Breast Cancer Research and Treatment最新文献

Background: Despite the increasing popularity of microsurgical techniques for the treatment of lymphedema, there is a lack of high-level, prospective, long-term data and standardized outcome metrics. The purpose of this study was to analyze the long-term outcomes of Lymphovenous Bypass (LVB) surgery throughout the past two decades.

Methods: We conducted a systematic review of PubMed, Embase, and Web of Science databases to identify prospective clinical trials investigating LVB for lymphedema treatment. Reported outcome data included limb volume measurements, number of cellulitis episodes, compression garment use, and the assessment of complications. For studies involving multiple procedures, only outcomes from the respective LVB cohorts were analyzed. Retrospective data analyses were excluded.

Results: Eight prospective studies (2009-2023) were included in the meta-analysis, comprising a total of 431 patients undergoing LVB with a mean follow-up of 21.8 ± 7.7 months. An average of 3.4 ± 1.0 anastomoses were performed per patient. LVB was associated with a 14.26% mean reduction in limb volume (95% CI 6.63-21.88; p < 0.0001) at one-year, and 46.3% (95% CI 24.9%-69.1%; p < 0.01) reduction/discontinuation of compression therapy following surgery. Patients also reported subjective symptom relief and reduced cellulitis episodes.

Conclusions: This systematic review provides the most comprehensive synthesis to date of long-term outcomes following LVB surgery for lymphedema. The findings support LVB as a safe and effective microsurgical intervention, with consistent reductions in limb volume, cellulitis episodes, and reliance on compression therapy.

Background: Compression sleeves are widely used for breast cancer-related lymphedema, but evidence on their effectiveness of prevention and treatment in volume reduction is limited.

Objective: To compare the effects of compression sleeves and conventional care on breast cancer-related lymphedema, providing evidence-based support for clinical application.

Methods: A systematic search of 9 databases was conducted up to June 9, 2025. Meta-analysis was performed using RevMan 5.4, and evidence quality was assessed with GRADE profiler 3.6.

Results: 1532 patients were included. Compression sleeves significantly reduced lymphedema incidence post-surgery (P =0 .02) and edema volume/circumference (P <0 .001), and improved shoulder flexion (P =0.02). No significant effects were seen on shoulder abduction (P =0 .18), subjective symptoms (P =0.62), or quality of life (P = 0.32). Evidence quality was moderate for incidence and volume/circumference reduction, and low for other outcomes.

Conclusion: This meta-analysis shows that compression sleeves reduce lymphedema incidence and volume/circumference, and improve shoulder flexion. They should be considered in lymphedema management, though further research is needed for other outcomes.

Purpose: Neoadjuvant chemotherapy (NACT) is often the preferred systemic treatment modality for advanced breast tumors. Delays in NACT initiation are associated with worse outcomes although it is unclear which patients are at the highest risk for delays and whether these delays impact pathologic complete response (pCR). We sought to determine the incidence, predictors, and cancer-related outcomes associated with delays in NACT initiation among patients with HER2-positive (HER2 +) breast cancer in the modern era.

Methods: We retrospectively analyzed a cohort of patients with stage II-III HER2 + breast cancer who were treated with NACT and surgery using the National Cancer Database. Multivariable logistic regression, adjusted for demographic, socioeconomic and tumor characteristics, was used to identify characteristics associated with and the likelihood of achieving a pCR with delays in NACT initiation.

Results: 56,868 patients were included in the analysis. Delays in NACT initiation of > 60 days from diagnosis was observed in 9% of patients. In a multivariable analysis, patients who were Black (OR 1.88 95%CI 1.74-2.04), Hispanic (OR 2.19, 95%CI 2.00-2.39), had Medicaid (2.14, 95%CI 1.97-2.32), or no insurance (2.39, 95%CI 2.09-2.72) were more likely to be delayed. Delay was associated with a lower likelihood of achieving pCR (OR 0.86 95% CI 0.81-0.92) and an increased risk of death (HR 1.15 95%CI 1.03-1.29).

Conclusion: There are racial, ethnic, and socioeconomic disparities in NACT initiation delays and an association with worse cancer-related outcomes. Future studies and interventions are needed to mitigate these delays.

Purpose: Structural racism may be associated with disparities in breast cancer access to care and outcomes. We examined the association between contemporary mortgage lending bias (redlining) and the receipt of guideline-concordant systemic treatment.

Methods: Women with stage I-III invasive breast cancer in 2010-2017 were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database. Contemporary redlining was estimated using 2010-2017 Home Mortgage Disclosure Act data. Simple and multiple logistic regression models estimated the unadjusted and adjusted odds of receiving guideline-concordant systemic treatment: appropriate receipt of chemotherapy, HER2/neu (HER2)-targeted therapy, hormonal therapy, and a composite systemic treatment measure.

