Biochemistry, Genetics and Molecular Biology › Cancer Research

Breast Cancer Treatment Studies

Works Count: 89962

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This cluster of papers focuses on molecular research, treatment response, and prognostic markers in breast cancer. It covers topics such as gene expression patterns, molecular subtypes, neoadjuvant therapy, radiotherapy, and the impact of hormone receptors on survival. The papers also discuss the development of clinical practice guidelines for breast cancer management.

Keywords

Gene Expression; Breast Tumours; Treatment Response; Molecular Subtypes; Prognostic Markers; Neoadjuvant Therapy; Radiotherapy; Hormone Receptors; Survival Analysis; Clinical Practice Guidelines

Polychemotherapy for early breast cancer: an overview of the randomised trials

1998-09-01

Mary Clarke , Rory Collins , Claire Davies +3 more

Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials

2012-02-01

R Peto , Christopher Davies , Jon Godwin +7 more

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Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials

2005-05-01

Descriptive analysis of estrogen receptor (ER)‐negative, progesterone receptor (PR)‐negative, and HER2‐negative invasive breast cancer, the so‐called triple‐negative phenotype

2007-03-26

Katrina Bauer , Monica Brown , Rosemary D. Cress +2 more

Abstract BACKGROUND. Tumor markers are becoming increasingly important in breast cancer research because of their impact on prognosis, treatment, and survival, and because of their relation to breast cancer subtypes. … Abstract BACKGROUND. Tumor markers are becoming increasingly important in breast cancer research because of their impact on prognosis, treatment, and survival, and because of their relation to breast cancer subtypes. The triple‐negative phenotype is important because of its relation to the basal‐like subtype of breast cancer. METHODS. Using the population‐based California Cancer Registry data, we identified women diagnosed with triple‐negative breast cancer between 1999 and 2003. We examined differences between triple‐negative breast cancers compared with other breast cancers in relation to age, race/ethnicity, socioeconomic status (SES), stage at diagnosis, tumor grade, and relative survival. RESULTS. A total of 6370 women were identified as having triple‐negative breast cancer and were compared with the 44,704 women with other breast cancers. Women with triple‐negative breast cancers were significantly more likely to be under age 40 (odds ratio [OR], 1.53), and non‐Hispanic black (OR, 1.77) or Hispanic (OR, 1.23). Regardless of stage at diagnosis, women with triple‐negative breast cancers had poorer survival than those with other breast cancers, and non‐Hispanic black women with late‐stage triple‐negative cancer had the poorest survival, with a 5‐year relative survival of only 14%. CONCLUSIONS. Triple‐negative breast cancers affect younger, non‐Hispanic black and Hispanic women in areas of low SES. The tumors were diagnosed at later stage and were more aggressive, and these women had poorer survival regardless of stage. In addition, non‐Hispanic black women with late‐stage triple‐negative breast cancer had the poorest survival of any comparable group. Cancer 2007. © 2007 American Cancer Society.

Breast cancer metastasis: markers and models

2005-08-01

Britta Weigelt , Johannes L. Peterse , Laura J. vanʼt Veer

pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long‐term follow‐up

1991-11-01

C.W. Elston , Ian O. Ellis

Morphological assessment of the degree of differentiation has been shown in numerous studies to provide useful prognostic information in breast cancer, but until recently histological grading has not been accepted … Morphological assessment of the degree of differentiation has been shown in numerous studies to provide useful prognostic information in breast cancer, but until recently histological grading has not been accepted as a routine procedur mainly because of perceived problems with reproducibility and consistency. In the Nottingham/Tenovus Primary Breast Cancer Study the most commonly used method, described by Bloom & Richardson, has been modified in order to make the criteria more objective. The revised technique involves semiquantitative evaluation of three morphological features–the percentage of tubule formation, the degree of nuclear pleomorphism and an accurate mitotic count using a defined field area. A numerical scoring system is used and the overall grade is derived from a summation of individual scores for the three variables; three grades of differentiation are used. Since 1973, over 2200 patients with primary operable breast cancer have been entered into a study of multiple prognostic factors. Histological grade, assessed in 1831 patients, shows a very strong correlation with prognosis; patients with grade I tumours have a significantly better survival than those with grade II and III tumours (P<0.0001). These results demonstrate that this method for histological grading provides important prognostic information and, if the grading protocol is followed consistently, reproducible results can be obtained. Histological grade forms part of the multifactorial Nottingham prognostic index, together with tumour size and lymph node stage, which is used to stratify individual patients for appropriate therapy.

Five-Year Results of a Randomized Clinical Trial Comparing Total Mastectomy and Segmental Mastectomy with or without Radiation in the Treatment of Breast Cancer

1985-03-14

Bernard Fisher , Madeline Bauer , Richard G. Margolese +7 more

In 1976 we began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of Stage I and II breast tumors ≤4 cm in size. The … In 1976 we began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of Stage I and II breast tumors ≤4 cm in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental mastectomy alone, or segmental mastectomy followed by breast irradiation. All patients had axillary dissections, and patients with positive nodes received chemotherapy. Life-table estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant-disease–free, and overall survival at five years that was no worse than that after total breast removal. In fact, disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy (P = 0.04), and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy (P = 0.07, and 0.06, respectively). A total of 92.3 per cent of women treated with radiation remained free of breast tumor at five years, as compared with 72.1 per cent of those receiving no radiation (P<0.001). Among patients with positive nodes 97.9 per cent of women treated with radiation and 63.8 per cent of those receiving no radiation remained tumor-free (P<0.001), although both groups received chemotherapy. We conclude that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for Stage I and II breast tumors ≤4 cm, provided that margins of resected specimens are free of tumor. (N Engl J Med 1985; 312:665–73.)

Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases

1989-01-01

Christine L. Carter , Carol Allen , Donald E. Henson

Two of the most important prognostic indicators for breast cancer are tumor size and extent of axillary lymph node involvement. Data on 24,740 cases recorded in the Surveillance, Epidemiology, and … Two of the most important prognostic indicators for breast cancer are tumor size and extent of axillary lymph node involvement. Data on 24,740 cases recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used to evaluate the breast cancer survival experience in a representative sample of women from the United States. Actuarial (life table) methods were used to investigate the 5-year relative survival rates in cases with known operative/pathologic axillary lymph node status and primary tumor diameter. Survival rates varied from 45.5% for tumor diameters equal to or greater than 5 cm with positive axillary nodes to 96.3% for tumors less than 2 cm and with no involved nodes. The relation between tumor size and lymph node status was investigated in detail. Tumor diameter and lymph node status were found to act as independent but additive prognostic indicators. As tumor size increased, survival decreased regardless of lymph node status; and as lymph node involvement increased, survival status also decreased regardless of tumor size. A linear relation was found between tumor diameter and the percent of cases with positive lymph node involvement. The results of our analyses suggest that disease progression to distant sites does not occur exclusively via the axillary lymph nodes, but rather that lymph node status serves as an indicator of the tumor's ability to spread.

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Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy

1992-01-01

Early Breast Cancer Trialist's Collaborative Group

Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer

2002-10-17

Bernard Fisher , Stewart Anderson , John Bryant +5 more

In 1976, we initiated a randomized trial to determine whether lumpectomy with or without radiation therapy was as effective as total mastectomy for the treatment of invasive breast cancer. In 1976, we initiated a randomized trial to determine whether lumpectomy with or without radiation therapy was as effective as total mastectomy for the treatment of invasive breast cancer.

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Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis

2014-02-14

Patricia Cortazar , Lijun Zhang , Michael Untch +7 more

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An online survival analysis tool to rapidly assess the effect of 22,277 genes on breast cancer prognosis using microarray data of 1,809 patients

2009-12-17

Balázs Győrffy , András Lánczky , Aron C. Eklund +4 more

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Triple-Negative Breast Cancer

2010-11-10

William D. Foulkes , Ian E. Smith , Jorge S. Reis‐Filho

Triple-negative breast cancer, so called because it lacks expression of the estrogen receptor, progesterone receptor, and HER2, is often, but not always, a basal-like breast cancer. This review focuses on … Triple-negative breast cancer, so called because it lacks expression of the estrogen receptor, progesterone receptor, and HER2, is often, but not always, a basal-like breast cancer. This review focuses on its origin, molecular and clinical characteristics, and treatment.

Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis

2011-02-08

Armando E. Giuliano

<h3>Context</h3>Sentinel lymph node dissection (SLND) accurately identifies nodal metastasis of early breast cancer, but it is not clear whether further nodal dissection affects survival.<h3>Objective</h3>To determine the effects of complete axillary … <h3>Context</h3>Sentinel lymph node dissection (SLND) accurately identifies nodal metastasis of early breast cancer, but it is not clear whether further nodal dissection affects survival.<h3>Objective</h3>To determine the effects of complete axillary lymph node dissection (ALND) on survival of patients with sentinel lymph node (SLN) metastasis of breast cancer.<h3>Design, Setting, and Patients</h3>The American College of Surgeons Oncology Group Z0011 trial, a phase 3 noninferiority trial conducted at 115 sites and enrolling patients from May 1999 to December 2004. Patients were women with clinical T1-T2 invasive breast cancer, no palpable adenopathy, and 1 to 2 SLNs containing metastases identified by frozen section, touch preparation, or hematoxylin-eosin staining on permanent section. Targeted enrollment was 1900 women with final analysis after 500 deaths, but the trial closed early because mortality rate was lower than expected.<h3>Interventions</h3>All patients underwent lumpectomy and tangential whole-breast irradiation. Those with SLN metastases identified by SLND were randomized to undergo ALND or no further axillary treatment. Those randomized to ALND underwent dissection of 10 or more nodes. Systemic therapy was at the discretion of the treating physician.<h3>Main Outcome Measures</h3>Overall survival was the primary end point, with a noninferiority margin of a 1-sided hazard ratio of less than 1.3 indicating that SLND alone is noninferior to ALND. Disease-free survival was a secondary end point.<h3>Results</h3>Clinical and tumor characteristics were similar between 445 patients randomized to ALND and 446 randomized to SLND alone. However, the median number of nodes removed was 17 with ALND and 2 with SLND alone. At a median follow-up of 6.3 years (last follow-up, March 4, 2010), 5-year overall survival was 91.8% (95% confidence interval [CI], 89.1%-94.5%) with ALND and 92.5% (95% CI, 90.0%-95.1%) with SLND alone; 5-year disease-free survival was 82.2% (95% CI, 78.3%-86.3%) with ALND and 83.9% (95% CI, 80.2%-87.9%) with SLND alone. The hazard ratio for treatment-related overall survival was 0.79 (90% CI, 0.56-1.11) without adjustment and 0.87 (90% CI, 0.62-1.23) after adjusting for age and adjuvant therapy.<h3>Conclusion</h3>Among patients with limited SLN metastatic breast cancer treated with breast conservation and systemic therapy, the use of SLND alone compared with ALND did not result in inferior survival.<h3>Trial Registration</h3>clinicaltrials.gov Identifier: NCT00003855

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Immunohistochemical and Clinical Characterization of the Basal-Like Subtype of Invasive Breast Carcinoma

2004-08-15

Torsten O. Nielsen , Forrest D. Hsu , Kristin C. Jensen +7 more

Abstract Purpose: Expression profiling studies classified breast carcinomas into estrogen receptor (ER)+/luminal, normal breast-like, HER2 overexpressing, and basal-like groups, with the latter two associated with poor outcomes. Currently, there exist … Abstract Purpose: Expression profiling studies classified breast carcinomas into estrogen receptor (ER)+/luminal, normal breast-like, HER2 overexpressing, and basal-like groups, with the latter two associated with poor outcomes. Currently, there exist clinical assays that identify ER+/luminal and HER2-overexpressing tumors, and we sought to develop a clinical assay for breast basal-like tumors. Experimental Design: To identify an immunohistochemical profile for breast basal-like tumors, we collected a series of known basal-like tumors and tested them for protein patterns that are characteristic of this subtype. Next, we examined the significance of these protein patterns using tissue microarrays and evaluated the prognostic significance of these findings. Results: Using a panel of 21 basal-like tumors, which was determined using gene expression profiles, we saw that this subtype was typically immunohistochemically negative for estrogen receptor and HER2 but positive for basal cytokeratins, HER1, and/or c-KIT. Using breast carcinoma tissue microarrays representing 930 patients with 17.4-year mean follow-up, basal cytokeratin expression was associated with low disease-specific survival. HER1 expression was observed in 54% of cases positive for basal cytokeratins (versus 11% of negative cases) and was associated with poor survival independent of nodal status and size. c-KIT expression was more common in basal-like tumors than in other breast cancers but did not influence prognosis. Conclusions: A panel of four antibodies (ER, HER1, HER2, and cytokeratin 5/6) can accurately identify basal-like tumors using standard available clinical tools and shows high specificity. These studies show that many basal-like tumors express HER1, which suggests candidate drugs for evaluation in these patients.

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Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials

2011-10-22

Sarah C. Darby , Paul McGale , Candace R. Correa +7 more

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A Multigene Assay to Predict Recurrence of Tamoxifen-Treated, Node-Negative Breast Cancer

2004-12-11

Soonmyung Paik , Steven Shak , Gong Tang +7 more

The likelihood of distant recurrence in patients with breast cancer who have no involved lymph nodes and estrogen-receptor-positive tumors is poorly defined by clinical and histopathological measures.We tested whether the … The likelihood of distant recurrence in patients with breast cancer who have no involved lymph nodes and estrogen-receptor-positive tumors is poorly defined by clinical and histopathological measures.We tested whether the results of a reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of 21 prospectively selected genes in paraffin-embedded tumor tissue would correlate with the likelihood of distant recurrence in patients with node-negative, tamoxifen-treated breast cancer who were enrolled in the National Surgical Adjuvant Breast and Bowel Project clinical trial B-14. The levels of expression of 16 cancer-related genes and 5 reference genes were used in a prospectively defined algorithm to calculate a recurrence score and to determine a risk group (low, intermediate, or high) for each patient.Adequate RT-PCR profiles were obtained in 668 of 675 tumor blocks. The proportions of patients categorized as having a low, intermediate, or high risk by the RT-PCR assay were 51, 22, and 27 percent, respectively. The Kaplan-Meier estimates of the rates of distant recurrence at 10 years in the low-risk, intermediate-risk, and high-risk groups were 6.8 percent (95 percent confidence interval, 4.0 to 9.6), 14.3 percent (95 percent confidence interval, 8.3 to 20.3), and 30.5 percent (95 percent confidence interval, 23.6 to 37.4). The rate in the low-risk group was significantly lower than that in the high-risk group (P<0.001). In a multivariate Cox model, the recurrence score provided significant predictive power that was independent of age and tumor size (P<0.001). The recurrence score was also predictive of overall survival (P<0.001) and could be used as a continuous function to predict distant recurrence in individual patients.The recurrence score has been validated as quantifying the likelihood of distant recurrence in tamoxifen-treated patients with node-negative, estrogen-receptor-positive breast cancer.

