This report highlights a rare but significant complication associated with the use of granulocyte-colony stimulating factor (G-CSF) therapy, specifically splenic infarction, in a 67-year-old male with chronic myelomonocytic leukaemia (CMML) undergoing chemotherapy. G-CSFs, such as pegfilgrastim, are frequently used to prevent febrile neutropenia in cancer patients undergoing myelotoxic chemotherapy. While G-CSF is effective in reducing the risk of neutropenia, its administration has been linked to uncommon but severe complications such as splenic infarction and rupture. Our patient, receiving dose-dense chemotherapy with G-CSF support, developed severe abdominal pain midway through treatment. A computed tomography (CT) scan revealed multiple splenic hypodensities consistent with splenic infarction, but no active bleeding. Conservative management was successfully employed, avoiding surgical intervention. This case underscores the need for vigilance when administering G-CSF, particularly in patients at high risk for complications, and contributes to the limited body of literature on G-CSF-induced splenic infarction.

LEARNING POINTS

Clinical vigilance in G-CSF therapy This report highlights the need for heightened awareness of rare but severe complications, such as splenic infarction, associated with granulocyte-colony stimulating factor (G-CSF) therapy. Internists managing patients on chemotherapy must recognise early signs of such complications to optimise patient outcomes.Risk-benefit assessment It emphasises the importance of individualised treatment strategies, balancing the lifesaving benefits of G-CSF in preventing febrile neutropenia with the potential risks, particularly in patients with predisposing conditions such as chronic myelomonocytic leukaemia (CMML).Conservative management insights The successful non-surgical management of splenic infarction in this case underscores the potential for conservative approaches, providing valuable guidance for internists in similar clinical scenarios.

Divide and Conquer-Targeted Therapy for Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) is the most aggressive and malignant type of breast cancer with limited treatment options and poor prognosis. One of the most significant impediments in TNBC treatment is the high heterogeneity of this disease, as highlighted by the detection of several molecular subtypes of TNBC. Each subtype is driven by distinct mutations and pathway aberrations, giving rise to specific molecular characteristics closely connected to clinical behavior, outcomes, and drug sensitivity. This review summarizes the knowledge regarding TNBC molecular subtypes and how it can be harnessed to devise tailored treatment strategies instead of blindly using targeted drugs. We provide an overview of novel targeted agents and key insights about new treatment modalities with an emphasis on the androgen receptor signaling pathway, cancer stem cell-associated pathways, phosphatidylinositol 3-kinase (PI3K)/AKT pathway, growth factor signaling, and immunotherapy.

Psycho-spiritual wellbeing and coping strategies of women with breast cancer post-radiation therapy in Kumasi, Ghana

Breast cancer (BCa) is one of the leading causes of mortality among women in most countries in sub-Saharan Africa (SSA). Female survivors of BCa have been the primary subjects of most studies with a focus on therapies like chemotherapy and mastectomy but less on radiation therapy especially experiences post-radiation therapy. We explored the psycho-spiritual well-being and coping strategies of women with BCa post-radiation therapy in Kumasi, Ghana. In this qualitative enquiry, we purposively recruited seventeen (17) women with BCa post-radiation therapy. The participants were interviewed, and the interviews were audio-taped and transcribed verbatim. Thematic analysis was conducted with the aid of NVivo 10.0. The main themes that emerged from the data indicated psychological characteristics of relief, emotional changes related to anxiety, agitation and distress due to frequent hospital visits as well as improved prayer life or religiosity and faith for healing. Also, four sub-themes of coping were identified: Religious coping strategy, diversionary therapy, breast pad utilization and social engagement. Radiation therapy in women with BCa is highly stressful particularly the requirement of frequent hospital visits. We recommend the inclusion of psychological management for women with BCa during and post-radiation therapy to improve their overall psycho-spiritual well-being.

Diagnosis-Related Group-Based Financing of Gynecologic Oncology Clinics: A Systematic Review

Background/Objectives: Diagnosis-related group (DRG)-based financing, a subcategory of case-based payment models, has been established as the primary reimbursement scheme in most high-income countries. Almost 40 years thereafter, the impact of the reform on gynecologic oncology funding and recompensation has not been clearly elucidated. This systematic review aims to address the scarce bibliographic data, consolidate the information regarding DRG-based systems in gynecologic oncology, evaluate the advantages and challenges of its implementation worldwide, and examine alternative and complementary recompensation schemes in this context. Methods: A stringent and comprehensive literature review of original articles using online databases (Google Scholar and Pubmed) yielded 173 potential results. Results: These were further assessed for relevance and eligibility and, finally, an in-depth investigation of 15 articles was conducted. We concluded that, despite the fact that DRG-based financing may be beneficial in most healthcare scenarios, the reimbursement scheme is challenged in the context of gynecologic oncology. Conclusions: An innovative approach comprising a combination of the values of case-based and value-based payment models would extend healthcare services beyond acute treatments and propose new perspectives in holistic healthcare provision in a financially sustainable environment.

