Breast Journal最新文献

Background: The efficacy of HLX02, a trastuzumab biosimilar, in combination with chemotherapy for treating metastatic breast cancer (BC) has been established as equivalent to the reference Herceptin. This study aimed to assess the treatment response of HLX02-based neoadjuvant therapy in HER2-positive BC, with a focus on HR-positive versus HR-negative subgroups. Additionally, we investigated the potential role of a CDK4/6 inhibitor in combination with anti-HER2 therapy.

Methods: This retrospective study included HER2-positive BC patients who received HLX02-based neoadjuvant therapy followed by curative surgery at Anhui Provincial Cancer Hospital between March 2021 and August 2023. Pathological complete response (pCR) rates were analyzed, and subgroup analyses evaluated predictors of pCR. In vitro experiments using BT-474 and MCF-7 cell lines assessed the effects of combining CDK4/6 inhibitors with anti-HER2 therapy on cell viability and apoptosis.

Results: The study included 67 patients with a median age of 53 years. The overall pCR rate was 53.73%, with higher pCR rates observed in HR-negative patients compared to HR-positive patients (63.89% vs. 41.94%). Dual HER2 blockade with HLX02 and pertuzumab was associated with a numerically improved pCR rate (62.16%). ER expression significantly increased post-treatment, potentially indicating treatment resistance mechanisms. In vitro, the combination of CDK4/6 inhibitors with anti-HER2 therapy significantly reduced cell viability and promoted apoptosis in HR-positive, HER2-positive cell lines.

Conclusion: HLX02 demonstrates real-world efficacy as part of neoadjuvant therapy for HER2-positive BC, especially in HR-negative patients. The lower pCR rate in HR-positive patients highlights the need for additional strategies. Combining CDK4/6 inhibitors with anti-HER2 therapy presents a promising approach for HR-positive HER2-positive patients, warranting further clinical validation.

Purpose: To investigate the conventional ultrasound and contrast-enhanced ultrasound (CEUS) imaging features of pseudoangiomatous stromal hyperplasia (PASH).

Methods: Retrospective analysis of clinical and imaging data of 29 patients diagnosed with PASH from June 2014 to June 2023.

Results: The median age of the patients was 39 years. Linear/cystic hypoechoic areas could be detected within the lesion in 12 cases (41.4%), and in 17 cases, the lesions had extensive conventional ultrasound findings with no significant features. The ultrasound-measured lesion diameters were smaller than those measured in surgically resected lesions, and the statistical difference was highly significant (p < 0.01). Fifteen cases underwent CEUS examination, with 7 lesions (46.7%) demonstrating uniform enhancement and 8 lesions (53.3%) exhibiting nonuniform enhancement. Within the enhanced regions, perfusion defects were observed, all of which were of the patchy type. The areas of patchy perfusion defects corresponded to the linear/cystic hypoechoic regions observed in the conventional sonographic images of the lesions. The use of CEUS provided additional diagnostic clarity compared with conventional ultrasound. Specifically, the specificity for identifying PASH lesions increased from 35.7% with conventional ultrasound to 64.3% with CEUS, highlighting the value of CEUS in enhancing the diagnostic accuracy for PASH lesions.

Conclusion: This study suggests that linear/cystic hypoechoic areas on sonography may serve as crucial clues for the ultrasound diagnosis of PASH. The presence of diffuse patchy perfusion defects in CEUS contributes to the accurate diagnosis of PASH.

Objective: To investigate the efficacy of microwave ablation (MVA) combined with Chai Hu Qing Gan Tang (CHQGT) for idiopathic granulomatous mastitis (IGM).

Methods: 480 patients were divided into the CHQGT combination group (CHQGT + MVA), corticosteroid combination group (glucocorticoids + MVA) and control group (glucocorticoids), with 160 cases in each group. Data on patient information, treatment effects, adverse effects and breast appearance were collected. Network pharmacology was used to identify the effective active ingredients and target information of CHQGT. The Gene Cards database was used to obtain the relevant targets of IGM, and the drug-component–common target relationship network was constructed using Cytoscape 3.9.1 software.

Results: All treatment groups showed significant differences in Visual Analog Scale score, Hamilton Depression Rating Scale score, Hamilton Anxiety Rating Scale, mass size and the total effective rate (p < 0.001). There was a statistically significant difference in the rate of excellent breast shape between the three groups after treatment (p < 0.001), with the rate higher in the CHQGT liver decoction combined with glucocorticoids treatment group compared with the control group. There was a statistically significant difference in the incidence of adverse reactions and recurrence rate between the three groups within 2 years after treatment (p < 0.001), with the incidence of adverse reactions and recurrence rate higher in the control group than in the glucocorticoid combination and CHQGT decoction combination groups. Network pharmacology identified 199 active ingredients and 23 drug-disease targets of CHQGT. The molecular docking results showed that the main active components screened had good binding activity with their corresponding target proteins.

Conclusion: The combination of CHQGT and MWA is comparable in overall therapeutic efficacy to the combination of glucocorticoids and MWA. However, the CHQGT and MWA combination is superior in reducing lump size, alleviating patient pain and accelerating recovery.