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A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast Cancer

2003-08-06

Umberto Veronesi , Giovanni Paganelli , Giuseppe Viale +7 more

Although numerous studies have shown that the status of the sentinel node is an accurate predictor of the status of the axillary nodes in breast cancer, the efficacy and safety … Although numerous studies have shown that the status of the sentinel node is an accurate predictor of the status of the axillary nodes in breast cancer, the efficacy and safety of sentinel-node biopsy require validation.From March 1998 to December 1999, we randomly assigned 516 patients with primary breast cancer in whom the tumor was less than or equal to 2 cm in diameter either to sentinel-node biopsy and total axillary dissection (the axillary-dissection group) or to sentinel-node biopsy followed by axillary dissection only if the sentinel node contained metastases (the sentinel-node group).The number of sentinel nodes found was the same in the two groups. A sentinel node was positive in 83 of the 257 patients in the axillary-dissection group (32.3 percent), and in 92 of the 259 patients in the sentinel-node group (35.5 percent). In the axillary-dissection group, the overall accuracy of the sentinel-node status was 96.9 percent, the sensitivity 91.2 percent, and the specificity 100 percent. There was less pain and better arm mobility in the patients who underwent sentinel-node biopsy only than in those who also underwent axillary dissection. There were 15 events associated with breast cancer in the axillary-dissection group and 10 such events in the sentinel-node group. Among the 167 patients who did not undergo axillary dissection, there were no cases of overt axillary metastasis during follow-up.Sentinel-node biopsy is a safe and accurate method of screening the axillary nodes for metastasis in women with a small breast cancer.

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Metastatic Behavior of Breast Cancer Subtypes

2010-05-25

Hagen F. Kennecke , Rinat Yerushalmi , Ryan Woods +5 more

Prognostic and predictive factors are well established in early-stage breast cancer, but less is known about which metastatic sites will be affected.Patients with early-stage breast cancer diagnosed between 1986 and … Prognostic and predictive factors are well established in early-stage breast cancer, but less is known about which metastatic sites will be affected.Patients with early-stage breast cancer diagnosed between 1986 and 1992 with archival tissue were included. Subtypes were defined as luminal A, luminal B, luminal/human epidermal growth factor receptor 2 (HER2), HER2 enriched, basal-like, and triple negative (TN) nonbasal. Distant sites were classified as brain, liver, lung, bone, distant nodal, pleural/peritoneal, and other. Cumulative incidence curves were estimated for each site according to competing risks methods. Association between the site of relapse and subtype was assessed in multivariate models using logistic regression.Median follow-up time among 3,726 eligible patients was 14.8 years. Median durations of survival with distant metastasis were 2.2 (luminal A), 1.6 (luminal B), 1.3 (luminal/HER2), 0.7 (HER2 enriched), and 0.5 years (basal-like; P < .001). Bone was the most common metastatic site in all subtypes except basal-like tumors. In multivariate analysis, compared with luminal A tumors, luminal/HER2 and HER2-enriched tumors were associated with a significantly higher rate of brain, liver, and lung metastases. Basal-like tumors had a higher rate of brain, lung, and distant nodal metastases but a significantly lower rate of liver and bone metastases. TN nonbasal tumors demonstrated a similar pattern but were not associated with fewer liver metastases.Breast cancer subtypes are associated with distinct patterns of metastatic spread with notable differences in survival after relapse.

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American Society of Clinical Oncology 2007 Update of Recommendations for the Use of Tumor Markers in Breast Cancer

2007-10-22

Lyndsay N. Harris , Herbert A. Fritsche , Robert Mennel +6 more

To update the recommendations for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast cancer.For the 2007 update, an Update Committee composed of members … To update the recommendations for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast cancer.For the 2007 update, an Update Committee composed of members from the full Panel was formed to complete the review and analysis of data published since 1999. Computerized literature searches of MEDLINE and the Cochrane Collaboration Library were performed. The Update Committee's literature review focused attention on available systematic reviews and meta-analyses of published tumor marker studies. In general, significant health outcomes (overall survival, disease-free survival, quality of life, lesser toxicity, and cost-effectiveness) were used for making recommendations. Recommendations andThirteen categories of breast tumor markers were considered, six of which were new for the guideline. The following categories showed evidence of clinical utility and were recommended for use in practice: CA 15-3, CA 27.29, carcinoembryonic antigen, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, urokinase plasminogen activator, plasminogen activator inhibitor 1, and certain multiparameter gene expression assays. Not all applications for these markers were supported, however. The following categories demonstrated insufficient evidence to support routine use in clinical practice: DNA/ploidy by flow cytometry, p53, cathepsin D, cyclin E, proteomics, certain multiparameter assays, detection of bone marrow micrometastases, and circulating tumor cells.

Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013

2013-08-06

Aron Goldhirsch , Eric P. Winer , Alan S. Coates +7 more

The 13th St Gallen International Breast Cancer Conference (2013) Expert Panel reviewed and endorsed substantial new evidence on aspects of the local and regional therapies for early breast cancer, supporting … The 13th St Gallen International Breast Cancer Conference (2013) Expert Panel reviewed and endorsed substantial new evidence on aspects of the local and regional therapies for early breast cancer, supporting less extensive surgery to the axilla and shorter durations of radiation therapy. It refined its earlier approach to the classification and management of luminal disease in the absence of amplification or overexpression of the Human Epidermal growth factor Receptor 2 (HER2) oncogene, while retaining essentially unchanged recommendations for the systemic adjuvant therapy of HER2-positive and 'triple-negative' disease. The Panel again accepted that conventional clinico-pathological factors provided a surrogate subtype classification, while noting that in those areas of the world where multi-gene molecular assays are readily available many clinicians prefer to base chemotherapy decisions for patients with luminal disease on these genomic results rather than the surrogate subtype definitions. Several multi-gene molecular assays were recognized as providing accurate and reproducible prognostic information, and in some cases prediction of response to chemotherapy. Cost and availability preclude their application in many environments at the present time. Broad treatment recommendations are presented. Such recommendations do not imply that each Panel member agrees: indeed, among more than 100 questions, only one (trastuzumab duration) commanded 100% agreement. The various recommendations in fact carried differing degrees of support, as reflected in the nuanced wording of the text below and in the votes recorded in supplementary Appendix S1, available at Annals of Oncology online. Detailed decisions on treatment will as always involve clinical consideration of disease extent, host factors, patient preferences and social and economic constraints.

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Gene Expression Profiling in Breast Cancer: Understanding the Molecular Basis of Histologic Grade To Improve Prognosis

2006-02-14

Christos Sotiriou , Pratyaksha Wirapati , Sherene Loi +7 more

Background: Histologic grade in breast cancer provides clinically important prognostic information. However, 30%–60% of tumors are classified as histologic grade 2. This grade is associated with an intermediate risk of … Background: Histologic grade in breast cancer provides clinically important prognostic information. However, 30%–60% of tumors are classified as histologic grade 2. This grade is associated with an intermediate risk of recurrence and is thus not informative for clinical decision making. We examined whether histologic grade was associated with gene expression profiles of breast cancers and whether such profiles could be used to improve histologic grading. Methods: We analyzed microarray data from 189 invasive breast carcinomas and from three published gene expression datasets from breast carcinomas. We identified differentially expressed genes in a training set of 64 estrogen receptor (ER)–positive tumor samples by comparing expression profiles between histologic grade 3 tumors and histologic grade 1 tumors and used the expression of these genes to define the gene expression grade index. Data from 597 independent tumors were used to evaluate the association between relapse-free survival and the gene expression grade index in a Kaplan–Meier analysis. All statistical tests were two-sided. Results: We identified 97 genes in our training set that were associated with histologic grade; most of these genes were involved in cell cycle regulation and proliferation. In validation datasets, the gene expression grade index was strongly associated with histologic grade 1 and 3 status; however, among histologic grade 2 tumors, the index spanned the values for histologic grade 1–3 tumors. Among patients with histologic grade 2 tumors, a high gene expression grade index was associated with a higher risk of recurrence than a low gene expression grade index (hazard ratio = 3.61, 95% confidence interval = 2.25 to 5.78; P <.001, log-rank test). Conclusions: Gene expression grade index appeared to reclassify patients with histologic grade 2 tumors into two groups with high versus low risks of recurrence. This approach may improve the accuracy of tumor grading and thus its prognostic value.

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Response to Neoadjuvant Therapy and Long-Term Survival in Patients With Triple-Negative Breast Cancer

2008-02-05

Cornelia Liedtke , Chafika Mazouni , Kenneth R. Hess +7 more

Purpose Triple-negative breast cancer (TNBC) is defined by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression. In this study, we … Purpose Triple-negative breast cancer (TNBC) is defined by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression. In this study, we compared response to neoadjuvant chemotherapy and survival between patients with TNBC and non-TNBC. Patients and Methods Analysis of a prospectively collected clinical database was performed. We included 1,118 patients who received neoadjuvant chemotherapy at M.D. Anderson Cancer Center for stage I-III breast cancer from 1985 to 2004 and for whom complete receptor information were available. Clinical and pathologic parameters, pathologic complete response rates (pCR), survival measurements, and organ-specific relapse rates were compared between patients with TNBC and non-TNBC. Results Two hundred fifty-five patients (23%) had TNBC. Patients with TNBC compared with non-TNBC had significantly higher pCR rates (22% v 11%; P = .034), but decreased 3-year progression-free survival rates (P < .0001) and 3-year overall survival (OS) rates (P < .0001). TNBC was associated with increased risk for visceral metastases (P = .0005), lower risk for bone recurrence (P = .027), and shorter postrecurrence survival (P < .0001). Recurrence and death rates were higher for TNBC only in the first 3 years. If pCR was achieved, patients with TNBC and non-TNBC had similar survival (P = .24). In contrast, patients with residual disease (RD) had worse OS if they had TNBC compared with non-TNBC (P < .0001). Conclusion Patients with TNBC have increased pCR rates compared with non-TNBC, and those with pCR have excellent survival. However, patients with RD after neoadjuvant chemotherapy have significantly worse survival if they have TNBC compared with non-TNBC, particularly in the first 3 years.

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Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials

2011-08-01

C Davies , Jon Godwin , Richard Gray +7 more

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Ki67 Index, HER2 Status, and Prognosis of Patients With Luminal B Breast Cancer

2009-05-13

Maggie C.U. Cheang , Stephen Chia , David Voduc +7 more

Gene expression profiling of breast cancer has identified two biologically distinct estrogen receptor (ER)-positive subtypes of breast cancer: luminal A and luminal B. Luminal B tumors have higher proliferation and … Gene expression profiling of breast cancer has identified two biologically distinct estrogen receptor (ER)-positive subtypes of breast cancer: luminal A and luminal B. Luminal B tumors have higher proliferation and poorer prognosis than luminal A tumors. In this study, we developed a clinically practical immunohistochemistry assay to distinguish luminal B from luminal A tumors and investigated its ability to separate tumors according to breast cancer recurrence-free and disease-specific survival. Tumors from a cohort of 357 patients with invasive breast carcinomas were subtyped by gene expression profile. Hormone receptor status, HER2 status, and the Ki67 index (percentage of Ki67-positive cancer nuclei) were determined immunohistochemically. Receiver operating characteristic curves were used to determine the Ki67 cut point to distinguish luminal B from luminal A tumors. The prognostic value of the immunohistochemical assignment for breast cancer recurrence-free and disease-specific survival was investigated with an independent tissue microarray series of 4046 breast cancers by use of Kaplan–Meier curves and multivariable Cox regression. Gene expression profiling classified 101 (28%) of the 357 tumors as luminal A and 69 (19%) as luminal B. The best Ki67 index cut point to distinguish luminal B from luminal A tumors was 13.25%. In an independent cohort of 4046 patients with breast cancer, 2847 had hormone receptor–positive tumors. When HER2 immunohistochemistry and the Ki67 index were used to subtype these 2847 tumors, we classified 1530 (59%, 95% confidence interval [CI] = 57% to 61%) as luminal A, 846 (33%, 95% CI = 31% to 34%) as luminal B, and 222 (9%, 95% CI = 7% to 10%) as luminal–HER2 positive. Luminal B and luminal–HER2-positive breast cancers were statistically significantly associated with poor breast cancer recurrence-free and disease-specific survival in all adjuvant systemic treatment categories. Of particular relevance are women who received tamoxifen as their sole adjuvant systemic therapy, among whom the 10-year breast cancer–specific survival was 79% (95% CI = 76% to 83%) for luminal A, 64% (95% CI = 59% to 70%) for luminal B, and 57% (95% CI = 47% to 69%) for luminal–HER2 subtypes. Expression of ER, progesterone receptor, and HER2 proteins and the Ki67 index appear to distinguish luminal A from luminal B breast cancer subtypes.

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Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

2010-05-01

Stefan Aebi , T. Davidson , Günther Gruber +1 more

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Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials

2014-03-21

P McGale , Carolyn Taylor , Candace R. Correa +7 more

Postmastectomy radiotherapy was shown in previous meta-analyses to reduce the risks of both recurrence and breast cancer mortality in all women with node-positive disease considered together. However, the benefit in … Postmastectomy radiotherapy was shown in previous meta-analyses to reduce the risks of both recurrence and breast cancer mortality in all women with node-positive disease considered together. However, the benefit in women with only one to three positive lymph nodes is uncertain. We aimed to assess the effect of radiotherapy in these women after mastectomy and axillary dissection.

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Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer

2002-10-17

Umberto Veronesi , Natale Cascinelli , Luigi Mariani +5 more

We conducted 20 years of follow-up of women enrolled in a randomized trial to compare the efficacy of radical (Halsted) mastectomy with that of breast-conserving surgery.From 1973 to 1980, 701 … We conducted 20 years of follow-up of women enrolled in a randomized trial to compare the efficacy of radical (Halsted) mastectomy with that of breast-conserving surgery.From 1973 to 1980, 701 women with breast cancers measuring no more than 2 cm in diameter were randomly assigned to undergo radical mastectomy (349 patients) or breast-conserving surgery (quadrantectomy) followed by radiotherapy to the ipsilateral mammary tissue (352 patients). After 1976, patients in both groups who had positive axillary nodes also received adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil.Thirty women in the group that underwent breast-conserving therapy had a recurrence of tumor in the same breast, whereas eight women in the radical-mastectomy group had local recurrences (P<0.001). The crude cumulative incidence of these events was 8.8 percent and 2.3 percent, respectively, after 20 years. In contrast, there was no significant difference between the two groups in the rates of contralateral-breast carcinomas, distant metastases, or second primary cancers. After a median follow-up of 20 years, the rate of death from all causes was 41.7 percent in the group that underwent breast-conserving surgery and 41.2 percent in the radical-mastectomy group (P=1.0). The respective rates of death from breast cancer were 26.1 percent and 24.3 percent (P=0.8).The long-term survival rate among women who undergo breast-conserving surgery is the same as that among women who undergo radical mastectomy. Breast-conserving surgery is therefore the treatment of choice for women with relatively small breast cancers.

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Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011

2011-06-28

Aron Goldhirsch , W. C. Wood , Alan S. Coates +3 more

The 12th St Gallen International Breast Cancer Conference (2011) Expert Panel adopted a new approach to the classification of patients for therapeutic purposes based on the recognition of intrinsic biological … The 12th St Gallen International Breast Cancer Conference (2011) Expert Panel adopted a new approach to the classification of patients for therapeutic purposes based on the recognition of intrinsic biological subtypes within the breast cancer spectrum. For practical purposes, these subtypes may be approximated using clinicopathological rather than gene expression array criteria. In general, systemic therapy recommendations follow the subtype classification. Thus, 'Luminal A' disease generally requires only endocrine therapy, which also forms part of the treatment of the 'Luminal B' subtype. Chemotherapy is considered indicated for most patients with 'Luminal B', 'Human Epidermal growth factor Receptor 2 (HER2) positive', and 'Triple negative (ductal)' disease, with the addition of trastuzumab in 'HER2 positive' disease. Progress was also noted in defining better tolerated local therapies in selected cases without loss of efficacy, such as accelerated radiation therapy and the omission of axillary dissection under defined circumstances. Broad treatment recommendations are presented, recognizing that detailed treatment decisions need to consider disease extent, host factors, patient preferences, and social and economic constraints.