Prognostic Implications of Magee Equation 3 and Residual Cancer Burden in Patients Receiving Neoadjuvant Chemotherapy for Hormone Receptor-Positive HER2-Negative Breast Cancer

Breast cancer (BC) presents significant molecular heterogeneity, complicating prognosis and treatment strategies. Although molecular testing enhances our understanding of BC, high costs can limit accessibility in certain health care settings. This retrospective cohort study evaluates the prognostic value of Magee equation 3 (ME3) and residual cancer burden (RCB) in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative BC treated at the Instituto do Câncer do Estado de São Paulo from January 2011 to January 2024. We included 203 women, with a mean age of 50.2 years, diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative BC (stages I-III), who completed neoadjuvant chemotherapy followed by surgery. ME3 scores were categorized as low (<18), intermediate (18-25), and high (>25), whereas RCB was classified into 4 groups (0, 1, 2, or 3). Associations between ME3 and RCB categories were analyzed using χ2 and Cochran-Mantel-Haenszel tests. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method with log-rank tests. Prior to neoadjuvant chemotherapy, 60.1% of patients had tumors >5 cm, 69.5% had positive lymph nodes, and 85.7% had invasive carcinoma of nonspecial type, with a mean Ki67 index of 35.5%. Analysis revealed that 22.2% of patients had ME3 >25, 39.9% had ME3 18-25, and 37.9% had ME3 <18. A significant inverse association was found between RCB and ME3 (P < .0001). At a median follow-up of 91.4 months (range: 8-157 months), significant associations were noted for OS (log-rank P = .0059) and DFS (log-rank P = .0028) with ME3 categories; patients with low ME3 showed better outcomes. In patients with RCB-3, those with ME3 <18 had a lower risk of recurrence compared with those with ME3 18-25 (hazard ratio: 4.70, 95% CI: 2.00-11.02; P = .0004) and ME3 > 25 (hazard ratio: 5.18, 95% CI: 1.85-14.15; P = .0017). Similarly, lower risks of death were observed for ME3 < 18 versus higher ME3 categories. In conclusion, ME3 significantly correlates with OS and DFS, suggesting that it may serve as a valuable alternative to molecular assays in resource-limited settings. Combining ME3 with RCB enhances individualized risk stratification, providing a more precise prognostic assessment for patients with high RCB.

Tumor characteristics and survival rate of axillary metastatic breast cancer patients: a three decades retrospective cohort study

BACKGROUND

Lymph node (LN) involvement, as an important prognostic factor in breast cancer (BC) patients, has a crucial role in their therapeutic approach. Consequently, a great desire is to thoroughly assess the patients based on their axillary LN status. The present study evaluated the characteristics and survival rate of axillary metastatic BC patients in a Tertiary and referral center.

METHOD

The overall survival, disease-free survival, and clinicopathological characteristics of axillary metastatic BC patients referred to the Cancer Research Center in Tehran, Iran, from 1991 to 2022 were assessed retrospectively. We obtained patients' clinical data from prospectively maintained registries.

RESULT

Among the total 3399 recruited patients, 49.1%, 26.3%,13.1%, and 6.4% were pN0, pN1, pN2 and pN3, respectively. The pN0 group patients showed a significantly lower Hazard Ratio (HR) for DFS and OS compared to others. Moreover, estrogen and progesterone receptors, human epidermal growth factor2, tumor pathology type and tumor grade were prognostic factors of axillary LN status. Accordingly, pN0 patients had a lower recurrence risk than the others (P = 0.01).

CONCLUSION

The axillary lymph node status has been considered as one of the fundamental factors determining the therapeutic strategy and prognosis of BC patients, which has an association with tumor characteristics. Regarding the crucial impact of the LN status on the survival landscape of breast cancer patients, accurate detection of the involved one and close screening follow-up of patients with more metastatic LNs during the surgery have a high value.

A Case of Cystic Neutrophilic Granulomatous Mastitis in Which Mycobacteroides abscessus Was Detected

INTRODUCTION

Cystic neutrophilic granulomatous mastitis (CNGM) is characterized by granulomas with cysts that sometimes contain bacteria in the lumen, a surrounding neutrophilic infiltrate, and Langhans giant cells. There are no universally accepted diagnostic criteria for CNGM. Corynebacterium kroppenstedtii, a Gram-positive bacillus, has been reported to cause several infections, but the exact cause remains unclear. We report our experience with a case of CNGM, thought to be due to a rare Mycobacteroides abscessus infection.

