Translational breast cancer research : a journal focusing on translational research in breast cancer最新文献

Background and objective: Lymphedema is a chronic, progressive disease secondary to damage to the lymphatic system that results in interstitial fluid accumulation, fat deposition and inflammation. Lymphatic surgery includes a spectrum of procedures aimed to treat these sequelae of lymphedema as well as decrease the risk of lymphedema if performed as prophylactic surgery. We reviewed the literature regarding current surgical treatment options for lymphedema, imaging approaches, and directions the field may head towards both in treatment access and techniques.

Methods: We systematically reviewed PubMed, Embase, and Cochrane Library databases to identify approaches to surgical management of lymphedema, including physiologic and reductive methods, as well as challenges that lymphedema patients face for adequate access and insurance coverage to surgical treatment options.

Key content and findings: Lymphatic surgery can be broadly categorized as physiologic or reductive. Physiologic lymphatic surgery functions to decrease the fluid burden associated with lymphedema and includes lymphovenous bypass as well as vascularized lymph node transplant procedures. Reductive lymphatic surgery reduces the fibroadipose component of lymphedema and include suction lipectomy and excisional procedures. Advances in imaging technology as well as supermicrosurgical techniques have allowed for reproducible, positive clinical outcomes after lymphatic procedures. Access to care and coverage of procedures are persistent challenges in the field, though increasing adoption and research have led to important strides forward to providing patients with this care.

Conclusions: Lymphatic surgery can improve symptoms and quality of life for lymphedema patients. A clear understanding of the predominant pathology in a patient (i.e., fluid dominant vs. fat dominant) can help guide counseling and surgical management options for patients. Despite the established benefits for patients, equitable access and insurance coverage for lymphedema surgery are still required.

Background and objective: In the era of de-escalation and minimally invasive locoregional treatments across many fields of surgical oncology, the treatment of the axilla in breast cancer has garnered significant interest. While the knowledge of axillary lymph node involvement is crucial for multidisciplinary management, the surgical approach to the axillary basin can have potential disadvantages that may impact the quality of life. The objective of this narrative review is to examine studies about de-escalation of axillary treatment in various clinical scenarios, namely the settings of upfront surgery and neoadjuvant systemic treatments. Moreover, trials investigating omission of axillary surgery were examined.

Methods: As of July 2024, a comprehensive literature search, compilation, and analysis were conducted across PubMed, Scopus, Web of Sciences, and ClinicalTrials.gov.

Key content and findings: In patients with clinically node-negative lymph nodes and up to two positive sentinel nodes, avoiding axillary lymph node dissection is a safe option. As for patients receiving neoadjuvant systemic treatment, axillary lymph node dissection is unnecessary if no residual tumor burden remained in the lymph nodes after surgery. Additionally, studies have shown that axillary radiotherapy can be as effective as axillary dissection in certain cases. The avoidance of any axillary surgery might be proposed to highly select sub-groups patients with small tumors and negative on clinical and ultrasound evaluation lymph nodes.

Conclusions: To date, determining the appropriate axillary treatment remains a complex decision that must be made by multidisciplinary teams with expertise in personalized breast cancer treatment.

Background and objective: Breast, endometrial, and ovarian cancers (OCs) are significant public health concerns. Approximately three million patients are diagnosed with one of the three tumor types annually. The three tumor types exhibit related epidemiological trends, lifestyle risk factors, and tumor-specific characteristics which may influence their incidence and outcomes. While the majority of the literature examining hormone dependence of cancer appropriately is centered around breast cancer (BC), insufficient attention has been paid to how lessons from the biology of endometrial and OC may inform what we know about the biology of BC and vice versa. This narrative review seeks to address that unmet need.

Methods: The construction of this narrative review involved searching PubMed in April and July 2024 for manuscripts related to breast cancer metabolism, ovarian cancer metabolism, and endometrial cancer metabolism. Only manuscripts written in English were considered.

Key content and findings: This narrative review discusses epidemiologic, systemic, and local factors that may affect breast, endometrial, and OC. Simultaneously analyzing these three tumors offers an opportunity to gain unifying insights into reproductive hormone-dependent cancer biology; unfortunately, the field lacks studies directly comparing the impact of the aforementioned factors on these three tumor types. Therefore, we are limited to comparing the impact of similar systemic factors on tumor progression in each tumor type.

Conclusions: There is some convergence of systemic metabolic changes, particularly with regard to factors associated with obesity, on the biology of breast, ovarian, and endometrial cancer. However, future research is needed in order to clarify the convergent-or potentially divergent-mechanism(s) by which obesity affects breast, endometrial and OC.

Background: During management of node-positive breast cancer, neoadjuvant systemic therapy (NST) is often used to de-escalate surgical intervention. To identify pathology-proven positive nodes regardless of visual changes after NST, breast biopsy clips or markers are inserted under ultrasound guidance as part of standard care, though most markers are used off-label in the axilla. However, clipped nodes may be difficult to visually confirm with ultrasound after a pathological complete response. This can affect the ease of executing subsequent procedures, such as surgical resection, because identifying the marked or clipped nodes in these cases is problematic. The mechanisms that affect these changes in clip conspicuity are poorly understood, making it challenging to improve ultrasound conspicuity of clips in the clinical setting. The aim of this study is to determine which of these mechanisms are inherent to ultrasound as an imaging modality and if they can be accounted for by adjustments to ultrasound scanner settings.

Methods: The effect of viewing angle on brightness is assessed in multiple imaging targets, including five commercially-available clips, suspended in gelatin phantoms. Off-gassing from insertion of a dry clip into tissue is assessed as another possible explanation for the observed changes in conspicuity.