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American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cancer

2010-04-20

M. Elizabeth H. Hammond , Daniel F. Hayes , Mitch Dowsett +7 more

To develop a guideline to improve the accuracy of immunohistochemical (IHC) estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer and the utility of these receptors as predictive … To develop a guideline to improve the accuracy of immunohistochemical (IHC) estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer and the utility of these receptors as predictive markers.

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Effect of preoperative chemotherapy on the outcome of women with operable breast cancer.

1998-08-01

Bernard Fisher , John Bryant , Norman Wolmark +7 more

PURPOSE To determine, in women with primary operable breast cancer, if preoperative doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan; AC) therapy yields a better outcome than postoperative AC therapy, if a relationship … PURPOSE To determine, in women with primary operable breast cancer, if preoperative doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan; AC) therapy yields a better outcome than postoperative AC therapy, if a relationship exists between outcome and tumor response to preoperative chemotherapy, and if such therapy results in the performance of more lumpectomies. PATIENTS AND METHODS Women (1,523) enrolled onto National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 were randomly assigned to preoperative or postoperative AC therapy. Clinical tumor response to preoperative therapy was graded as complete (cCR), partial (cPR), or no response (cNR). Tumors with a cCR were further categorized as either pathologic complete response (pCR) or invasive cells (pINV). Disease-free survival (DFS), distant disease-free survival (DDFS), and survival were estimated through 5 years and compared between treatment groups. In the preoperative arm, proportional-hazards models were used to investigate the relationship between outcome and tumor response. RESULTS There was no significant difference in DFS, DDFS, or survival (P = .99, .70, and .83, respectively) among patients in either group. More patients treated preoperatively than postoperatively underwent lumpectomy and radiation therapy (67.8% v 59.8%, respectively). Rates of ipsilateral breast tumor recurrence (IBTR) after lumpectomy were similar in both groups (7.9% and 5.8%, respectively; P = .23). Outcome was better in women whose tumors showed a pCR than in those with a pINV, cPR, or cNR (relapse-free survival [RFS] rates, 85.7%, 76.9%, 68.1%, and 63.9%, respectively; P < .0001), even when baseline prognostic variables were controlled. When prognostic models were compared for each treatment group, the preoperative model, which included breast tumor response as a variable, discriminated outcome among patients to about the same degree as the postoperative model. CONCLUSION Preoperative chemotherapy is as effective as postoperative chemotherapy, permits more lumpectomies, is appropriate for the treatment of certain patients with stages I and II disease, and can be used to study breast cancer biology. Tumor response to preoperative chemotherapy correlates with outcome and could be a surrogate for evaluating the effect of chemotherapy on micrometastases; however, knowledge of such a response provided little prognostic information beyond that which resulted from postoperative therapy.

Tamoxifen for Prevention of Breast Cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study

1998-09-16

Bernard Fisher , Joseph P. Costantino , D. Lawrence Wickerham +7 more

Background: The finding of a decrease in contralateral breast cancer incidence following tamoxifen administration for adjuvant therapy led to the concept that the drug might play a role in breast … Background: The finding of a decrease in contralateral breast cancer incidence following tamoxifen administration for adjuvant therapy led to the concept that the drug might play a role in breast cancer prevention. To test this hypothesis, the National Surgical Adjuvant Breast and Bowel Project initiated the Breast Cancer Prevention Trial (P-1) in 1992. Methods: Women (N = 13 388) at increased risk for breast cancer because they 1) were 60 years of age or older, 2) were 35–59 years of age with a 5-year predicted risk for breast cancer of at least 1.66%, or 3) had a history of lobular carcinoma in situ were randomly assigned to receive placebo (n = 6707) or 20 mg/day tamoxifen (n = 6681) for 5 years. Gail's algorithm, based on a multivariate logistic regression model using combinations of risk factors, was used to estimate the probability (risk) of occurrence of breast cancer over time. Results: Tamoxifen reduced the risk of invasive breast cancer by 49% (two-sided P<.00001), with cumulative incidence through 69 months of follow-up of 43.4 versus 22.0 per 1000 women in the placebo and tamoxifen groups, respectively. The decreased risk occurred in women aged 49 years or younger (44%), 50–59 years (51%), and 60 years or older (55%); risk was also reduced in women with a history of lobular carcinoma in situ (56%) or atypical hyperplasia (86%) and in those with any category of predicted 5-year risk. Tamoxifen reduced the risk of noninvasive breast cancer by 50% (two-sided P<.002). Tamoxifen reduced the occurrence of estrogen receptor-positive tumors by 69%, but no difference in the occurrence of estrogen receptor-negative tumors was seen. Tamoxifen administration did not alter the average annual rate of ischemic heart disease; however, a reduction in hip, radius (Colles'), and spine fractures was observed. The rate of endometrial cancer was increased in the tamoxifen group (risk ratio = 2.53; 95% confidence interval = 1.35–4.97); this increased risk occurred predominantly in women aged 50 years or older. All endometrial cancers in the tamoxifen group were stage I (localized disease); no endometrial cancer deaths have occurred in this group. No liver cancers or increase in colon, rectal, ovarian, or other tumors was observed in the tamoxifen group. The rates of stroke, pulmonary embolism, and deep-vein thrombosis were elevated in the tamoxifen group; these events occurred more frequently in women aged 50 years or older. Conclusions: Tamoxifen decreases the incidence of invasive and noninvasive breast cancer. Despite side effects resulting from administration of tamoxifen, its use as a breast cancer preventive agent is appropriate in many women at increased risk for the disease. [J Natl Cancer Inst 1998;90:1371–88]

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Definition and Impact of Pathologic Complete Response on Prognosis After Neoadjuvant Chemotherapy in Various Intrinsic Breast Cancer Subtypes

2012-04-17

Gϋnter von Minckwitz , Michael Untch , Jens‐Uwe Blohmer +7 more

Purpose The exact definition of pathologic complete response (pCR) and its prognostic impact on survival in intrinsic breast cancer subtypes is uncertain. Methods Tumor response at surgery and its association … Purpose The exact definition of pathologic complete response (pCR) and its prognostic impact on survival in intrinsic breast cancer subtypes is uncertain. Methods Tumor response at surgery and its association with long-term outcome of 6,377 patients with primary breast cancer receiving neoadjuvant anthracycline-taxane–based chemotherapy in seven randomized trials were analyzed. Results Disease-free survival (DFS) was significantly superior in patients with no invasive and no in situ residuals in breast or nodes (n = 955) compared with patients with residual ductal carcinoma in situ only (n = 309), no invasive residuals in breast but involved nodes (n = 186), only focal-invasive disease in the breast (n = 478), and gross invasive residual disease (n = 4,449; P < .001). Hazard ratios for DFS comparing patients with or without pCR were lowest when defined as no invasive and no in situ residuals (0.446) and increased monotonously when in situ residuals (0.523), no invasive breast residuals but involved nodes (0.623), and focal-invasive disease (0.727) were included in the definition. pCR was associated with improved DFS in luminal B/human epidermal growth factor receptor 2 (HER2) –negative (P = .005), HER2-positive/nonluminal (P < .001), and triple-negative (P < .001) tumors but not in luminal A (P = .39) or luminal B/HER2-positive (P = .45) breast cancer. pCR in HER2-positive (nonluminal) and triple-negative tumors was associated with excellent prognosis. Conclusion pCR defined as no invasive and no in situ residuals in breast and nodes can best discriminate between patients with favorable and unfavorable outcomes. Patients with noninvasive or focal-invasive residues or involved lymph nodes should not be considered as having achieved pCR. pCR is a suitable surrogate end point for patients with luminal B/HER2-negative, HER2-positive (nonluminal), and triple-negative disease but not for those with luminal B/HER2-positive or luminal A tumors.

The Triple Negative Paradox: Primary Tumor Chemosensitivity of Breast Cancer Subtypes

2007-04-15

Lisa A. Carey , Elizabeth Claire Dees , Lynda Sawyer +7 more

Abstract Purpose: Gene expression analysis identifies several breast cancer subtypes. We examined the relationship of neoadjuvant chemotherapy response to outcome among these breast cancer subtypes. Experimental Design: We used immunohistochemical … Abstract Purpose: Gene expression analysis identifies several breast cancer subtypes. We examined the relationship of neoadjuvant chemotherapy response to outcome among these breast cancer subtypes. Experimental Design: We used immunohistochemical profiles [human epidermal growth factor receptor 2–positive (HER2+)/hormone receptor–negative for HER2+/estrogen receptor–negative (ER−), hormone receptor and HER2− for basal-like, hormone receptor–positive for luminal] to subtype a prospectively maintained data set of patients with breast cancer treated with neoadjuvant anthracycline-based (doxorubicin plus cyclophosphamide, AC) chemotherapy. We analyzed each subtype for clinical and pathologic response to neoadjuvant chemotherapy and examined the relationship of response to distant disease–free survival and overall survival. Results: Of the 107 patients tested, 34 (32%) were basal-like, 11 (10%) were HER2+/ER−, and 62 (58%) were luminal. After neoadjuvant AC, 75% received subsequent chemotherapy and all received endocrine therapy if hormone receptor–positive. The chemotherapy regimen and pretreatment stage did not differ by subtype. Clinical response to AC was higher among the HER2+/ER− (70%) and basal-like (85%) than the luminal subtypes (47%; P &lt; 0.0001). Pathologic complete response occurred in 36% of HER2+/ER−, 27% of basal-like, and 7% of luminal subtypes (P = 0.01). Despite initial chemosensitivity, patients with the basal-like and HER2+/ER− subtypes had worse distant disease–free survival (P = 0.04) and overall survival (P = 0.02) than those with the luminal subtypes. Regardless of subtype, only 2 of 17 patients with pathologic complete response relapsed. The worse outcome among basal-like and HER+/ER− subtypes was due to higher relapse among those with residual disease (P = 0.003). Conclusions: Basal-like and HER2+/ER− subtypes are more sensitive to anthracycline-based neoadjuvant chemotherapy than luminal breast cancers. Patients that had pathologic complete response to chemotherapy had a good prognosis regardless of subtype. The poorer prognosis of basal-like and HER2+/ER− breast cancers could be explained by a higher likelihood of relapse in those patients in whom pathologic complete response was not achieved.

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Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials

2005-12-01

Mike Clarke , Rory Collins , Sarah C. Darby +7 more

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Gene Expression and Benefit of Chemotherapy in Women With Node-Negative, Estrogen Receptor–Positive Breast Cancer

2006-05-24

Soonmyung Paik , Gong Tang , Steven Shak +7 more

Purpose The 21-gene recurrence score (RS) assay quantifies the likelihood of distant recurrence in women with estrogen receptor–positive, lymph node–negative breast cancer treated with adjuvant tamoxifen. The relationship between the … Purpose The 21-gene recurrence score (RS) assay quantifies the likelihood of distant recurrence in women with estrogen receptor–positive, lymph node–negative breast cancer treated with adjuvant tamoxifen. The relationship between the RS and chemotherapy benefit is not known. Methods The RS was measured in tumors from the tamoxifen-treated and tamoxifen plus chemotherapy–treated patients in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B20 trial. Cox proportional hazards models were utilized to test for interaction between chemotherapy treatment and the RS. Results A total of 651 patients were assessable (227 randomly assigned to tamoxifen and 424 randomly assigned to tamoxifen plus chemotherapy). The test for interaction between chemotherapy treatment and RS was statistically significant (P = .038). Patients with high-RS (≥ 31) tumors (ie, high risk of recurrence) had a large benefit from chemotherapy (relative risk, 0.26; 95% CI, 0.13 to 0.53; absolute decrease in 10-year distant recurrence rate: mean, 27.6%; SE, 8.0%). Patients with low-RS (< 18) tumors derived minimal, if any, benefit from chemotherapy treatment (relative risk, 1.31; 95% CI, 0.46 to 3.78; absolute decrease in distant recurrence rate at 10 years: mean, −1.1%; SE, 2.2%). Patients with intermediate-RS tumors did not appear to have a large benefit, but the uncertainty in the estimate can not exclude a clinically important benefit. Conclusion The RS assay not only quantifies the likelihood of breast cancer recurrence in women with node-negative, estrogen receptor–positive breast cancer, but also predicts the magnitude of chemotherapy benefit.

A Gene-Expression Signature as a Predictor of Survival in Breast Cancer

2002-12-18

Marc J. van de Vijver , Yudong D. He , Laura van ′t Veer +7 more

A more accurate means of prognostication in breast cancer will improve the selection of patients for adjuvant systemic therapy. A more accurate means of prognostication in breast cancer will improve the selection of patients for adjuvant systemic therapy.

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Gene-expression profiles to predict distant metastasis of lymph-node-negative primary breast cancer

2005-02-01

Yixin Wang , Jan G.M. Klijn , Yi Zhang +7 more

Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes

1997-06-01

Umberto Veronesi , Giovanni Paganelli , Viviana Galimberti +7 more

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Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence

2007-08-01

Rebecca Dent , Maureen Trudeau , Kathleen I. Pritchard +7 more

Abstract Purpose: To compare the clinical features, natural history, and outcomes for women with “triple-negative” breast cancer with women with other types of breast cancer. Experimental Design: We studied a … Abstract Purpose: To compare the clinical features, natural history, and outcomes for women with “triple-negative” breast cancer with women with other types of breast cancer. Experimental Design: We studied a cohort of 1,601 patients with breast cancer, diagnosed between January 1987 and December 1997 at Women's College Hospital in Toronto. Triple-negative breast cancers were defined as those that were estrogen receptor negative, progesterone receptor negative, and HER2neu negative. The prognostic significance of triple-negative breast cancer was explored. Results: The median follow-up time of the 1,601 women was 8.1 years. One hundred and eighty of 1,601 patients (11.2%) had triple-negative breast cancer. Compared with other women with breast cancer, those with triple-negative breast cancer had an increased likelihood of distant recurrence (hazard ratio, 2.6; 95% confidence interval, 2.0-3.5; P &lt; 0.0001) and death (hazard ratio, 3.2; 95% confidence interval, 2.3-4.5; P &lt; 0.001) within 5 years of diagnosis but not thereafter. The pattern of recurrence was also qualitatively different; among the triple-negative group, the risk of distant recurrence peaked at ∼3 years and declined rapidly thereafter. Among the “other” group, the recurrence risk seemed to be constant over the period of follow-up. Conclusions: Triple-negative breast cancers have a more aggressive clinical course than other forms of breast cancer, but the adverse effect is transient.

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Prognostic and predictive factors in breast cancer by immunohistochemical analysis.

1998-02-01

D. Craig Allred , Jennet Harvey , Melora D. Berardo +1 more

Ki67 expression in breast cancer

2016-02-01

Mohamed A. Elkablawy , Abdulkader M. Albasri , Rabab Mohammed +3 more

To evaluate Ki67 immunoexpression pattern in Saudi breast cancer (BC) patients and investigate any possible predictive or prognostic value for Ki67.This is a retrospective study designed to quantitatively assess the … To evaluate Ki67 immunoexpression pattern in Saudi breast cancer (BC) patients and investigate any possible predictive or prognostic value for Ki67.This is a retrospective study designed to quantitatively assess the Ki67 proliferative index (PI) in retrieved paraffin blocks of 115 Saudi BC patients diagnosed between January 2005 and March 2015 at the Department of Pathology, King Fahd Hospital, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. The Ki67 PI was correlated with individual and combined immunoprofile data of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2/neu) with their clinicopathological parameters. Ki67 immunoreactivity was highly expressed (greater than 25% of the tumor cells were positive) in 85 (73.9%) patients. The Ki67 PI was significantly associated with poor prognostic clinicopathological parameters including old age (p less than 0.02), high tumor grade (p less than 0.01), lymph node metastasis (p less than 0.001), and Her-2/neu positivity (p less than 0.009). However, the association with ER positivity, PR positivity, tumor size, and lymphovascular invasion were not statistically significant. The Ki67 PI was significantly associated with BC molecular subtypes that were Her2/neu positive (luminal B and HER-2) subtypes compared with the Her2/neu negative (luminal A) subtype (p less than 0.04).The Ki67 PI is significantly higher in Saudi BC patients comparing with the reported literature. Ki67 PI was highest in the HER-2 and luminal-B molecular subtypes. Along with other prognostic indicators, Ki67 PI may be useful in predicting prognosis and management of Saudi BC patients.