Results: Overall compliance rates were 85%, 96%, and 87% for chemotherapy, HER2-targeted therapy, and hormonal therapy, respectively. For the composite outcome, 95% received some or fully concordant care. In unadjusted and adjusted models, women living in higher redlined neighborhoods were less likely to receive guideline-concordant care for all modalities, except hormonal therapy (p = 0.846). For HER2-targeted therapy and composite score, the redlining effect differed by dual Medicare-Medicaid enrollment eligibility status. Dual eligibility eliminated the negative effect of redlining. Among those not dual eligible, the negative effect of redlining persisted.

Conclusions: Older breast cancer survivors living in higher redlined areas were less likely to receive guideline-concordant chemotherapy, HER2-targeted therapy, and overall systemic treatment. While more work is needed to better understand structural racism and neighborhood socioeconomic disinvestment to address equitable access to cancer care, the housing sector may be one actionable policy target. Care teams should consider patient context to ensure high quality care.

Objective: Surgical operation serves as a primary approach for addressing cancer of the breast, but it also has potential complications, including hemorrhaging following surgery. Identifying the risk variables associated with this problem may assist individuals in stratifying and optimizing their risks. A meta-analysis and comprehensive review was conducted to pinpoint the risk variables associated with postoperative hemorrhaging in breast carcinoma.

Methods: We performed a systematic review and searched through Cochrane Library, PubMed, WoS, Embase, China National Knowledge Infrastructure, and Wanfang. The investigation spanned from the creation of the records until May 2025. A meta-analysis was performed to investigate the risk variables associated with postoperative hemorrhaging in breast carcinoma patients.

Results: 8 studies were included, comprising 82,012 patients. A total of 10 risk factors were analyzed. They are mastectomy and axillary lymph node dissection, antithrombotic medication, age ≥ 60 years old, hypertension, and diabetes, chronic pulmonary illness, congestive heart failure, reconstruction and neoadjuvant chemotherapy. These results indicated that among the multiple risk factors included in the analysis, 3 had statistically significant effects on postoperative bleeding following breast cancer surgery: specifically, mastectomy (OR = 1.93,95%CI:1.20-3.09), hypertension(OR = 1.23,95%CI:1.05-1.44), CHF(OR = 2.18,95%CI:1.54-3.08).

Conclusion: Breast cancer risk factors for postoperative hemorrhage include mastectomy, hypertension and CHF. Understanding the risk factors closely related to postoperative bleeding in breast cancer is helpful for identifying high-risk patients with postoperative bleeding, who can benefit from enhanced prevention and treatment. In the future, more and larger sample size studies are needed to continue to investigate additional indicators of risk for hemorrhaging following surgery in breast carcinoma.

Purpose: Breast cancer is the most commonly diagnosed cancer worldwide. To evaluate the safety and efficacy of abemaciclib in combination with endocrine therapy (ET) for the treatment of Hormone Receptor/ Human Epidermal Growth Factor Receptor 2 (HR + /HER2-) advanced or metastatic breast cancer, this systematic review and meta-analysis compared several treatment regimens and patient groups.

Methods: In this systematic review and meta-analysis, we searched (PubMed, Scopus, and the Cochrane from inception to 5 April 2025) to identify the studies that compared abemaciclib plus ET to ET alone. The measure effects used were hazard ratios (HR) for overall survival (OS), progression-free survival (PFS), and invasive disease-free survival (IDFS), while risk ratios (RR) for objective response rate (ORR), clinical benefit rate (CBR), and adverse effects· Forest plots were created using a random effects model, with a p-value < 0·05 was considered statistically significant. This study is registered on PROSPERO (CRD420251009464).

Results: We included fourteen studies comprising 16,116 patients (8592 with abemaciclib plus ET and 7524 with ET alone), abemaciclib plus ET significantly improved PFS (HR 0·54; 95% CI 0·49-0·59, p = 0·00001), IDFS (HR 0·68; 95% CI 0·59-0·78, p = 0·00001), ORR (RR 2·87; 95% CI 1·85-4·44, p = 0·0001), and CBR (RR 1·32; 95% CI 1·14-1·52, p = 0·0002), and a non-statistically significant OS (HR of 0·86; 95% CI 0·74-1·01, p = 0·06). Abemaciclib increased the risk of adverse events; cardiovascular events (4·82 times), increased blood creatinine (8·51 times), nausea (1·95 times), vomiting (2·51 times), abdominal pain (2·64 times), decreased appetite (2·59 times), diarrhea (4·20 times), aspartate aminotransferase (AST) (2·15 times), alanine aminotransferase (ALT) (2·28 times), anemia (3·79 times), thrombocytopenia (5·73 times), leukopenia (5·48 times), neutropenia (8·74 times)· However, it showed a reduced risk of arthralgia (0·73 times).

Conclusion: The combination therapy provides a clinically significant improvement in survival and treatment responses, even though the toxicity is increased but manageable, and requires careful prescription.

Purpose: To improve clinical decision-making in patients with breast cancer receiving CDK 4/6 inhibitors, we examined Duffy status and relative medication modification at Boston Medical Center.