Breast cancer presents a significant risk to public health and is the primary cause of cancer-related death in women. Awareness of metastatic breast cancer (mBC) continues to increase, and advances have been made; however, challenges remain for many patient populations that do not receive equal opportunities along the treatment pathway. The Underserved Patient Population (UPP) Coalition Task Force, a group of international experts in mBC, held meetings between 2022 and 2023 to prioritise the needs of UPPs and propose solutions. The key unmet needs identified included the following: delayed diagnosis of mBC due to difficulties in the presentation of patients to the healthcare system and a lack of primary care physician and non–breast cancer specialist understanding of the signs and symptoms of mBC; difficulty navigating the mBC patient pathway due to suboptimal use of multidisciplinary care and limited communication between HCPs; unequal access to the most appropriate mBC treatment options and supportive therapy due to the unconscious bias of HCPs, and direct and indirect financial toxicity for patients; and negative impact on QoL resulting from the limited uptake of shared decision-making, low prioritisation of patient preferences and a lack of personalised care. This paper aims to shine light on initiatives supporting underserved patients with mBC, illustrate the remaining gaps in care and call upon the global community to change how care is delivered to UPPs.

Background: The clinical impact of HER2-low status on the efficacy of cyclin-dependent kinase 4/6 inhibitor (CDK4/6i). Therapy in patients with hormone receptor-positive (HR+), HER2-negative metastatic breast cancer (MBC) remains unclear.

Methods: We conducted a multicenter, retrospective analysis including 212 female patients with HR+/HER2−MBC treated with CDK4/6is between 2018 and 2022. Patients were classified as HER2-zero or HER2-low based on immunohistochemistry results. Progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) were compared between the two groups.

Results: Median PFS was 16.0 months in the HER2-low group and 13.9 months in the HER2-zero group (p = 0.40). In first-line therapy, PFS was numerically longer in the HER2-low group (18.6 vs. 14.9 months; p = 0.26) although this was not statistically significant. ORR was 71.4% in HER2-low and 62% in HER2-zero patients, and DCR was 86.6% and 82%, respectively (both p > 0.05). Subgroup analyses showed that within the HER2-low group, patients with ≥ 2 metastatic sites had significantly shorter PFS compared with those with a single site (14.1 vs. 20.2 months; p = 0.02), and the presence of visceral metastases was associated with poorer PFS (p = 0.003). Overall survival (OS) data were immature, with only 24.6% of the patients deceased at the time of analysis.

Conclusion: HER2 status did not significantly impact treatment outcomes with CDK4/6i in HR+/HER2-negative MBC patients. However, subgroup analyses indicated that metastatic burden, particularly the number of metastatic sites and the presence of visceral disease, may adversely influence PFS. These findings highlight the need for further validation in larger prospective studies.

Aim: To investigate the association between mammographic extratumoral signs, specifically their subclassifications, of nonspiculate and noncalcified masses (NSNCMs) and prognostic factors in breast cancer.

Materials and Methods: This retrospective study analyzed imaging and pathological data from 374 patients, categorizing extratumoral signs into structural abnormalities (parenchymal and trabecular) and halo, while also undergoing subclassification. The focus prognostic factors were achieved through screening. Then, univariate and multivariate analyses were performed. Correlation analysis was also employed to determine the relationship between subclassifications and prognostic factors.

Results: Lymphovascular invasion (LVI), Ki-67 levels, and stromal tumor-infiltrating lymphocytes (sTIL) levels were identified as the focus prognostic factors. Among tumor signs, only tumor margin was associated with sTIL levels. Extratumoral trabecular signs exhibited a significant correlation with LVI (OR = 2.5, p = 0.007) and Ki-67 levels (OR = 1.23, p = 0.001). Specifically, the parallel sign showed a positive correlation with LVI (p = 0.009, r = 0.134), while the reticular sign displayed a positive correlation with Ki-67 levels (p = 0.009, r = 0.134). Extratumoral parenchymal signs were found to be an independent predictor for sTIL levels (OR = 0.64, p < 0.001), with a negative correlation observed between the contraction sign and sTIL levels (p < 0.001, r = −0.185), as well as between the atrophy sign and sTIL levels (p = 0.046, r = −0.103).

Conclusion: Specific extratumoral structural abnormalities of mammographic malignant NSNCMs showed a significant correlation with prognostic factors in breast cancer, warranting increased attention in research and clinical practice.

Breast cancer (BC) treatment is developing toward more precise and personalized care through the approval of different comprehensive approaches. Clinical practice emphasizes significant patient-to-patient variability in treatment response among patients, even those with similar clinical and biological profiles. Recent studies have demonstrated that the glycocalyx is an essential organelle that plays an important role in many cellular processes and can be a promising target for treatment. The glycocalyx of cancer cells is a key component influencing the interaction between the tumor and the immune system. Glycan modifications attached to glycoproteins and glycolipids are a common characteristic of the transition to malignancy. We review how the specific structure and function of the glycocalyx are regulated at the molecular level, contribute to immune evasion, and can be overcome by using both traditional drugs and combination therapies, as well as drugs not previously used in standard cancer treatments, to address treatment resistance associated with glycocalyx alterations.