CASE PRESENTATION

We report the case of a 36-year-old Japanese woman with granulomatous mastitis due to Mycobacteroides abscessus who had not undergone surgery and was not immunosuppressed. She presented with a chief complaint of pain and swelling in her left breast for 1 month. Mammography showed asymmetrical focal increased density, and ultrasonography showed an irregular hypoechoic area in the left 3 o'clock position. Contrast-enhanced magnetic resonance imaging showed segmental non-mass-enhancement. Ultrasound-guided vacuum-assisted biopsy with pathology revealed granulomatous mastitis. Ziehl-Neelsen staining revealed red-staining bacilli. The patient was followed up for observation because her breast pain had decreased after the examination, and there was no redness or fever. However, the breast pain has not completely disappeared, and intermittent purulent discharge from the biopsy site persisted for 5 months. Hence, two 12-Fr drains were inserted along the ductal dilatation-like hypoechoic area. Imipenem, amikacin, and clarithromycin were administered for 8 days. After 8 days of this therapy, the patient developed a drug-associated rash; therefore, antimicrobial therapy was discontinued, and the drains were removed. Her symptoms improved, and magnetic resonance imaging after 1 month showed that the previous imaging findings in her left breast had disappeared. At the time of writing, 18 months have passed since treatment, and no recurrence has been observed.

CONCLUSIONS

We experienced a rare case of CNGM associated with Mycobacteroides abscessus. This case suggests that a combination of drainage and antimicrobial therapy may shorten the duration of antimicrobial therapy in CNGM.

Coping and Positive Body Image in Young Women with Breast Cancer: The Buffering Role of Social Support

Background/Objectives: Considering the unique body image challenges faced by young women with breast cancer, this study aims to deepen our understanding of how coping strategies and perceived social support contribute to fostering positive body image in this population. This is an important issue as body image is capable of influencing women's self-esteem and psychological adaptation to breast cancer. Methods: A sample of 157 young women with breast cancer (M age = 41.43; SD = 6.05; Min 26 years, Max 50 years), 43% of whom had undergone breast reconstruction, completed an online survey. The survey included measures of coping strategies, positive body image, and perceived social support. Results: No significant differences in coping strategies, perceived social support, or positive body image were observed based on reconstruction status. Moderation analyses revealed that both avoidant and problem-focused coping were significantly associated with positive body image at moderate and high levels of perceived social support, but not at low levels of perceived social support. Perceived social support moderated the relationship between coping strategies and positive body image in women with breast cancer. Conclusions: These findings highlight the importance of social support in enhancing the effectiveness of both avoidant and problem-focused coping strategies in promoting positive body image. Future interventions should prioritize strengthening social support networks to optimize psychological outcomes in this population.

Peripheral blood PD-1+ T lymphocytes as biomarkers in liquid biopsies for solid tumors: Clinical significance and prognostic applications

A shift toward a T cell exhaustion phenotype is associated with the upregulation of expression of programmed cell death protein 1 (PD-1) on T lymphocytes in patients with malignant solid tumors. The interaction between PD-1 and programmed death-ligand 1 (PD-L1) inhibits PD-1+ T lymphocyte function, impacting their anti-tumor immune activity. Immune checkpoint inhibitors targeting PD-1/PD-L1 have revolutionized the treatment of various solid malignancies, improving therapeutic efficacy and survival outcomes. Peripheral blood analysis of liquid biopsies is being increasingly used to identify populations most likely to benefit from various treatment modalities. PD-1+ T lymphocytes represent the primary cell population responsive to immunotherapeutic interventions for patients with solid malignancies, as evidenced by the altered PD-1 expression levels and proportion of cells comprising the overall population of immunocytes. PD-1+ T cells in peripheral blood exert an associative and reciprocal predictive effect on homologous intratumoral cells. Distinct subpopulations of PD-1+ T cells exhibit differential ability to proliferate in the periphery and can be characterized by tumor antigen-specific and exhaustion phenotypes. These characteristics have prognostic implications, aiding in the prediction of the efficacy of antitumor therapy and predicting survival outcomes. We highlight distinct subpopulations of PD-1+ T cells, their exhaustion and antigen-specific phenotypes, and their dynamic changes over treatment, providing insights into their utility for tailoring personalized therapies. For the first time, this review discusses the role of peripheral PD-1+ T lymphocytes as prognostic biomarkers in liquid biopsies, focusing on their clinical significance, predictive value during therapy, and future research directions.