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Postoperative Radiotherapy in High-Risk Premenopausal Women with Breast Cancer Who Receive Adjuvant Chemotherapy

1997-10-02

Marie Overgaard , Per Syrak Hansen , Jens Overgaard +7 more

Irradiation after mastectomy can reduce locoregional recurrences in women with breast cancer, but whether it prolongs survival remains controversial. We conducted a randomized trial of radiotherapy after mastectomy in high-risk … Irradiation after mastectomy can reduce locoregional recurrences in women with breast cancer, but whether it prolongs survival remains controversial. We conducted a randomized trial of radiotherapy after mastectomy in high-risk premenopausal women, all of whom also received adjuvant systemic chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF).

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The Sentinel Node in Breast Cancer — A Multicenter Validation Study

1998-10-01

David N. Krag , Donald L. Weaver , Takamaru Ashikaga +7 more

Pilot studies indicate that probe-guided resection of radioactive sentinel nodes (the first nodes that receive drainage from tumors) can identify regional metastases in patients with breast cancer. To confirm this … Pilot studies indicate that probe-guided resection of radioactive sentinel nodes (the first nodes that receive drainage from tumors) can identify regional metastases in patients with breast cancer. To confirm this finding, we conducted a multicenter study of the method as used by 11 surgeons in a variety of practice settings.

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Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group.

1998-09-19

C. Focan , S. M. Steinberg , M Blichert-Toft +7 more

Histological Grading and Prognosis in Breast Cancer

1957-09-01

H. J. G. Bloom , W Richardson

Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer

2018-06-03

Joseph A. Sparano , Robert J. Gray , Della Makower +7 more

The recurrence score based on the 21-gene breast cancer assay predicts chemotherapy benefit if it is high and a low risk of recurrence in the absence of chemotherapy if it … The recurrence score based on the 21-gene breast cancer assay predicts chemotherapy benefit if it is high and a low risk of recurrence in the absence of chemotherapy if it is low; however, there is uncertainty about the benefit of chemotherapy for most patients, who have a midrange score.We performed a prospective trial involving 10,273 women with hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary node-negative breast cancer. Of the 9719 eligible patients with follow-up information, 6711 (69%) had a midrange recurrence score of 11 to 25 and were randomly assigned to receive either chemoendocrine therapy or endocrine therapy alone. The trial was designed to show noninferiority of endocrine therapy alone for invasive disease-free survival (defined as freedom from invasive disease recurrence, second primary cancer, or death).Endocrine therapy was noninferior to chemoendocrine therapy in the analysis of invasive disease-free survival (hazard ratio for invasive disease recurrence, second primary cancer, or death [endocrine vs. chemoendocrine therapy], 1.08; 95% confidence interval, 0.94 to 1.24; P=0.26). At 9 years, the two treatment groups had similar rates of invasive disease-free survival (83.3% in the endocrine-therapy group and 84.3% in the chemoendocrine-therapy group), freedom from disease recurrence at a distant site (94.5% and 95.0%) or at a distant or local-regional site (92.2% and 92.9%), and overall survival (93.9% and 93.8%). The chemotherapy benefit for invasive disease-free survival varied with the combination of recurrence score and age (P=0.004), with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25.Adjuvant endocrine therapy and chemoendocrine therapy had similar efficacy in women with hormone-receptor-positive, HER2-negative, axillary node-negative breast cancer who had a midrange 21-gene recurrence score, although some benefit of chemotherapy was found in some women 50 years of age or younger. (Funded by the National Cancer Institute and others; TAILORx ClinicalTrials.gov number, NCT00310180 .).

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Breast Cancer Treatment

2019-01-22

Adrienne G. Waks , Eric P. Winer

<h3>Importance</h3> Breast cancer will be diagnosed in 12% of women in the United States over the course of their lifetimes and more than 250 000 new cases of breast cancer … <h3>Importance</h3> Breast cancer will be diagnosed in 12% of women in the United States over the course of their lifetimes and more than 250 000 new cases of breast cancer were diagnosed in the United States in 2017. This review focuses on current approaches and evolving strategies for local and systemic therapy of breast cancer. <h3>Observations</h3> Breast cancer is categorized into 3 major subtypes based on the presence or absence of molecular markers for estrogen or progesterone receptors and human epidermal growth factor 2 (<i>ERBB2</i>; formerly<i>HER2</i>): hormone receptor positive/<i>ERBB2 </i>negative (70% of patients),<i>ERBB2</i>positive (15%-20%), and triple-negative (tumors lacking all 3 standard molecular markers; 15%). More than 90% of breast cancers are not metastatic at the time of diagnosis. For people presenting without metastatic disease, therapeutic goals are tumor eradication and preventing recurrence. Triple-negative breast cancer is more likely to recur than the other 2 subtypes, with 85% 5-year breast cancer–specific survival for stage I triple-negative tumors vs 94% to 99% for hormone receptor positive and<i>ERBB2</i>positive. Systemic therapy for nonmetastatic breast cancer is determined by subtype: patients with hormone receptor–positive tumors receive endocrine therapy, and a minority receive chemotherapy as well; patients with<i>ERBB2</i>-positive tumors receive<i>ERBB2</i>-targeted antibody or small-molecule inhibitor therapy combined with chemotherapy; and patients with triple-negative tumors receive chemotherapy alone. Local therapy for all patients with nonmetastatic breast cancer consists of surgical resection, with consideration of postoperative radiation if lumpectomy is performed. Increasingly, some systemic therapy is delivered before surgery. Tailoring postoperative treatment based on preoperative treatment response is under investigation. Metastatic breast cancer is treated according to subtype, with goals of prolonging life and palliating symptoms. Median overall survival for metastatic triple-negative breast cancer is approximately 1 year vs approximately 5 years for the other 2 subtypes. <h3>Conclusions and Relevance</h3> Breast cancer consists of 3 major tumor subtypes categorized according to estrogen or progesterone receptor expression and<i>ERBB2</i>gene amplification. The 3 subtypes have distinct risk profiles and treatment strategies. Optimal therapy for each patient depends on tumor subtype, anatomic cancer stage, and patient preferences.

Breast cancer

2019-09-23

Nadia Harbeck , Frédérique Penault‐Llorca , Javier Cortés +6 more

European guidelines for quality assurance in breast cancer screening and diagnosis

2013-01-01

Isabel Amendoeira , Nick Perry , M. Broeders +4 more

The fourth edition of the European guidelines for quality assurance in breast cancer screening and diagnosis was published by the European Commission in 2006. The present supplements to the fourth … The fourth edition of the European guidelines for quality assurance in breast cancer screening and diagnosis was published by the European Commission in 2006. The present supplements to the fourth edition have been produced by the same groups of experts originally established under the Europe Against Cancer programme that have developed and updated the guidelines since the early 1990s. Over the years, the scope and the depth of the multidisciplinary guidelines have expanded, and recommendations and protocols have been updated to keep pace with developments in the field. The present supplements lay a cornerstone for a new, completely revised fifth edition of the guidelines

Minimally invasive axillary lymph node dissection versus conventional axillary lymph node dissection: a comparative study on short-term efficacy in breast cancer

2025-06-25

Zongyan Li , Zuxiao Chen , Lina Wei +7 more | Surgical Endoscopy

Letter to the editor: a Commentary on “The Development and Validation of a Risk Stratification System for Assessing Axillary Status After Neoadjuvant Therapy in Node-positive Breast Cancer: a Multicenter, Prospective, Observational Study”

2025-06-25

Li Liao , Xiangfu Sun , Fan Wang | International Journal of Surgery

Using [18F]FDG PET/CT to Identify Optimal Responders to Neoadjuvant Therapy in Breast Cancer—Results from a Prospective Patient Cohort

2025-06-25

Fabrizia Gelardi , Paola Tiberio , Rosalba Torrisi +7 more | Cancers

Background/objectives: Pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer (BC) is a solid indicator of favourable prognosis, potentially also being useful for more conservative patient management. We … Background/objectives: Pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer (BC) is a solid indicator of favourable prognosis, potentially also being useful for more conservative patient management. We aim to explore the potential of [18F]FDG PET/CT as a non-invasive method to predict response to NAC. Methods: In this prospective, observational cohort study, we enrolled BC patient candidates for NAC who underwent baseline and preoperative [18F]FDG PET/CT. NAC response was determined using final histopathology. PET images were assessed qualitatively and semi-quantitatively, and the findings correlated with NAC response. Results: In total, 133 BC patients were included. The visual analysis of preoperative PET/CT detected residual disease (RD) with high specificity (>93%) and moderate sensitivity, based on pCR/RD classification and RCB index. Semiquantitative measures (SUVmax, TBR) were significantly higher in non-responders across the classification methods (p < 0.001 for all). Conclusions: These findings highlight the potential of preoperative [18F]FDG PET/CT as a complementary tool for identifying excellent responders to NAC across BC subtypes or response criteria. This could inform personalised treatment and potentially allow for surgery to be omitted in selected patients.

Bilateral Primary Breast Cancer: A Case of Synchronous Diagnosis and Management of Ductal Carcinoma <i>In Situ</i> and Invasive Ductal Carcinoma

2025-06-24

Yan Wang , Yong Chen , Bo Zhang +1 more | British Journal of Hospital Medicine

Aims/Background Bilateral breast cancer (BBC) is an uncommon subtype of breast cancer which occurs either synchronously or metachronously. Synchronous BBC with distinct histological types in the left and right breasts … Aims/Background Bilateral breast cancer (BBC) is an uncommon subtype of breast cancer which occurs either synchronously or metachronously. Synchronous BBC with distinct histological types in the left and right breasts is particularly rare. Case Presentation This report presents a case of a 57-year-old female patient diagnosed with bilateral primary breast cancer, characterized by ductal carcinoma in situ (DCIS) in one breast and invasive ductal carcinoma (IDC) in the other. The patient initially sought medical attention due to a palpable mass and pain in her left breast, leading to a diagnosis confirmed through imaging studies and biopsy. The patient was treated with three cycles of neoadjuvant therapy, followed by a modified radical mastectomy on the left breast and a lumpectomy on the right breast. Postoperatively, the patient received endocrine therapy and radiotherapy, with no evidence of recurrence observed to date. Conclusion Further research and clinical advancements are necessary to optimize treatment and care strategies for patients with bilateral breast cancer, ensuring that their unique therapeutic needs are effectively addressed.

ASO Visual Abstract: Intraoperative Radiation Therapy (IORT) for Breast Cancer: The Final Analysis of a Prospective Cohort of 1828 Cases

2025-06-24

Melvin J. Silverstein , Brian Kim , Kevin Lin +5 more | Annals of Surgical Oncology

The current practice of volumetric modulated arc therapy for breast cancer in Europe – A survey by the EFOMP VMAT breast working group

2025-06-24

Timo Koivumäki , Alessandro Clivio , Paul Doolan +6 more | Physica Medica

[Comparison of the efficacy, safety, and cost-effectiveness of trastuzumab biosimilar HLX02 and the originator combined with pertuzumab and chemotherapy in the neoadjuvant treatment of patients with HER-2-positive breast cancer].

2025-06-23

Z X Lei , Die Sang , Bo Lan +7 more | PubMed

Objective: To compare the efficacy, safety, and cost-effectiveness of the trastuzumab originator (HST) versus its biosimilar (HLX02) combined with pertuzumab and chemotherapy as neoadjuvant treatment in patients with HER-2-positive breast … Objective: To compare the efficacy, safety, and cost-effectiveness of the trastuzumab originator (HST) versus its biosimilar (HLX02) combined with pertuzumab and chemotherapy as neoadjuvant treatment in patients with HER-2-positive breast cancer. Methods: This retrospective cohort study included 175 patients with HER-2-positive breast cancer who received neoadjuvant therapy followed by curative surgery at the Cancer Hospital Chinese Academy of Medical Sciences between October 2020 and January 2024. Patients were divided into two groups based on the trastuzumab formulation used: the HST group (n=89) and the HLX02 group (n=86).The efficacy, safety, and trastuzumab-related treatment costs were compared between the two groups. Moreover, using Logistic regression model to identify the factors influencing total pathological complete response (tpCR) rates. Results: There were statistically significant differences in clinical T stage and surgical approach between the HST and HLX02 groups (P＜0.05). Other clinicopathological characteristics, such as age and histological grade, showed no statistically significant differences (P＞0.05), with most baseline characteristics remaining balanced between the two groups. There were no significant differences in tpCR rates (P=0.957) or Miller-Payne (MP) grading rates (P=0.991) between the HST and HLX02 groups. The tpCR rates for the two groups were 55.1% (49/89) and 54.7% (47/86), respectively. The rates of achieving grade 5 (G5) in the postoperative MP pathological grading system were 55.1% (49/89) and 55.8% (48/86), respectively, with no statistically significant difference (P=0.991). Univariate and multivariate Logistic regression analyses showed that hormone receptor status is an independent risk factor affecting tpCR (OR=0.31, 95% CI; 0.16-0.61, P＜0.001). The incidence of adverse event during neoadjuvant therapy was similar between the groups, with no occurrences of trastuzumab-related cardiac toxicity. The HLX02 regimen showed a lower cost-effectiveness ratio (586.48 vs. 604.96) and reduced trastuzumab treatment costs during neoadjuvant therapy compared to HST [tpCR:(31 208.37±2 191.00) CNY vs. (33 224.49±2 741.00) CNY; non-tpCR: 33 030.05±5 787.00) CNY vs. (33 412.50±4 203.00) CNY, P＜0.05]. Conclusions: In the neoadjuvant treatment of early-stage HER-2-positive breast cancer, HLX02 combined with pertuzumab and chemotherapy demonstrates similar efficacy and safety to the trastuzumab originator, while offering a significant cost advantage.

Shadows and Light: The Evolution of Postmastectomy Radiation Therapy and Regional Nodal Irradiation in the Era of De-Escalation

2025-06-23

Parisa Shamsesfandabadi , Bindu Rusia , Chirag Shah | JCO Oncology Practice

Radiation therapy represents a cornerstone in the management of breast cancer, from early-stage to advanced cancers. For appropriately selected patients, postmastectomy radiation therapy (PMRT) and regional nodal irradiation (RNI) have … Radiation therapy represents a cornerstone in the management of breast cancer, from early-stage to advanced cancers. For appropriately selected patients, postmastectomy radiation therapy (PMRT) and regional nodal irradiation (RNI) have historically been shown to improve locoregional control and survival. However, PMRT is associated with an increased risk of cardiopulmonary toxicity, lymphedema, and reconstruction complications. This has led clinicians to re-evaluate a one-size-fits-all approach to PMRT and RNI, instead, looking for a more refined approach to maximizing the therapeutic ratio. This review explores the historical foundations, landmark trials, and paradigm-shifting updates that have transformed PMRT and RNI from broad, uniform strategies into nuanced, patient-specific therapies. Emphasis is placed on the evolution of patient selection, advances in fractionation, and the integration of new approaches. This is a story of progress, precision, and the pursuit of balance in the management of patients with breast cancer.