Trial Registration: ClinicalTrials.gov identifier: NCT00770354, NCT00925548, NCT01731587, NCT00088413, NCT00179309, NCT00986609, NCT05812326, NCT04020575, NCT05239143, NCT01279603, and NCT03562637

Background: Although presurgical endocrine therapy has been used to enhance the rate of breast cancer conservation, its prognostic relevance is unknown. The search for a valid prognostic factor equivalent to pathological complete response in presurgical chemotherapy remains a challenge in presurgical endocrine therapy. This study investigated the efficacy of presurgical short-term endocrine therapy (preSTE) and assessed prognostic factors, including the preoperative endocrine prognostic index (PEPI) score.

Methods: From October 2012 to November 2021, 269 postmenopausal women diagnosed with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative breast cancer underwent endocrine therapy with a nonsteroidal aromatase inhibitor during the presurgical waiting period. The primary endpoint was to assess the changes in tumor size using ultrasonography, and Ki67 expression levels before and after preSTE. The secondary endpoint was the prognosis of patients categorized using the PEPI score.

Results: The median age of patients was 68 years (range, 41–89 years). The median tumor size was 1.65 cm (range, 0.4–7.5 cm). The average pretreatment Ki67 expression level was 10% (range, 0%–90%). The median duration of endocrine therapy was 39 days (range, 2–88 days). Tumor diameter and Ki67 expression levels were significantly decreased to 1.43 cm (range, 0.45–5.83 cm) and 3.0% (range, 0%–85%) after preSTE, respectively. After the median observation period of 928 days, patients with PEPI scores ≥ 4 showed worse disease-free survival compared with those with lower PEPI scores. In terms of mortality, patients with PEPI score ≥ 4 had worse overall survival than did patients with lower PEPI scores.

Conclusions: Endocrine therapy during the waiting period for surgery might be effective in reducing tumor size, and the Ki67 expression level and PEPI score might be useful in predicting the prognosis of patients with postmenopausal HR+ breast cancer.

Neoadjuvant therapy before surgery offers varying benefits as a well-established treatment option for breast cancer. This study specifically evaluated the effectiveness of neoadjuvant endocrine therapy (NET), neoadjuvant chemotherapy (NCT), and neoadjuvant chemo-endocrine therapy (NCET) in patients with estrogen receptor (ER)–positive breast cancer. This meta-analysis was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searching was conducted to retrieve articles from databases including PubMed, Cochrane Library, EMBASE, CNKI, and Wanfang. The primary outcome measured by odds ratios (ORs) with 95% confidence intervals (CIs) focused on assessing pooled effect sizes. Random-effects or fixed-effect models were conducted according to the existence of statistical heterogeneity. A total of 15 eligible articles were included in the analysis. The results indicated clinical response (CR) (OR = 0.54; 95% CI = 0.41 to 0.73; I² = 39.6%) and clinical complete response (cCR) (OR = 0.31; 95% CI = 0.12 to 0.85; I² = 68.0%) after NET was significantly higher than NCT. However, no significant difference was shown in pathological complete response (pCR) (OR = 0.49; 95% CI = 0.23 to 1.04; I² = 0.0%) and breast-conserving surgery (BCS) (OR = 0.49; 95% CI = 0.23 to 1.04; I² = 0.0%). The combined paradigm of NCET presented no significant improvement compared with monotherapy of NET or NCT. Overall, both NET and NCT are effective neoadjuvant treatment options for patients with ER+ breast cancer. More explicit clinical decision indicators need to be further clarified. And NCET does not offer additional benefits over NET or NCT in patients with ER+ breast cancer.

Background and Objectives: We evaluated the prognostic value of pretreatment axillary nodal volume in breast cancer patients treated with neoadjuvant systemic therapy.

Methods: We retrospectively reviewed 302 breast cancer patients with biopsy-proven axillary LN involvement who received neoadjuvant systemic therapy. Axillary nodal volumes were obtained from pretreatment magnetic resonance imaging. Univariate and multivariate analyses for disease-free survival (DFS) and overall survival (OS) rates were conducted.

Results: The median follow-up period was 57.0 months, and 5-year DFS and OS rates were 81.6% and 91.9%, respectively. Pretreatment axillary nodal volume ranged from 0.2 mL to 134.2 mL, and the first tertile (2.6 mL) and fifth quintile (12.0 mL) were chosen as the optimal cutoff points for survival outcomes. In the multivariate analysis, nodal volume (< 2.6 mL vs. 2.6–12.0 mL vs. ≥ 12.0 mL) was a significant prognostic factor for DFS (5-year DFS, 90.1% vs. 79.6% vs. 72.2%) and OS (5-year OS, 97.9% vs. 90.9% vs. 84.2%), whereas the N stage was not.

Conclusions: In breast cancer patients treated with neoadjuvant systemic therapy, larger pretreatment axillary nodal volume was associated with poor survival outcomes.