Advancements in clinical research and emerging therapies for triple-negative breast cancer treatment

Triple-negative breast cancer (TNBC), defined by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) expression, is acknowledged as the most aggressive form of breast cancer (BC), comprising 15%-20% of all primary cases. Despite the prevalence of TNBC, effective and well-tolerated targeted therapies remain limited, with chemotherapy continuing to be the mainstay of treatment. However, the horizon is brightened by recent advancements in immunotherapy and antibody-drug conjugates (ADCs), which have garnered the U.S. Food and Drug Administration (FDA) approval for various stages of TNBC. Poly (ADP-ribose) polymerase inhibitors (PARPi), particularly for TNBC with BRCA mutations, present a promising avenue, albeit with the challenge of resistance that must be addressed. The success of phosphoinositide-3 kinase (PI3K) pathway inhibitors in hormone receptor (HR)-positive BC suggests potential applicability in TNBC, spurring optimism within the research community. This review endeavors to offer a comprehensive synthesis of both established and cutting-edge targeted therapies for TNBC. We delve into the specifics of PARPi, androgen receptor (AR) inhibitors, Cancer stem cells (CSCs), PI3K/Protein Kinase B (AKT)/mammalian target of rapamycin (mTOR), the transforming growth factor-beta (TGF-β), Ntoch, Wnt/β-catenin, hedgehog (Hh) pathway inhibitors, Epigenetic target-mediated drug delivery, ADCs, immune checkpoint inhibitors (ICIs)and novel immunotherapeutic solutions, contextualizing TNBC within current treatment paradigms. By elucidating the mechanisms of these drugs and their prospective clinical applications, we aim to shed light on the challenges and underscore the beacon of hope that translational research and innovative therapies represent for the oncology field.

Cyclin-dependent kinase 4/6 inhibitor-associated pulmonary toxicity: a disproportionality analysis from 2015 to 2023 based on the FAERS database

OBJECTIVES

This study aimed to describe the pulmonary toxicity of cyclin-dependent kinase 4/6 inhibitors (CDK 4/6 inhibitors) (palbociclib, ribociclib, and abemaciclib) in patients being treated for breast cancer using the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

RESEARCH DESIGN AND METHODS

Disproportionality analysis was performed to assess pulmonary toxicity associated with CDK 4/6 inhibitors. Clinical characteristics, onset time, sensitivity analysis, subgroup analyses, drug combinations, comorbidities, and co-reported events were performed.

RESULTS

Out of 83,505 CDK 4/6 inhibitor-related adverse events (AEs) documented in the FAERS database during the study period, 437 cases of pneumonitis, 555 cases of pulmonary edema, and 181 cases of pulmonary thrombosis related to CDK 4/6 inhibitors were analyzed. Pneumonitis and pulmonary thrombosis had the strongest signal strength in abemaciclib; pulmonary edema had the strongest signal strength in ribociclib. The median latency for pneumonitis, pulmonary edema, and pulmonary thrombosis was 66-173.5 days, 27-131 days, and 68-279 days, respectively. Pulmonary toxicity is statistically significant disproportionality in females as well as in patients over 60 years old.

CONCLUSION

Abemaciclib was most strongly associated with pneumonitis and pulmonary thrombosis. Ribociclib was most strongly associated with pulmonary edema. The correlation with pulmonary toxicity was, in descending order, abemaciclib, ribociclib, and palbociclib.

Clinical efficacy of different methods for treatment of granulomatous lobular mastitis: A systematic review and network meta-analysis

OBJECTIVE

This network meta-analysis aims to evaluate the recurrence rates of various treatment options for granulomatous lobular mastitis.

METHODS

We systematically searched and identified eligible studies in PubMed, EMBASE, Cochrane Library, and Web of Science databases until September 30, 2023. Original studies reporting the recurrence rates of various treatments were included. Subsequently, literature screening, data extraction, and network meta-analysis were conducted. This study was registered with PROSPERO (registration number CRD 42023434773).

RESULTS

Nineteen articles involving 1,095 patients were included in this study. The network meta-analysis revealed that several treatment combinations reduced the recurrence rate compared to observation: Surgery + Local steroid injection + Systemic steroids therapy (OR: 0.23, 95% CI 0.01 to 4.53), Local steroid injection (OR: 0.34, 95% CI 0.02 to 6.81), Surgery + Systemic steroids therapy (OR: 0.36, 95% CI 0.02 to 5.29), Surgery + Traditional Chinese Medicine (OR: 0.33, 95% CI 0.01 to 9.11), Systemic steroids therapy + MTX (OR: 0.62, 95% CI 0.01 to 34.59), and Systemic steroids therapy + drainage (OR: 0.76, 95% CI 0.05 to 10.67). Among these, Surgery + Local steroid injection + Systemic steroids therapy demonstrated superior efficacy. The surface under cumulative ranking curve (SUCRA) values were highest for Surgery + Local steroid injection + Systemic steroids therapy (0.85), followed by Local steroid injection (0.78) and Surgery + Systemic steroids therapy (0.77).

CONCLUSIONS

Steroid-based combination therapy may be the first choice for IGM patients, with a comprehensive strategy of local and systemic steroids combined with surgery having the best effect on IGM.