Lymphatic Contrast-enhanced Ultrasound as a Noninvasive Predictor of Sentinel Lymph Node Metastasis in Breast Cancer: A Prospective Diagnostic Study

2025-06-23

Jundong Yao , Husha Li , Hailong Wang +6 more | Annals of Surgical Oncology

Sentinel lymph node biopsy (SLNB) using radioisotopes/blue dye remains limited by radiation exposure and logistical constraints. This study prospectively evaluates lymphatic contrast-enhanced ultrasound (L-CEUS) for SLN mapping and metastasis detection … Sentinel lymph node biopsy (SLNB) using radioisotopes/blue dye remains limited by radiation exposure and logistical constraints. This study prospectively evaluates lymphatic contrast-enhanced ultrasound (L-CEUS) for SLN mapping and metastasis detection in early-stage breast cancer. A total of 251 consecutive patients underwent L-CEUS-guided SLN biopsy. Enhancement patterns (Types I-V) and filling defects were correlated with histopathology. Diagnostic performance was compared to conventional ultrasound parameters and surgical SLNB (n = 102). L-CEUS successfully localized SLNs in 98.4% (247/251) of cases. Using Types III-V enhancement as metastatic criteria, L-CEUS demonstrated 99.0% sensitivity and 88.1% specificity (AUC 0.935). Incorporating filling defects improved specificity to 95.4% (AUC 0.967). Cortical thickness (>3.0 mm) outperformed nodal short-axis in metastasis prediction (AUC 0.874 vs. 0.702, p < 0.001). Compared with blue dye, L-CEUS identified fewer SLNs/patient (3.11 ± 0.81 vs. 3.59 ± 1.2, p = 0.001) with shorter procedural time (4.09 ± 0.25 vs. 12.12 ± 2.75 min, p < 0.001). Eight false-negatives involved micro-metastases (n = 3) and skip lesions (n = 5). L-CEUS provides high diagnostic accuracy for SLN evaluation while eliminating radiation exposure. Its real-time imaging capability and rapid procedural time support integration into standard axillary staging protocols, particularly where radioisotopes are unavailable. Prospective validation of long-term outcomes is warranted.

In Regard to Leonardi et al, “Salvage breast conserving surgery and reirradiation with intraoperative electrons for recurrent breast cancer: A multicentric study on behalf of AIRO (Italian Association of Radiotherapy and clinical Oncology)”

2025-06-23

Jean‐Michel Hannoun‐Lévi , Csaba Polgár , Vratislav Strnad +1 more | Practical Radiation Oncology

Combined prognostic impact of initial clinical stage and residual cancer burden after neoadjuvant systemic therapy in triple-negative and HER2-positive breast cancer: an analysis of the I-SPY2 randomized clinical trial

2025-06-23

Roberto A. Leon‐Ferre , Katrina Dimitroff , Christina Yau +7 more | Breast Cancer Research

Operable triple-negative (TNBC) and HER2-positive breast cancer are often treated with neoadjuvant systemic therapy (NAST). NAST response is highly prognostic, with pathologic complete response (pCR) being associated with low risk … Operable triple-negative (TNBC) and HER2-positive breast cancer are often treated with neoadjuvant systemic therapy (NAST). NAST response is highly prognostic, with pathologic complete response (pCR) being associated with low risk of recurrence or death. In contrast, residual disease (RD) after NAST is associated with higher risks and is an indication for escalated postoperative therapy. Recent studies suggest that tumor (T) size and nodal (N) status at diagnosis influence clinical outcomes independent of NAST response. We evaluated the impact of initial clinical stage on clinical outcomes according to response to NAST in I-SPY2. Patients with stage II or III TNBC or HER2-positive breast cancer treated on the I-SPY2 trial (NCT01042379) with required data on clinical T size and N status prior to NAST, residual cancer burden (RCB) index, recurrence and survival were included. Survival outcomes, including event-free (EFS), distant recurrence-free (DRFS), and overall survival (OS), were assessed using multivariable Cox proportional hazard models. Among 1,033 patients (TNBC: 638, HER2-positive: 395), the median follow-up was 4.4 years (range 0.3-10.2). 47% achieved pCR (TNBC: 44%, HER2-positive: 51%). Smaller baseline T size, but not N status, was associated with higher pCR rates. However, in those not achieving pCR, RCB class was correlated with both baseline T size and N status in TNBC, and with baseline N status (but not T size) in HER2-positive. Among patients with RD, larger baseline T size was independently associated with worse EFS and DRFS in TNBC and HER2-positive, and with OS in TNBC; while N status was associated with EFS and DRFS in TNBC on univariate analysis only. We did not identify an association between baseline T size or N status and outcomes in patients achieving pCR. Tumor size at diagnosis remained an independent prognostic factor in patients with TNBC and HER2-positive breast cancer with RD after NAST. In contrast, patients achieving pCR had excellent outcomes regardless of initial disease extent, supporting the relevance of pCR as a surrogate endpoint in breast cancer. I-SPY 2 TRIAL beginning December 31, 2009: Neoadjuvant and Personalized Adaptive Novel Agents to Treat Breast Cancer (I-SPY 2), NCT01042379.

Benefit of adjuvant chemotherapy in luminal A-like early breast cancer in women aged 40 years or younger: results of a national multi-institutional study

2025-06-23

Ondine Dufour , Gilles Houvenæghel , Jean‐Marc Classe +7 more | Research Square (Research Square)

<title>Abstract</title> Background: Young age is an established adverse prognostic factor in early-stage breast cancer (eBC), irrespective of molecular subtype or stage at diagnosis. However, the benefit of adjuvant chemotherapy (aCT) … <title>Abstract</title> Background: Young age is an established adverse prognostic factor in early-stage breast cancer (eBC), irrespective of molecular subtype or stage at diagnosis. However, the benefit of adjuvant chemotherapy (aCT) in patients aged ≤ 40 years with luminal A-like BC remains unclear. This study evaluates the impact of aCT on clinical outcomes in this population. Methods: We conducted a retrospective analysis of a multicenter cohort comprising 23,134 eBC patients treated between 1990 and 2014. Eligible patients were aged ≤ 40 years with luminal A-like tumors (SBR grade 1 or 2, endocrine receptor (ER)-positive, HER2-negative). The impact of aCT on disease-free survival (DFS) and overall survival (OS) was assessed using multivariate Cox regression, adjusting for key prognostic factors. Results: A total of 464 patients met the inclusion criteria, of whom 295 received aCT. Patients who underwent aCT had more unfavorable prognostic features, including younger age, larger tumors, higher grade, lymphovascular invasion, and nodal involvement. Multivariate analysis demonstrated a significant OS benefit with aCT (HR = 0.21, 95% CI [0.05–0.84], <italic>p = 0.028</italic>), whereas DFS improvement did not reach statistical significance (HR = 0.57, 95% CI [0.27–1.22], <italic>p = 0.147</italic>). Independent predictors of OS included tumor size, macroscopic lymph node involvement, and radiotherapy, while only tumor size was significantly associated with DFS. Conclusions: In patients aged ≤ 40 years with luminal A-like eBC, aCT confers a significant OS benefit. Although a trend toward improved DFS was observed, statistical significance was not achieved. Further studies are warranted to refine patient selection criteria and optimize therapeutic strategies for this subgroup.

Introducing an oncoplastic approach for centrally located breast cancer patients

2025-06-23

Mohammadreza Karoobi , Seyed Mostafa Meshkati Yazd , Fatemeh Aminolroaya +5 more | World Journal of Surgical Oncology

A Dose-Image Optimization Trial for Voluven®-Assisted Indocyanine Green Fluorescence-Guided Breast Cancer Sentinel Lymph Node Surgery

2025-06-23

Yung-Chun Hsieh , Chiun‐Sheng Huang , Yang‐Hsiang Chan | Annals of Surgical Oncology

Sentinel lymph node biopsy (SLNB) is critical in breast cancer staging, and indocyanine green (ICG) has emerged as a promising fluorescent tracer. Optimizing ICG concentration with an appropriate solvent such … Sentinel lymph node biopsy (SLNB) is critical in breast cancer staging, and indocyanine green (ICG) has emerged as a promising fluorescent tracer. Optimizing ICG concentration with an appropriate solvent such as Voluven® could improve imaging quality and SLN detection, yet the ideal protocol remains undefined. This study investigates the optimal ICG:Voluven concentration for SLNB in breast cancer surgery. In a prospective trial (April 2022-June 2023), 12 women with early breast cancer underwent SLNB with ICG:Voluven at 0.5 mg/mL (5×, n = 3), 0.25 mg/mL (10×, n = 6), or 0.125 mg/mL (20×, n = 3). Outcomes included SLN retrieval, signal-to-background ratio (SBR), areola-to-axilla traveling time (AAT), safety, and cost, assessed via Stryker SPY Portable Handheld Imaging System. The 10× group (0.25 mg/mL) showed the highest median SBR (127.4, range 90.9-256.0) versus 5× (26.3, 2.7-133.2) and 20× (39.1, 5.3-98.4), retrieving three SLNs per patient consistently, unlike fewer in other groups. The 20× group had the shortest AAT (44.3 s) but lower SBR and procedural issues (e.g., subcutaneous dissection). The 5× group had the longest AAT (144.3 s) and reduced SLN detection. No adverse events occurred. The equivalent drug cost was around 1.5 US dollars per patient. The 0.25 mg/mL ICG:Voluven concentration offers an optimal balance of fluorescence imaging quality, SLN detection, and procedural efficiency for SLNB in breast cancer surgery. Its safety, effectiveness, and low cost make it a practical choice, especially in resource-limited settings. Larger studies are needed to validate these results and refine the protocol further.

ASO Author Reflections: Adjuvant Therapy Options for Older Women with Early Stage Breast Cancer

2025-06-23

Tori C Nierenberg , Jennifer K. Plichta | Annals of Surgical Oncology

Indocyanine Green Fluorescence-Guided Axillary Reverse Mapping for Axillary Lymph Node Dissection in Breast Cancer: The FARM Trial

2025-06-23

Chu Luan Nguyen , Deepali Poels , Basilie Teoh +7 more | Annals of Surgical Oncology

Advancing breast cancer research through real-world data from the Singapore Joint Breast Cancer Registry

2025-06-23

Fuh Yong Wong , Bryan J. Chua , Rebecca Dent +7 more | ESMO Real World Data and Digital Oncology

Application of N-NOSE for Evaluating the Response to Neoadjuvant Chemotherapy in Breast Cancer Patients

2025-06-21

Yoshihisa Tokumaru , Yoshimi Niwa , Ryutaro Mori +7 more | Cells

Background: Breast cancer remains a leading cause of cancer-related deaths despite advances in its diagnosis and treatment. Accurate evaluation of the response to neoadjuvant chemotherapy (NAC), especially in HER2-positive and … Background: Breast cancer remains a leading cause of cancer-related deaths despite advances in its diagnosis and treatment. Accurate evaluation of the response to neoadjuvant chemotherapy (NAC), especially in HER2-positive and triple-negative subtypes, is critical. The current methods, including imaging and liquid biopsies, have limitations. N-NOSE, a novel urine-based cancer screening test using Caenorhabditis elegans (C. elegans) chemotaxis, offers a non-invasive alternative. This study investigates the potential of N-NOSE to predict the NAC response in breast cancer patients for improved treatment evaluations. Materials and Methods: This prospective study enrolled 36 breast cancer patients undergoing NAC and surgery to assess the predictive power of the N-NOSE method using urine samples. A chemotaxis analysis of C. elegans was used to calculate the index reduction scores (IRS1–3), reflecting the changes in tumor-related odorants across the treatment stages. Results: Between August 2020 and May 2023, 36 breast cancer patients were enrolled to evaluate the predictive value of N-NOSE IRSs for NAC response. A pathological complete response (pCR) was achieved in 36.1% of the patients. Among the three IRS types analyzed in the 35 patients, IRS3, which showed the IRS at pre-treatment minus that after surgery, showed the highest predictive performance for a pCR, with an AUC of 0.75, indicating its potential utility as a non-invasive biomarker for treatment response evaluations. Conclusions: Index reduction scores evaluated using the N-NOSE method may reflect the efficacy of NAC in breast cancer patients. Future large-scale and multi-institutional prospective studies are warranted.

Patient‐reported outcome thresholds and their associations with survival, adverse events, and quality of life in a pooled analysis of breast cancer trials

2025-06-21

Bradley D. Menz , Natansh D. Modi , Ahmad Y. Abuhelwa +7 more | International Journal of Cancer

Abstract Researchers at the EORTC recently recommended clinical thresholds for the QLQ‐C30 to facilitate actionable insights in clinical practice. We evaluate the distribution of these thresholds and associations with outcomes … Abstract Researchers at the EORTC recently recommended clinical thresholds for the QLQ‐C30 to facilitate actionable insights in clinical practice. We evaluate the distribution of these thresholds and associations with outcomes in breast cancer. Data were pooled from two early‐stage and six advanced‐stage breast cancer trials. EORTC thresholds were applied to available QLQ‐C30 data to identify clinically important PRO domains. Associations between the number of clinically important PRO domains at baseline with overall survival (OS), invasive‐disease‐free survival (IDFS), progression‐free survival (PFS), grade ≥3 adverse events (AEs), and serious AEs were evaluated using Cox‐regression. Data from 8544 breast cancer patients, of whom 2428 (41%) of the 5893 early‐stage and 1486 (56%) of the 2651 advanced‐stage patients reported ≥3 clinically important PRO domains. In the early‐stage, each additional clinically important PRO domain was associated with worsened grade ≥3 AEs (HR, 1.03 [95%CI, 1.01–1.04], p = 0.001) and serious AEs (1.05 [1.03–1.07], p < 0.001). In the advanced‐stage, each additional clinically important PRO domain was associated with worsened OS (1.05 [1.03–1.07], p < 0.001), PFS (1.03 [1.01–1.04], p = 0.002), grade ≥3 AEs (1.04 [1.02–1.06], p < 0.001), and serious AEs (1.07 [1.04–1.11], p < 0.001). A substantial proportion of breast cancer patients report clinically important PRO domains at baseline, with increasing numbers associated with worsening AEs, survival, and quality‐of‐life.

Contrast-enhanced Mammography for Early Prediction of Neoadjuvant Therapy Response in Breast Cancer

2025-06-20

Roberto Lo Gullo , Janice S. Sung , Katja Pinker | Radiology Imaging Cancer

Personalized neoadjuvant strategy using 70-gene assay to increase breast-conserving surgery in ER+/HER2– breast cancer

2025-06-20

Wonshik Han , Eunhye Kang , Ji Gwang Jung +7 more | npj Breast Cancer

We investigated whether tailored neoadjuvant therapy (chemotherapy [NCT] or endocrine therapy [NET]) guided by a 70-gene assay could improve breast-conserving surgery (BCS) rates among patients with ER-positive/HER2-negative breast cancer initially … We investigated whether tailored neoadjuvant therapy (chemotherapy [NCT] or endocrine therapy [NET]) guided by a 70-gene assay could improve breast-conserving surgery (BCS) rates among patients with ER-positive/HER2-negative breast cancer initially deemed ineligible for BCS. Of 130 prospectively enrolled patients (stage II-IIIA, across four Korean centers), 92 were analyzed. Patients classified as high genomic risk received NCT, while low-risk patients underwent NET (letrozole ± leuprolide for premenopausal women) for 16-24 weeks. The primary endpoint-achieving the surgeon-defined target tumor size for BCS-was reached in 69.6% (95% CI: 59.1-78.7%), significantly surpassing the predefined goal of 50.8% (p < 0.05). The actual overall BCS rate was 59.8% (64.7% NCT, 45.8% NET). Pathologic complete response occurred in 2.2%, exclusively in the NCT group. Thus, pretreatment genomic profiling effectively guided therapy selection, substantially increasing BCS eligibility while sparing low-risk patients unnecessary chemotherapy toxicity.