Results: Brightness was found to vary significantly with viewing angle for some clips. An ex vivo examination of clip conspicuity with time found no changes that would indicate effects such as off-gassing after dry clip insertion.

Conclusions: Viewing angle is not affected by any other settings on an ultrasound system besides probe position, suggesting that conspicuity may not be recoverable if repositioning cannot clarify clip location. Even when viewing angle is not a concern in tissue, the presence of other bright scatterers in the field of view can obscure the location of the clip.

No treatment has been established for meningeal carcinomatosis (MC) in advanced metastatic breast cancer, and its prognosis is poor. In recent years, systemic therapies such as trastuzumab deruxtecan and tucatinib have been reported effective for human epidermal growth factor receptor 2 (HER2)-positive breast cancer, however, these cannot be used for all MC. The difficulty in diagnosing and treating MC is attributed to its diverse pathology. As a result, in clinical practice, diagnosis is often delayed, and symptoms persist. This review focuses on whether neurological symptoms can be effectively alleviated even with unestablished treatments by classifying the pathology of MC into meningitis, hydrocephalus-related intracranial hypertension symptoms, focal brain damage such as epilepsy, cranial nerve disorders, and spinal cord symptoms and evaluating the diagnosis and condition. Hydrocephalus can be managed with drainage and ventriculoperitoneal shunt surgery, and meningitis symptoms and cranial nerve disorders can be managed with whole brain radiotherapy. Antiepileptic drugs are essential for epilepsy, and supportive care is necessary, as are steroids for cranial nerve disorders. However, MC is not caused by a single condition but can occur in combination thus the therapeutic effectiveness of palliative therapy for neurological symptoms is currently unknown, and research is limited. In the future, if a lineup of highly effective systemic therapies such as tyrosine kinase inhibitors for ALK gene-positive lung cancer is established, treatment strategies for MC may change. However at present, rapid diagnosis and prompt neurological palliative treatment play an important role in the neurological symptoms management of MC.

Background and objective: With the rapid development of breast cancer treatment, breast cancer pathologic diagnosis has faced many requirements and challenges. This article reviews and summarizes important results that will change the clinical practice of breast cancer in 2023 and 2024.

Methods: As of April 2024, a comprehensive literature search, compilation, and analysis were conducted across PubMed, Baidu Scholar, ClinicalTrials.gov, and relevant academic conferences.

Key content and findings: This article focused on invasive lobular carcinoma (ILC), phyllodes tumors, new advances in immunohistochemical (IHC) indexes, updated advances in neoadjuvant therapy for breast cancer, and advances in the study of human epidermal growth factor receptor 2 (HER2)-low breast cancer. ILC has unique molecular distribution and clinical characteristics, distinguishing it from the traditional molecular classification and clinical features of invasive ductal carcinoma. Understanding the accurate diagnosis, immune microenvironment, and genetic changes of phyllodes tumors holds pivotal importance in guiding clinical treatment. Pathologic evaluation after neoadjuvant therapy is essential for the treatment of breast cancer patients, but clear and uniform criteria are lacking. With the breakthrough of new antibody-drug conjugate drugs in the treatment of breast cancer patients with low HER2 expression, the pattern of traditional anti-HER2 treatment has changed, bringing targeted benefit opportunities for more breast cancer patients. At the same time, the dichotomy used for breast cancer HER2 detection and interpretation has also been broken, which puts forward more accurate requirements for pathological diagnosis. IHC results for HER2 low also exhibit variability and are influenced by various factors.

Conclusions: Breast cancer treatment and pathology have made significant progress in 2023 and 2024. This will help ensure more accurate diagnoses and provide long-term treatment benefits for patients.

Background and objective: Triple-negative breast cancer (TNBC) is more aggressive when compared with other breast cancer subtypes, and advanced TNBC (aTNBC) has always been a challenge for clinical treatment. In recent years, significant progress has been made in the research of antibody-drug conjugates (ADCs), especially targeting trophoblast cell-surface antigen 2 (TROP2), as an effective regimen to enhance the potential survival benefit and quality of life of relevant patients. The objective of this narrative review is to provide a comprehensive knowledge on latest progress of ADCs in the treatment of aTNBC. Furthermore, the clinical significance and future research directions for ADCs are also discussed.

Methods: As of December 2023, literature spanning the past decade was comprehensively searched and analyzed across PubMed, Wanfang Data, ClinicalTrials.gov, and relevant academic conferences, to identify the latest published literature or ongoing trials on ADCs for aTNBC. The selected literature primarily focused on the drug structural profile, pharmacological mechanism, important trials targeting different antigens, and other exploratory investigations.

Key content and findings: The advent of precision therapy has been facilitated by the new generation ADCs, which have demonstrated the capacity to prolong survival in patients with refractory aTNBC, and promote the research on molecular biological characteristics of aTNBC. Meanwhile, several clinical issues on treatment are emerging, including a detailed understanding of the clinical profile differences among specific ADCs, identification of the potential indications for ADCs, and management strategies for the adverse effects related to ADCs. Additionally, it is essential to clarify the clinical significance of the expression level of the target antigen for ADCs, to comprehend resistance mechanisms to ADCs, and to determine the optimal sequence of treatments between different ADCs. Furthermore, there is a need to investigate the potential of combination immunotherapy with ADCs. Up to date, the preliminary investigations on the aforementioned issues have been initiated, and further research will facilitate the enhancement of ADCs clinical utilization.

Conclusions: The use of ADCs has been recommended by various clinical guidelines, and significantly altering the landscape of treatment for aTNBC. Nevertheless, further investigation are required to determine the most effective use of ADCs.