Methods: We performed a retrospective chart review of patients with breast cancer receiving CDK 4/6 inhibitors at Boston Medical Center between January 1, 2021 and June 1, 2024. We included Duffy status as a covariate, where those with unknown Duffy status were assumed to be Duffy non-null.

Results: Of the 71 patients included, race was White in 21% and Black in 54%, where 90% of patients with Duffy-null associated neutrophil count (DANC) were Black. When stratifying by Duffy status, Duffy non-null (38/71) and null patients (21/71) had median pre-treatment nadir absolute neutrophil count (ANC) 2.6 (IQR 1.8) and 1.7 (IQR 1.0) and post-treatment nadir ANC 1.6 (IQR 1.2) and 1.0 (IQR 0.6). Overall, no patients meeting criteria for grades 3-4 neutropenia were hospitalized for neutropenic fever. Older patients had higher odds of dose reduction or treatment delay (adjusted odds ratio [aOR] 3.04, 95% confidence interval [CI] 1.06-9.07). However, patients with DANC had no significant differences in rates of dose reduction or treatment delay [aOR 1.31, 95% confidence interval (CI) 0.37-4.73].

Conclusion: Despite having lower ANC than their non-null counterparts, Duffy null patients on CDK 4/6 inhibitors received standard starting doses without significant differences in dose reduction or treatment delay.

Background: Metastatic metaplastic triple-negative breast cancer (mMpTNBC) is a rare, aggressive subtype with poor responsiveness to standard therapies. Sacituzumab govitecan (SG) is effective in metastatic TNBC (mTNBC), but data in mMpTNBC are limited to case reports.

Patients and methods: This multinational, multicenter, retrospective case series was conducted within the CEBCC-102 real-world evidence project across 18 cancer centers. Female patients with histologically confirmed mMpTNBC treated with ≥ 2L SG outside of clinical trials in Poland, the Czech Republic and Slovakia between August 2021 and June 2025 were included. Clinical data, treatment outcomes, and adverse events (AEs) were collected from medical records and analysed.

Results: Among 303 patients with mTNBC treated with SG in second and later lines within the CEBCC-102 project, 13 women (4.3%) had mMpTNBC and were included in this analysis. Median age was 58 years. PD-L1 CPS ≥ 10 was found in 83% of tested cases. Overall response rate was 36.4%, clinical benefit rate 45.5%, median progression-free survival 3.2 months and median overall survival 8.9 months. Neutropenia (N = 9, 69%) was the most common AE; no febrile neutropenia or treatment discontinuations due to toxicity occurred.

Conclusions: This first international real-world series of SG in mMpTNBC shows clinically relevant activity and manageable toxicity, addressing a critical evidence gap and supporting further prospective studies, particularly in PD-L1-positive disease.

Purpose: We aimed to investigate the prevalence and spectrum of ESR1 mutations alongside cell-free DNA (cfDNA) dynamics in patients with estrogen receptor-positive metastatic breast cancer recruited to the phase II IRIS study who had progressed on first-line aromatase inhibitor (AI) therapy and then continued their AI in combination with Irusostat (40 mg), an irreversible steroid sulfatase inhibitor.

Methods: cfDNA was isolated from 96 serial plasma samples from 24 patients, alongside primary tumour DNA (n = 16), and analysed by next-generation sequencing using a custom-designed mutation panel on the Illumina NovaSeq platform.

Results: Thirteen of 16 tumour DNA samples harboured at least one somatic mutation across nine genes. Twenty one of the 24 patients (88%) had at least one somatic mutation in cfDNA (248 total mutations across 10 genes). Circulating tumour DNA ESR1 mutations (ctESR1m) were the most prevalent, present in 16 patients (76%) with both stable (SD) and progressive disease (PD), showing no clear association with disease progression. Eleven patients had polyclonal ctESR1m within the ligand-binding domain, six at baseline, while five harboured a single ctESR1m variant. Five other patients acquired polyclonal mutations over treatment.

Conclusions: Analysis of serial plasma samples revealed highly dynamic ctESR1m during AI treatment and frequent detection of polyclonal ctESR1m in patients (both with SD and PD) recruited to the IRIS study. These findings, albeit in a limited sample size, underscore the challenge of targeting a single ESR1 mutation and emphasise the need for careful patient selection, specifically those with wild-type ESR1, in trials investigating sequential estrogen-lowering therapies.

Introduction: Breast cancer remains the most frequently diagnosed malignancy among women worldwide. Advances in treatment with the approval of multiple novel therapeutics have led to significant improvements in long-term survival and reduced mortality. Although clinicians are familiar with the more common toxicities linked to targeted therapies, ocular adverse effects often receive less attention. Increasing provider awareness of these potential eye-related toxicities is essential to ensure prompt recognition and timely referral to ophthalmologists for early intervention.

Methods: We reviewed evidence on the prevalence, characteristics, and management of ocular toxicities associated with novel targeted breast cancer therapies.

Conclusion: This review summarizes the major ocular toxicities linked to targeted therapies used in breast cancer and describes current strategies for their effective clinical management.