Imaging versus reality: How sensitive is positron emission tomography/computed tomography in early breast cancer lymph node assessment?

2025-06-20

Haryax V Pathak , G. C. Raghunandan , Piyush Chandra +1 more | Annals of Oncology Research and Therapy

Abstract: INTRODUCTION: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a nuclear imaging modality employed for evaluation of distant metastasis, response to chemotherapy or recurrence of disease in early breast … Abstract: INTRODUCTION: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a nuclear imaging modality employed for evaluation of distant metastasis, response to chemotherapy or recurrence of disease in early breast cancer (EBC), but its role in diagnosing locoregional axillary nodal disease is still unclear. Current guidelines dictate sentinel lymph node biopsy (SLNB) for evaluation of axillary involvement followed by axillary lymph node dissection (ALND). We conducted a study to test the sensitivity of FDG PET/CT in detecting lymph node metastasis in EBC, compared with post-ALND histopathological examination. MATERIALS AND METHODS: In a prospective single-center study at a rural tertiary hospital, 33 women with newly diagnosed EBC underwent FDG PET/CT for primary disease status and abnormally increased axillary nodal FDG uptake. These results were then compared with postoperative ALND histopathology report and the data collected were subjected to appropriate statistical analysis. RESULTS: Out of 33 patients who underwent FDG PET/CT followed by modified radical mastectomy and ALND, 24 patients had T2 lesions and 9 had T1 lesions. The sensitivity, specificity, and positive and negative predictive values for nodal metastasis on PET/CT were 50%, 100%, 100%, and 62.5%, respectively. CONCLUSIONS: FDG PET/CT exhibits moderate sensitivity and high specificity for axillary nodal metastasis in EBC. It is not advisable to use FDG PET/CT as a standalone investigation for axillary nodal staging in EBC as it cannot replace SLNB. SLNB remains the investigation of choice for nodal staging and requires capacity building, infrastructure, and training, especially in resource-poor institutions.

Can intraoperative sentinel node fine-needle aspiration biopsy replace sentinel node biopsy in early-stage breast cancer patients undergoing breast-conserving surgery?

2025-06-19

Israel Barco , Antonio Segura García , E. Vallejo +4 more | Clinical & Translational Oncology

The effects of adjuvant endocrine therapy on long-term outcomes from ductal carcinoma in situ: a systematic review and meta-analysis

2025-06-19

Qian Chen , Ian Campbell , Mark Elwood +3 more | The Breast

Although adjuvant endocrine therapy (ET) is a standard treatment for hormone receptor positive ductal carcinoma in situ (DCIS), its use is variably recommended by clinicians. This paper reviewed the effects … Although adjuvant endocrine therapy (ET) is a standard treatment for hormone receptor positive ductal carcinoma in situ (DCIS), its use is variably recommended by clinicians. This paper reviewed the effects of ET in relation to recurrence and survival across diverse populations. PubMed, Embase, Web of Science, and Cochrane were searched for studies that reported outcomes of DCIS treated with ET versus no ET. Three randomised trials and 42 cohort studies were included. In the trials, tamoxifen significantly reduced the risk of in-breast recurrence with a pooled hazard ratio (HR) of 0.69 (95 % CI: 0.60, 0.80). In the cohort studies, ET was associated with lower risks of any recurrence (HR 0.67; 95 % CI: 0.55, 0.83), ipsilateral breast tumour recurrence (HR 0.59; 0.51, 0.69), loco-regional recurrence (HR 0.74; 0.53, 1.02) and contralateral breast cancer (HR 0.70; 0.49, 1.00), and improved overall survival (HR 0.85; 0.79, 0.90). No significant association between ET and breast cancer specific survival was observed in either trials or cohort studies. Subgroup analyses within the cohort studies showed no significant differences in the pooled HRs for recurrence and survival by follow-up length, confounding adjustment or treatment type. The use of adjuvant ET reduces the risk of recurrence in patients with DCIS in clinical trials, as well as in the real-world setting. Survival benefits, however, warrant further study.

Sensitivity and specificity of MammaTyper® versus immunohistochemistry in the molecular subtyping of breast cancer: The SUBMARIN study

2025-06-19

Laia Bernet-Vegué , Stella Peláez Malagón , Margarita Rubio Alonso | Revista de Senología y Patología Mamaria

Visualization of research trend of neoadjuvant chemotherapy for breast cancer treatment: a bibliometric analysis

2025-06-19

Tian Tian , Chao Li , Chaosu Hu +4 more | Discover Oncology

Sentinel lymph node biopsy omission in early-stage breast cancer: current evidence and clinical practice

2025-06-19

Tao Huang , Wenkang Wang , Xianfu Sun | Frontiers in Oncology

Recent trials (e.g., SOUND, INSEMA) indicate that omitting SLNB in patients with small tumors, negative imaging, and favorable prognoses maintains outcomes, reduces complications, and improves quality of life (3,4). Specifically, … Recent trials (e.g., SOUND, INSEMA) indicate that omitting SLNB in patients with small tumors, negative imaging, and favorable prognoses maintains outcomes, reduces complications, and improves quality of life (3,4). Specifically, the INSEMA trial demonstrated that patients who omitted SLNB experienced significantly lower rates of persistent lymphedema (1.8% vs. 5.7%), restriction of arm/shoulder mobility (2.0% vs. 3.5%), and pain with arm/shoulder movement (2.0% vs. 4.2%) compared to those undergoing SLNB. Consequently, guidelines now suggest omitting routine SLNB in elderly patients and those with very low-risk tumors(2). This review summarizes current evidence, eligible populations, theoretical rationale, controversies, and future directions regarding SLNB omission in early breast cancer management.

Trends in Surgical Treatment for cT4 Breast Cancer After Neoadjuvant Systemic Therapy: A Nationwide Study in The Netherlands

2025-06-18

Britt A M Jansen , Johannes C. Kelder , Thomas Borchert +7 more | Annals of Surgical Oncology

Abstract Background Current guidelines recommend neoadjuvant systemic therapy (NST) followed by modified radical mastectomy (MRM) for stage T4 breast cancer. In this study, trends in MRM and de-escalated surgery of … Abstract Background Current guidelines recommend neoadjuvant systemic therapy (NST) followed by modified radical mastectomy (MRM) for stage T4 breast cancer. In this study, trends in MRM and de-escalated surgery of cT4a-c and cT4d breast cancer were evaluated and the impact of treatment on survival was assessed. Methods Patients with cT4N any M0 breast cancer who received NST between 1989 to 2020 were selected from the Netherlands Cancer Registry. Rates of MRM and de-escalated breast/axillary surgery were analyzed for the periods 1989–1999, 2000–2009, and 2010–2020. Cox proportional hazard regression with inverse probability weighing was used to estimate for confounding-adjusted hazard ratios (HRs) for overall survival. Crude relative survival was calculated using excess mortality ratios from national life tables. Results This study included 2,541 patients with cT4a-c and 1479 with cT4d breast cancer. The frequency of MRM decreased from 78% in 1989–1999 to 54% in 2010–2020 for cT4a-c and from 82% to 70% for cT4d patients. De-escalated surgery was associated with better overall survival than MRM, for both cT4a-c (HR 0.74, 95% confidence interval [CI] 0.63–0.87) and cT4d breast cancer (HR 0.78, 95% CI 0.63–0.96). Five-year crude relative survival for MRM versus de-escalated treatment was 66% (95% CI 0.64–0.69) versus 83% (95% CI 0.79–0.87) for cT4a-c, and 56% (95% CI 0.53–0.59) versus 70% (95% CI 0.64–0.76) for cT4d. Conclusions Modified radical mastectomy rates decreased over time. De-escalated surgery was associated with improved 5-year overall survival compared with MRM. These findings suggest that de-escalated surgery is at least equivalent to MRM in terms of survival and may support consideration of less invasive surgical approaches.

Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: ASCO Guideline Clinical Insights

2025-06-18

Ko Un Park , Raymond B. Mailhot Vega , Samantha Shams +4 more | JCO Oncology Practice

Update in the clinical utilization of chemoprevention for breast cancer: a narrative review

2025-06-17

Razan Mansour , Mahmoud Abunasser , Baha’ Sharaf +1 more | Frontiers in Oncology

Background Breast cancer, a leading cause of cancer-related deaths, prompts research into chemoprevention strategies. This narrative review explores risk factors, assessment tools, and summarizes the effectiveness and side effects of … Background Breast cancer, a leading cause of cancer-related deaths, prompts research into chemoprevention strategies. This narrative review explores risk factors, assessment tools, and summarizes the effectiveness and side effects of chemopreventive agents used for breast cancer risk reduction; Methods Published data from major clinical trials, meta-analyses, and data presented at major international conferences that addressed the utilization of tamoxifen, raloxifene, aromatase inhibitors (AI) and other potential drugs are reviewed. Risk assessments models utilized to assess women’s risk of getting breast cancer are discussed, too; Results Tamoxifen, a selective estrogen receptor modulator (SERM), demonstrated efficacy in reducing breast cancer risk in postmenopausal and premenopausal women. However, it poses several worrisome adverse events. Raloxifene, another SERM, has risk-reducing benefits with a better safety profile compared to tamoxifen. AI, like anastrozole and exemestane, reduced invasive breast cancer with better side effect profile. Denosumab, a monoclonal antibody that tackles receptor activator of nuclear factor kappa B (RANK-RANKL), is promising in preventing breast cancer in healthy carriers of pathogenic BRCA1 variants. Despite their proven efficacy, chemopreventive agents are underutilized underscoring the importance of raising the awareness of health care workers and women at-risk; Conclusion Chemopreventive agents present opportunities for reducing breast cancer risk. However, careful consideration of side effects and individual risk factors are crucial to enhance uptake rate. Further research is needed to compare the effectiveness of SERMs and AI in preventing breast cancer, especially in high-risk populations with pathogenic germline mutations.

Reply to Tjalma W.A. Comment on “Gentile et al. Superior Survival and Lower Recurrence Outcomes with Breast-Conserving Surgery Compared to Mastectomy Following Neoadjuvant Therapy in 607 Breast Cancer Patients. Cancers 2025, 17, 766”

2025-06-17

Damiano Gentile , Jacopo Canzian , E. Barbieri +3 more | Cancers

We would like to thank Dr [...] We would like to thank Dr [...]

Comment on Gentile et al. Superior Survival and Lower Recurrence Outcomes with Breast-Conserving Surgery Compared to Mastectomy Following Neoadjuvant Therapy in 607 Breast Cancer Patients. Cancers 2025, 17, 766

2025-06-17

Wiebren Tjalma | Cancers

The article by Gentile et al [...]. The article by Gentile et al [...].

Clinicopathological Spectrum of Breast Cancer Patients Presenting at a Tertiary Care Hospital in Sindh, Pakistan

2025-06-17

Sara Khalid Memon , Faiza Hameed , Nawaz Ali Dal +2 more | Cureus

ASO Author Reflections: Personalizing Tumor Size Assessment in Breast Cancer—A Framework for Dynamic, Patient-Centered Estimation

2025-06-17

Lee Holt , Tyler P Shern , Tolga Özmen | Annals of Surgical Oncology

Patient preferences for treatment pathways in early-stage breast cancer: application of a discrete choice experiment

2025-06-16

Christian Jackisch , Chikako Shimizu , Emuella Flood +6 more | Future Oncology

This study assessed patient preferences for four clinical trial pathways, which include multiple sequential treatments, in human epidermal growth factor receptor 2-negative early-stage breast cancer (eBC). It presents an innovative … This study assessed patient preferences for four clinical trial pathways, which include multiple sequential treatments, in human epidermal growth factor receptor 2-negative early-stage breast cancer (eBC). It presents an innovative application for a discrete choice experiment (DCE), yielding single-preference weights for complex pathways. Patients in Germany, Italy, and Japan with stage II/III BC completed an online DCE, which included a series of choice tasks with two hypothetical treatment profiles that varied in attributes associated with four eBC treatment pathways: overall pathway (event-free survival, fixed versus flexible, duration) and treatment-specific (side effects, regimen). Bayes modeling was used to estimate preference weights for each attribute level. Preferences for different eBC pathways were calculated by summing the respective pathway and treatment weights, adjusted for the duration of the respective treatments along the pathway. Mean pathway preference weights were compared among the four pathways and countries using analyses of variance. Pathway preferences were highly sensitive to treatment toxicity and surgical response. Additionally, a flexible pathway was preferred as it can mean a shorter pathway duration. Discussions with patients should be personalized per individual preferences and should cover the entire treatment pathway, not just the initial treatment step.

Changing practice patterns in axillary management for patients with node-positive breast cancer towards increased use of sentinel lymph node biopsy-alone after neoadjuvant chemotherapy: results of a survey (MF17-01) among Turkish surgeons

2025-06-16

Neslihan Cabıoğlu , Damla Ercan , İrem Karataş +7 more | Langenbeck s Archives of Surgery

Abstract Background This study aimed to determine the knowledge of major benchmark trials among Turkish general surgeons to investigate if they have adopted the results in their practice. Methods A … Abstract Background This study aimed to determine the knowledge of major benchmark trials among Turkish general surgeons to investigate if they have adopted the results in their practice. Methods A total of 101 general surgeons from the Turkish Federation of Breast Diseases Society (TFBDS) were asked to complete a survey that included 24 multiple-choice questions regarding the surgical practice in axillary surgery for early and locally advanced breast cancer. Results Most surgeons were familiar with prospective axillary surgery studies including ACOSOG Z0011 ( n = 77, 76.2%), AMAROS ( n = 76, 75.2%), IBCSG 23 − 01 ( n = 58, 57.4%), ACOSOG Z1071 ( n = 63, 62.4%), and SENTINA ( n = 67, 66.3%). Among the surgeons participating in the present survey, breast surgeons (38.6%) were less likely to perform axillary lymph node dissection (ALND) in early stage patients with a 1–2 positive sentinel lymph node biopsy (SLNB) with micro- or macrometastases, as opposed to those who defined themselves as general surgeons (ALND; 36.8% vs. 63.9%, p = 0.015). Almost all surgeons suggested neoadjuvant chemotherapy (NAC) for patients presenting with T4 (94.8%) or N2-3 disease (92.0%), whereas almost half of the surgeons (40.5%) always proceeded with NAC in patients with clinically node-positive cN1 breast cancer. Overall, 86.1% of surgeons performed SLNB in patients whose axilla became clinically negative after NAC. More than half of the surgeons (55.2%) preferred blue dye as the SLNB technique and 37 (42.5%) used the combined method. Among 87 surgeons, 24.1% ( n = 21) always, 39.1% ( n = 34) sometimes, and 36.8% ( n = 32) never preferred clip marking of axillary metastatic lymph nodes before NAC, whereas 56.4% performed targeted axillary dissection (TAD) after NAC. In cN+ patients before NAC, the majority of surgeons (74.3%) did not perform ALND in patients with at least three lymph nodes removed and SLNB negative. Of note, more than half of the surgeons (51.5%) did not perform ALND in the presence of isolated tumor cells or micrometastases among the three SLNs as long as regional nodal irradiation was received. However, 54.5% of the patients routinely underwent ALND in the presence of macrometastatic residual nodal disease after NAC. Conclusion Deescalating strategies in axillary surgery have been increasing in both initially clinically node-negative and-positive breast cancers as long as nodal radiation is provided.

Assessing the Efficacy of Current Histopathological Tumor Reporting Systems for Evaluating the Response to Neoadjuvant Chemotherapy for Breast Carcinoma: Protocol for an Observational Study

2025-06-16

Anita Sajjanar , Sunita Vagha | JMIR Research Protocols

Background With a predicted 2 million new cases identified globally in 2018, breast carcinomas are the most common cancer in women and the primary cause of cancer-associated mortality. In the … Background With a predicted 2 million new cases identified globally in 2018, breast carcinomas are the most common cancer in women and the primary cause of cancer-associated mortality. In the management of breast cancer, neoadjuvant chemotherapy treatment (NACT) has become a mainstay, particularly for patients with inflammatory and locally advanced breast cancer. It increases the possibility of breast-conserving surgery, facilitates tumor downstaging, and gives early indications of the effectiveness of treatment. Evaluating the histopathological response after NACT is crucial for prognosis and guiding subsequent treatment decisions. This study explores the various histopathological assessment systems used in breast carcinoma patients after NACT, focusing on the residual cancer burden (RCB) score, Miller-Payne system, Chevallier classification, Sataloff classification, National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-18 system, and the American Joint Committee on Cancer residual tumor size (R) categories. We compare their methodologies, strengths, limitations, and clinical significance, providing a detailed analysis of their roles in improving patient outcomes. Objective The aim of this study is to confirm the diagnosis of breast carcinoma based on histopathology, to evaluate various scoring systems through assessments of histomorphological features affecting post-NACT patients with breast carcinoma, to compare the various systems regarding the response to therapy and forming prognoses, and to develop an ideal histomorphological assessment system for breast carcinoma in post-NACT patients. The study also focused on how breast tumors respond to NACT and how this response can guide treatment decisions and improve the formulation of prognoses. Methods This observational study will be retrospective and prospective; it will include 128 patients diagnosed with breast carcinomas who have undergone NACT and were referred to a tertiary care hospital between January 2019 and December 2024. Following chemotherapy, a thorough examination of the histopathological specimens will be conducted to assess any changes in histomorphology. Results Data collection started in September 2021 and will be completed by December 2025. Data analysis began in January 2025, and the results are expected to be published in December 2025. Institutional ethics committee clearance was obtained prior to commencement of the study. This is a nonfunded academic study. Conclusions This project aims to evaluate and compare histopathological assessment systems in patients with breast carcinoma after NACT. Various histopathological systems, such as the RCB score, the Miller-Payne grading system, and other systems, each provide valuable insights into how well tumors respond to chemotherapy. The aim is to reveal essential histopathological parameters, leading to the refinement and potential modification of grading systems to improve clinical decision-making, treatment outcomes, and personalized care; however, challenges persist in standardization and consensus. International Registered Report Identifier (IRRID) DERR1-10.2196/56825

Calcium and CA 15-3 Level in Breast Cancer Patients Pre- and Post-Mastectomy Surgery

2025-06-15

Umi Aminotul Kirom , Budi Santosa , Edward Kurnia Setiawan Limijadi | INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY

Breast cancer has a potentially affect the calcium levels because of its role in regulating cell proliferation, differentiation, migration, invasion, metabolism, and apoptosis. Analysis related to changes in calcium levels … Breast cancer has a potentially affect the calcium levels because of its role in regulating cell proliferation, differentiation, migration, invasion, metabolism, and apoptosis. Analysis related to changes in calcium levels in breast cancer patients can contribute to developing patient treatment plans. CA 15-3 is a protein made primarily by breast cancer cells and is an epitope of the transmembrane glycoprotein (MUC1). High concentrations of calcium and CA 15-3 levels are associated with tumor burden and prognostic factors for breast cancer. This study aims to prove that there are differences in the results of an examination of calcium levels and CA 15-3 in breast cancer patients before and after mastectomy surgery. In this study, 50 female patients who were diagnosed with stage I, II, and III breast cancer had their serum CA 15-3 levels and calcium levels checked before and 10 days after surgery. The research analysis used for this difference test is the paired T-test and the Wilcoxon test. In this study, it was found that CA 15-3 levels decreased after breast surgery. Mean calcium levels before surgery were (10.092+1.2762 mg/dL). Mean calcium levels after surgery were (8.489+1.0204 mg/dL). CA 15-3 levels before surgery were 26.895+18.4914 UI/mL and after surgery were 21.678+11.9711 UI/mL. It can be concluded that there was a decrease in calcium levels of 1.603 mg/dL, and CA 15-3 levels decreased by 5.217 UI/mL between before and after mastectomy surgery.

Predictive risk factors of recurrence in breast cancer after neoadjuvant treatment: the NEORISK study

2025-06-14

Antonio Franco , Luisa Carbognin , Ida Paris +7 more | Future Oncology

Neoadjuvant chemotherapy (NACT) improves oncologic and cosmetic outcomes in breast cancer (BC), yet recurrence remains a concern. This study identifies factors associated with recurrence at 3 and 5 years in … Neoadjuvant chemotherapy (NACT) improves oncologic and cosmetic outcomes in breast cancer (BC), yet recurrence remains a concern. This study identifies factors associated with recurrence at 3 and 5 years in BC patients receiving NACT. A retrospective analysis of 933 stage I - III BC patients (2014-2021) evaluated event-free survival (EFS) predictors using multivariate analyses. Lower 5-year EFS was linked to axillary staging (cN, p < 0.001), molecular subtype (p < 0.001), surgery type (p = 0.030), and post-surgical nodal status (ypN, p = 0.005). High recurrence risk was observed with aggressive tumor biology, advanced disease, and residual nodal burden, while favorable responses correlated with better outcomes. Biological and clinical factors guide post-NACT strategies to reduce recurrence in high-risk BC patients.

Breast Tumors

2025-06-14

| TNM Online

Abstract The International Classification of Diseases for Oncology (ICD‐O‐4C50) applies only to carcinomas and concerns the male as well as the female breast. There should be histological confirmation of the … Abstract The International Classification of Diseases for Oncology (ICD‐O‐4C50) applies only to carcinomas and concerns the male as well as the female breast. There should be histological confirmation of the disease. The anatomical subsite of origin should be recorded but is not considered in classification. In the case of multiple simultaneous primary tumours in one breast, the tumour with the highest T category should be used for classification. The pathological classification requires the examination of the primary carcinoma with no gross tumour at the margins of resection. The pathological classification requires the resection and examination of at least the low axillary lymph nodes. Such a resection will ordinarily include six or more lymph nodes. For histopathological grading of invasive carcinoma, the Nottingham Histological Score is recommended. This chapter presents the prognostic factors for breast cancer.

Dose–volume histogram-based comparison of conventional and hypofractionated radiotherapy: lifetime attributable risk estimation in Indian breast carcinoma patients

2025-06-14

Amal Jose , Desh Deepak Ladia , Anju George +2 more | Radiological Physics and Technology

Dynamic Evolution of Vascular Features Based on Magnetic Resonance Imaging to Predict Pathological Response, Patterns of Recurrence and Survival Outcomes in Breast Cancer Neoadjuvant Chemotherapy

2025-06-13

Qiong Wu , Mingxi Zhu , Huaying Xie +7 more | Current Oncology

Neoadjuvant chemotherapy (NAC), followed by surgery and adjuvant therapy, constitutes the prevailing therapeutic paradigm for patients with locally advanced breast cancer (LABC) [...] Neoadjuvant chemotherapy (NAC), followed by surgery and adjuvant therapy, constitutes the prevailing therapeutic paradigm for patients with locally advanced breast cancer (LABC) [...]

Abstract P1-10-11: Preliminary Analysis of Sociodemographic and Clinical Characteristics of Patients with Early Breast Cancer in the Patient-Centered, Real-World EVOLVE Registry

2025-06-13

Haley S. Friedler , Michael C. S. Bissell , Kellie Ryan +7 more | Clinical Cancer Research

Abstract Background: Despite improvement in survival rates over time, recurrence and treatment-related adverse events remain concerning risks for patients with early (stage I-III) breast cancer (eBC). The EVOLVE Registry, a … Abstract Background: Despite improvement in survival rates over time, recurrence and treatment-related adverse events remain concerning risks for patients with early (stage I-III) breast cancer (eBC). The EVOLVE Registry, a patient-centered United States (US)-based registry was created to address the limitations of existing eBC databases and better understand real-world sociodemographics, clinical characteristics, diagnostic and treatment pathways, clinical outcomes, and patient experience in eBC. This is the first analysis of the ongoing EVOLVE Registry. Methods: The EVOLVE Registry, created through a collaboration between PicnicHealth and AstraZeneca, consists of the de-identified medical record data, along with patient-reported social determinants of health (SDoH) and patient-reported outcomes (PROs) data. Inclusion criteria were defined as eBC (invasive, non-metastatic) diagnosed ≤3 years prior to enrollment and ≥18 years old at consent. Patient enrollment began May 2023. Using PicnicHealth’s platform, all available retrospective medical records prior to enrollment, including pre-diagnosis, were retrieved. Following enrollment, medical records and survey/PRO were prospectively collected. eBC-specific data elements were abstracted from structured and narrative text. Rural/urban categorization was derived from Rural-Urban Commuting Area (RUCA) codes. While enrollment (target: 3,000 patients) and data collection is ongoing, data from medical records collected and completed surveys for patients enrolled in the EVOLVE Registry up to June 2024 were analyzed. Patient demographics, receptor status, and self-reported SDoH data are described. Results: A total of 1,428 patients with eBC enrolled as of June 2024 with a median of 7 years of visits pre-diagnosis and 2 years of visits post-diagnosis. Mean (range) age at diagnosis was 55 (24 - &gt;89) years, with 76% diagnosed between 40-69 years and 35% diagnosed ≤1 year of enrollment. Almost all patients (n=1,427) were female; 77% were White, 12% Black/African American, 2% Asian, 4% mixed race, and 5% other race; 13% were Hispanic/Latino; 93% resided in a metropolitan/micropolitan area and 7% small town/rural. Most patients had hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)- eBC (70%), followed by 15% HR-/HER2-, 11% HR+/HER2+, 4% HR-/HER2+, and 1% unknown. About half (55%) were diagnosed at stage I, 32% at stage II, and 13% at stage III. Of the 58% of patients who responded to the SDoH survey, 98% had some form of medical insurance; 20% had a high school education or less; 31% had full time employment, 10% part-time employment, and 27% were retired; 62% reported a household annual income of &lt;$75k; 57% owned their own housing; 25% were concerned about losing their housing; 16% reported lack of transportation access kept them from medical appointments. 47% reported current or former use of nicotine-based products, 89% of whom reported cigarette use and 25% reported e-cigarette/vape use. Conclusions: The EVOLVE Registry to date has enrolled a population broadly representative of patients with eBC in the US with regards to race, ethnicity, and eBC characteristics. The patient-reported SDoH indicated a highly insured population, however, this may not reflect financial burden and unmet needs, including for transportation and housing security, as those were still apparent in this population. With ongoing enrollment, this registry will help further the understanding of the evolving real-world treatment of eBC, existing disparities, and patient needs across diagnostic and treatment pathways that affect breast cancer outcomes. Citation Format: Haley S. Friedler, Michael C. S. Bissell, Kellie Ryan, Michele Baber, Xiaoqing Xu, Zulikhat Segunmaru, Chintal H. Shah, Qixin Li, Thomas Quinn, Amy Longenecker, Amy Bryer, Colleen Goldberg, Gillian Hanson, Maryam Lustberg, Maryam Lustberg, N Lynn Henry, Rachel A Greenup, Mariana Chavez-MacGregor, Joseph M. Unger, Alice Ho, Deborah Collyar, Miranda Gonzales, Tiffany Haynes, Josefa Briceno. Preliminary Analysis of Sociodemographic and Clinical Characteristics of Patients with Early Breast Cancer in the Patient-Centered, Real-World EVOLVE Registry [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-10-11.

Abstract P4-09-17: Oncotype DX® breast cancer assay in older patients: a real-life cohort

2025-06-13

Clément Grosnon , Djamel Ghebriou , Anne Sabaila +7 more | Clinical Cancer Research

Abstract Introduction: The 21-gene Oncotype DX® Breast Recurrence Score test was designed for HR+, HER2- early-stage breast cancer (eBC) to aid in the decision-making process regarding adjuvant chemotherapy. Its validity … Abstract Introduction: The 21-gene Oncotype DX® Breast Recurrence Score test was designed for HR+, HER2- early-stage breast cancer (eBC) to aid in the decision-making process regarding adjuvant chemotherapy. Its validity and utility have been demonstrated prospectively across multiple studies, though data on older patients remain limited.Methods: This retrospective cohort study included all consecutive patients over 70 with eBC treated between January 2018 and December 2023 at Tenon Hospital, Paris, France.Results: Of the 365 patients included, the mean age was 77.6 years (range 70-96). Among these, 84,4% had HR+/HER2- eBC. Most patients had invasive ductal carcinomas (75%), N0/Nmic node involvement (75%), grade 2 tumors (60%), and tumor sizes &lt;5 cm (65%). Axillary lymph node dissection was performed in 20% of the patients, while 66% underwent sentinel lymph node biopsy. Oncotype DX® testing was requested for 86 patients, 27,9% of HR+/HER2- eBCs. A Recurrence Score (RS) &gt;25 was found in 13 patients (15%), including those with N+ (15%), grade 3 (69%) and Ki67 &gt;20% (62%). Three patients had a RS &gt;25 with T2, grade 2 breast cancer. Chemotherapy was not initiated in 6 out of the 13 patients with a high RS: 2 were deemed unfit according to geriatric evaluation, 2 refused chemotherapy, and 2 for unknown reasons.Conclusion: This observational study provides valuable insights into the management of HR+ eBC in older patients, emphasizing the importance of considering Oncotype DX® to optimize treatment strategies in these patients. Citation Format: Clement Grosnon, Djamel Ghebriou, Anne Sabaila, David Buob, Mariana Nedelcu, Lauren Seknazi, Marjolaine Legac, Mathieu Jamelot, Coralie Prebet, Emile Darai, Cyril Touboul, Jean-Pierre Lotz, Joseph Gligorov, Marc-Antoine Benderra. Oncotype DX® breast cancer assay in older patients: a real-life cohort [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-09-17.

Abstract RF1-03: Three-year event-free survival (EFS) of the multicenter phase II TRAIN-3 study evaluating image-guided optimization of neoadjuvant chemotherapy duration in stage II and III HER2-positive breast cancer (BOOG 2018-01)

2025-06-13

Fleur M. Louis , Anna van der Voort , Mette van Ramshorst +7 more | Clinical Cancer Research

Abstract Background Neo-adjuvant treatment with 6-9 cycles anti-HER2 based chemotherapy leads to excellent long-term survival in patients with stage II-III HER2+ breast cancer, but comes with important side effects. The … Abstract Background Neo-adjuvant treatment with 6-9 cycles anti-HER2 based chemotherapy leads to excellent long-term survival in patients with stage II-III HER2+ breast cancer, but comes with important side effects. The TRAIN-3 study previously showed that one in three patients with hormone receptor negative (HR-) tumors and one in six with hormone receptor positive (HR+) tumors have an early pathologic complete response (pCR) after only three cycles of neo-adjuvant chemotherapy. Here, we present the results of the primary endpoint, 3-year event-free survival (EFS). Methods TRAIN-3 is a single-arm, phase 2 study in 43 hospitals in the Netherlands. Patients with stage II–III HER2-positive breast cancer received up to nine cycles of neoadjuvant systemic therapy with paclitaxel, trastuzumab, carboplatin and pertuzumab (PTC-Ptz) and were referred for surgery once a complete radiologic response was seen on MRI. Locoregional and endocrine treatment followed national guidelines. Patients with a pCR completed one year of trastuzumab and pertuzumab as adjuvant treatment. Patients with residual invasive disease completed the 9 cycles of PTC-Ptz followed by 14 cycles of T-DM1. EFS was estimated using Kaplan-Meier statistics on an intention-to-treat basis for each HR subgroup separately. Three-year EFS rates of 88% for HR- and 90% for HR+ tumors were taken as reference. The study would be declared successful if no more than 38 events in the HR- subgroup and 34 events in the HR+ subgroup occurred after 700 patient years of follow-up. Results 235 patients with HR- tumors received 1-3 (n=91, 38.7%), 4-6 (n=76, 32.3%) or 7-9 (n=68, 28.9%) cycles of PTC-Ptz. 232 patients with HR+ tumors received 1-3 (n=69, 29.7%), 4-6 (n=71, 30.6%) or 7-9 (n=92, 39.7%) cycles of PTC-Ptz. After a median follow-up of 39.7 months (IQR 34.8-45.4), 3-year EFS was 92.1% (95% CI 88.5-95.8) in the HR- subgroup and 92.0% (95% CI 88.5-95.6) in the HR+ subgroup. A total of 19 and 21 events were reported in patients with HR- and HR+ tumors respectively, meeting the primary endpoint. Events included 9 vs 8 distant recurrences, 7 vs 6 locoregional recurrences, 2 vs 4 non-breast second primary malignancies, 0 vs 3 second primary breast tumors, and 1 vs 0 non-breast cancer related death, in HR- and HR+ patients respectively. EFS rates in patients treated with 1-3 cycles of neoadjuvant systemic therapy were 96.0% (95% CI 91.6-100) in HR- and 97.1% (95% CI 93.3-100) in HR+ patients. Corresponding figures were 90.8% (95% CI 84.5-97.5) and 92.8% (95% CI 87.0-99.1) in patients treated with 4-6 cycles and 87.6% (95% CI 79.1-97.0) and 87.1% (80.3-94.6) in patients treated with 7-9 cycles. Conclusions In patients with stage II-III HER2+ breast cancer, MRI-guided treatment optimization is associated with excellent 3-year EFS. These results confirm our earlier findings on pCR rate that one in three patients with HR- disease and one in six patients with HR+ disease can be treated effectively with only three cycles of neoadjuvant chemotherapy. This approach offers a novel therapeutic option that provides a significant reduction in toxicity for this patient population. Citation Format: Fleur Louis, Anna van der Voort, Mette van Ramshorst, Antonios Daletzakis, Ingrid Mandjes, Inge Kemper, Mariette Agterof, Wim van der Steeg, Joan Heijns, Marlies van Bekkum, Ester Siemerink, Philomeen Kuijer, Astrid Scholten, Jelle Wesseling, Marie-Jeanne Vrancken Peeters, Ritse Mann, Gabe Sonke. Three-year event-free survival (EFS) of the multicenter phase II TRAIN-3 study evaluating image-guided optimization of neoadjuvant chemotherapy duration in stage II and III HER2-positive breast cancer (BOOG 2018-01) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr RF1-03.

Abstract P5-11-08: Primary analysis of radiotherapy data from prospective randomized controlled phase III VENUS trial: sentinel lymph node biopsy Versus No axillary surgery in early breast cancer clinically and UltraSonographically node negative

2025-06-13

Danielle Bastos Araújo , Giuliano Mendes Duarte , Sérgio Carlos Barros Esteves +7 more | Clinical Cancer Research

Abstract Background: Radiotherapy is an important treatment for breast cancer. The axilla possibly receives some dose of radiation from treatment in the breast field and could perhaps treat node-positive disease. … Abstract Background: Radiotherapy is an important treatment for breast cancer. The axilla possibly receives some dose of radiation from treatment in the breast field and could perhaps treat node-positive disease. Previous trials on de-escalation of axillary surgery, including omitting sentinel lymph node biopsy (SLNB), have not detailed or presented few radiotherapy data. VENUS is an ongoing trial that evaluates omission of SLNB in early breast cancer clinically and ultrasonographically node negative. This is a partial report on the first interim radiotherapy data collected up to 4.5 years after the VENUS trial has started. The objective is to evaluate radiotherapy dose in axilla and whether radiotherapy is being uniform between VENUS groups. Methods: prospective, multi-center, non–inferiority, phase III, randomized controlled clinical trial including T1-2 N0 (clinical/ultrasound) M0 breast cancer patients (&gt;18 years old) randomized into: SLNB or no axillary surgery. The sample size is calculated at 800 randomized women, with patients undergoing mastectomy and neoadjuvant chemotherapy being allowed. Randomization (1:1) is being stratified by age and tumor size. Endpoints include disease free survival after 5 years of follow-up (primary endpoint), overall survival, regional recurrence free survival, axillary recurrence rate, axillary morbidity rate, ultrasound accuracy and cost-effectiveness. Adjuvant radiotherapy planning was based on local protocols adopted by each study center. In the no-surgery group, axilla status was considered N0 during planning. Radiotherapy features analyzed were: planning, site, number and location of fields, whole-breast/boost dose, fractioning and estimates of dose volumetry (total and 90%) distribution in axillary levels I-III. VENUS trial is registered at ClinicalTrials.gov (NCT05315154) and ReBEC (RBR-8g6jbf). Results: Until June 2024, 372 women were randomized. Radiotherapy was performed in 249 (SLNB n=133 and no-surgery n=116). Two-D, 3D-IMRT and 3D-Conformational planning were applied for 7, 26, 200 patients, respectively, with no imbalance across study groups (p=0.34). Mean whole-breast dose was 3558.17cGy in SLNB and 3773.40cGy in no-surgery (p=0.22). Mean percentage of total prescribed breast doses distribution in axillary were: Level I 4.39% SLNB vs 2.34% no-surgery (p=0.21), Level II 0.31% SLNB vs 0.06% no-surgery (p=0.72), Level III 0.72% SLNB vs 0.00% no-surgery (p=0.08). Radiotherapy fields (axilla, supraclavicular fossa, breast and internal mammary) and boost are described and were all evenly balanced across study groups. Conclusion: Breast radiotherapy has achieved an unintentional low radiation dose in the axilla of some patients, mainly at Level I. However, there was no difference between VENUS trial groups in radiotherapy parameters. So far, with more than 40% of the sample size achieved, there has been no violation of radiotherapy procedure protocol in the VENUS trial. Of the axillary surgery de-escalation trials, up to now VENUS trial presented 42% radiotherapy data. Citation Format: Danielle Araujo, Giuliano Mendes Duarte, Sergio Carlos Barros Esteves, Rodrigo Menezes Jales, Maria Beatriz Kraft, Amanda Maria Sacilotto Detoni, Julia Yoriko Shinzato, Cassio Cardoso Filho, Renato Zocchio Torresan, Fabrício Palermo Brenelli, Higor Kassouf Mantovani, Grazielle Moraes Tavares, Eduardo Carvalho Pessoa, Idam de Oliveira Júnior, Ruffo de Freitas Júnior, Rosemar Macedo Sousa Rahal, Jorge Villanova Biazus, Andrea Pires Souto Damin, Vinicius Milani Budel, Lucas Roskamp Budel, Roberta Dantas Jales Alves de Andrade, Leonardo Ribeiro Soares, Marcelo Antonini, Francisco Pimentel, Darley de Lima Ferreira Filho, Sabas Carlos Vieira, Kamila Bezerra Fernandes Diocesano, Rafael Henrique Szymanski Machado, Luis Otávio Sarian. Primary analysis of radiotherapy data from prospective randomized controlled phase III VENUS trial: sentinel lymph node biopsy Versus No axillary surgery in early breast cancer clinically and UltraSonographically node negative [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-11-08.

Abstract RF2-03: Diagnostic performance of axillary ultrasound after neoadjuvant chemotherapy in initially node-positive breast cancer patients – results from the prospective AXSANA registry trial (NCT04373655)

2025-06-13

Steffi Hartmann , Dr.Prasobh G.R Dr.Prasobh G.R , Maggie Banys‐Paluchowski +7 more | Clinical Cancer Research

Abstract Background: Axillary ultrasound (AUS) is the most widely used imaging procedure to assess the lymph node status in breast cancer patients before surgery. While AUS provides excellent results for … Abstract Background: Axillary ultrasound (AUS) is the most widely used imaging procedure to assess the lymph node status in breast cancer patients before surgery. While AUS provides excellent results for predicting axillary involvement in patients undergoing primary surgery, its performance after neoadjuvant chemotherapy (NACT) so far has not been analyzed in large prospective multicentric studies, especially in patients who convert from node-positive to node-negative disease. Methods: The AXSANA study is a prospective, non-interventional, international registry study investigating different surgical axillary staging procedures with regard to disease-free survival, axillary recurrence rate, and quality of life in patients presenting initially with node-positive breast cancer who convert to a clinically node-negative status after NACT. In the current analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS after NACT are analyzed for all patients included in the AXSANA study between June 1, 2020, and May 31, 2024, whose surgical treatment after NACT was completed. All datasets were systematically monitored. Results: Among 3,841 eligible patients, 3,429 women (89.3%) underwent AUS after NACT before surgery. The result of the AUS was unclear in 168 of these patients (4.9%), suspicious in 1,061 (30.9%), and unsuspicious in 2,200 (64.2%). Axillary pathological complete response was achieved in 1,794 of 3,261 patients (55.0%) with either suspicious or unsuspicious AUS results after NACT. Sensitivity was 46.4% (95% CI 43.8%-49.0%), specificity 78.8% (95% CI 76.9%-80.7%), PPV 64.2% (95% CI 61.2%-67.1%), and NPV 64.3% (95% CI 62.2%-66.3%). Conclusions: To our knowledge, this analysis provides the largest dataset from a prospective cohort study to investigate the diagnostic performance of AUS after NACT in initially node-positive breast cancer patients. Our data clearly show that the pathological nodal status after NACT cannot reliably be determined with AUS alone. Consequently, surgical axillary staging remains indispensable to assess the axillary lymph node status after chemotherapy in node-positive breast cancer patients that convert to ycN0. Axillary lymph node dissection based on suspicious AUS results after NACT may lead to surgical overtreatment in many patients. Citation Format: Steffi Hartmann, Di Micco R, Banys-Paluchowski M, Schmidt E, Gentilini OD, Ditsch N, Stickeler E, de Boniface J, Schroth J, Karadeniz Cakmak G, Hahn M, Thill M, Reimer T, Fröhlich S, Wihlfahrt K, Berger T, Lux MP, Kolberg HC, Rubio IT, Gasparri ML, Kontos. Diagnostic performance of axillary ultrasound after neoadjuvant chemotherapy in initially node-positive breast cancer patients – results from the prospective AXSANA registry trial (NCT04373655) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr RF2-03.

Abstract P4-11-15: Variability in physician treatment decisions for HR+ / HER 2 negative Early Breast Cancer in young patients: a Latin-American survey

2025-06-13

Dana Narváez , Federico Waisberg , Victoria Costanzo +7 more | Clinical Cancer Research

Abstract Introduction: Breast cancer in young people (age ≤ 40), represents 5% of all breast cancer cases. Population outcomes for this group are often derived from subgroup analyses of randomized … Abstract Introduction: Breast cancer in young people (age ≤ 40), represents 5% of all breast cancer cases. Population outcomes for this group are often derived from subgroup analyses of randomized or retrospective trials. Limited data about physicians' knowledge, attitudes and practices as they relate to this diagnosis. The aim of our study was to evaluate the decision-making process in Latin-American oncologists for the treatment of young women with early breast cancer. Methods: A survey was designed with 30 items. Principal topics included: use of ovarian suppression, indication for adjuvant chemotherapy, fertility, use of genomic tests and recommendations for management of treatment-associated symptoms. Content validation was undertaken by Argentinian oncologists of SUMA (Argentinian Group for the treatment and research of breast cancer ). The study was conducted via an online questionnaire, sent by email to professional societies and to oncologists involved in the management of breast cancer patients. Descriptive analyses were included. Chi square test was performed to evaluate relationships between physician characteristics (country, gender, years of expertise, whether the physician worked in a tumor specific clinic or not) and responses. The level of statistical significance was set at p &lt; 0.05, two-tailed. Results: A total of 329 Latin American oncologists from 17 Latin-American countries participated in the electronic survey. The responding oncologists included 74.5% who treated patients with any tumor type (ALLT), 14.6% specialized in breast and gynecological tumors (BRGY), and 10.9% focused exclusively on breast tumors (BREX). Working in a tumor-specific clinic was associated with differential utilization of several treatments or diagnostic tests, including ovarian suppression (OFS) for therapeutic purposes during neo/adjuvant chemotherapy (74.7% ALLT, 91.6% BRGY, 86.1% BREX; p=0.031), selective recommendation for OFS with endocrine therapy during the adjuvant setting (51.4% ALLT, 66.6% BRGY, 75% BREX; p &lt; 0.001), and routine evaluations of FSH levels during treatment with OFS (70.5% ALLT, 86.8% BRGY, 86.2% BREX; p=0.038). Genetic counseling was always offered in young patients by 47.8%, 72.9% and 69.4% of physicians with ALLT, BRGY and BREX clinics, respectively (p=0.014). The use of genomic platforms for decision-making also differed: 55.6% of BREX oncologists reported always using these platforms in cases of young women compared to 38.8% of oncologists who treat all types of tumors (p &lt;0.001). Specifically, chemotherapy was recommended to patients with recurrence score higher than 20 by 49%, 77.8% and 60.4% of oncologists with ALLT, BRGY and BREX clinics, respectively (p=0.003) The reported practices did not differ among professionals from different countries. Conclusions: According to the results of our survey the approach to managing early HR+ HER2- negative breast cancer in young women differ depending by professional focus. Full results will be presented. Further research is needed to understand the basis for these differences. However, given the heterogeneity of responses, our study highlights the need for specific guidelines for the management of breast cancer in young patients. Citation Format: Dana P. Narvaez, Federico Waisberg, Victoria Costanzo, Danilo Aguirre, Cynthia Villarreal, Matías Chacón, Sergio Rivero, Alexis Ostinelli, Fernando Namuche Ojeda, Alvaro Encinas Casanave, María Lucila González Donna, Cinthia Gauna, Juana Vazquez, María P. Molina Espinosa, Sara C. Altuna Mujica, Ronald Limón, Kayra K.Sanchez Muñoz, Claudia Martinez, Adrian Nervo, Gonzalo Gomez Abuin, Santiago Bella, Andrea Aguilar, Vanesa Lopez, Pablo Mandó, Valeria Caceres. Variability in physician treatment decisions for HR+ / HER 2 negative Early Breast Cancer in young patients: a Latin-American survey [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-11-15.

Utilizing cohort-level and individual networks to predict best response in patients with metastatic triple negative breast cancer

2025-06-13

Daniel Bottomly , Christina Zheng , Allison Creason +3 more | npj Precision Oncology

Abstract Given the highly aggressive and heterogeneous nature of metastatic triple-negative breast cancer, molecular subtypes have been evaluated for their utility in patient stratification and therapeutic selection. Leveraging both our … Abstract Given the highly aggressive and heterogeneous nature of metastatic triple-negative breast cancer, molecular subtypes have been evaluated for their utility in patient stratification and therapeutic selection. Leveraging both our unique longitudinal multimodal analysis of serial tumor biopsies, as well as existing public reference cohorts, we refined clinically relevant molecular subtypes through de-novo network-based approaches. A plasma/B-cell related co-expression module emerged as a robust predictor of clinical response. Refinements of this module were significantly associated with pathological complete response and survival in the CALGB and METABRIC cohorts, as well as dramatically improving the call rate in a CLIA setting. We explored patient-specific networks to monitor individual adaptive responses to therapy, allowing for dynamic adjustments in treatment strategies. Our work supports the shift from traditional molecular subtyping towards a more integrated view that includes the tumor microenvironment and immune landscape in a network-based context.