Breast Cancer Research and Treatment最新文献

{"title":"Vascularized lymph node transfer (VLNT) versus lymphaticovenous anastomosis (LVA) for chronic breast cancer-related lymphedema (BCRL): a retrospective cohort study of effectiveness over time.","authors":"Elisabeth A Kappos, Adriano Fabi, Florian S Halbeisen, Alina Abu-Ghazaleh, Julia Stoffel, Birgit Aufmesser-Freyhardt, Julia Bukowiecki, Tristan M Handschin, Christoph Andree, Martin D Haug, Dirk J Schaefer, Sonia Fertsch, Katrin Seidenstücker","doi":"10.1007/s10549-024-07567-5","DOIUrl":"https://doi.org/10.1007/s10549-024-07567-5","url":null,"abstract":"<p><strong>Purpose: </strong>Microsurgical reconstruction, including vascularized lymph node transfer (VLNT) and lymphaticovenous anastomosis (LVA), have emerged as promising treatment options for chronic breast cancer-related lymphedema (BCRL). Despite their clinical relevance, the precise timelines for patient improvement following these interventions remain rather unexplored. Therefore, the goal of this study was to compare the long-term outcomes and improvement patterns over time of VLNT versus LVA to lay open potential differences and aid in personalized counseling of future patients.</p><p><strong>Methods: </strong>A prospectively maintained, encrypted database was analyzed for patients with chronic BCRL treated with either VLNT or LVA with a minimum follow-up of one year. Patient-specific variables, such as body weight and circumferential arm measurements at distinct locations on both arms were documented preoperatively and on regular postoperative outpatient follow-ups.</p><p><strong>Results: </strong>This study comprised 112 patients, of which 107 patients fully completed the one-year follow-up period. Both VLNT and LVA achieved significant arm size reductions. LVA showed an early peak in effectiveness within the first three months, followed by a subsequent decrease and eventual stabilization. Contrarily, VLNT exhibited a distinct pattern with two significant peaks at three and eighteen months.</p><p><strong>Conclusions: </strong>VLNT and LVA are both effective in long-term lymphedema management, yet they demonstrate marked differences in the timing of improvement. VLNT shows a delayed but more durable response, in contrast to the greater but shorter-lasting surge in effectiveness achieved by LVA. Interestingly, VLNT demonstrates an earlier onset of therapeutic impact than previously understood.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Receipt of guideline-concordant care and survival among young adult women with non-metastatic breast cancer.","authors":"Manami Bhattacharya, Benmei Liu, Allison W Kurian, Jennifer Stevens, Lindsey Enewold, Dolly C Penn","doi":"10.1007/s10549-024-07570-w","DOIUrl":"https://doi.org/10.1007/s10549-024-07570-w","url":null,"abstract":"<p><strong>Purpose: </strong>Adolescent and young adults (AYA) with breast cancer, compared to older adults, are diagnosed with more aggressive cancers, at more advanced stages and may undergo more aggressive treatment but have worse survival. Despite this, no research has studied the effects of the receipt of National Comprehensive Cancer Network (NCCN) defined guideline-concordant care (GCC) for breast cancer on AYA survival. We examined the association of GCC with survival among young adult (20-39 years old) breast cancer survivors.</p><p><strong>Methods: </strong>We used the Patterns of Care Study; a stratified random sample of 952 young adult women diagnosed with Stage I-III breast cancer in 2013. NCCN guidelines were used to categorize treatment as GCC or non-GCC. We used Kaplan-Meier curves, log-rank tests, and Cox-proportional hazards models to evaluate the effect of GCC on breast cancer-specific survival, stratifying by triple-negative breast cancer (TNBC) and non-TNBC, and adjusting for sociodemographic and clinical factors.</p><p><strong>Results: </strong>All univariate analyses showed that non-GCC was associated with worse survival than GCC. The association was statistically significant for non-TNBC (Hazard ratio: 3.45, CI 1.64-7.29) and TNBC (Hazard ratio: 3.70, CI 1.02-13.43) in multivariable Cox models adjusted for sociodemographic variables and for non-TNBC (Hazard ratio: 3.13, CI 1.13-8.72) when the model was adjusted for sociodemographic and clinical variables.</p><p><strong>Conclusion: </strong>Among young adult women with non-metastatic breast cancer, while receipt of NCCN GCC is univariately associated with better survival for both TNBC and non-TNBC, the effect of sociodemographic and clinical factors on the association differs by TNBC status. Further investigation with larger TNBC samples is needed.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apo10 and TKTL1 in blood macrophages as potential biomarkers for early diagnosis of operable breast cancer.","authors":"Minqing Wu, Qiyu Huang, Lijuan Zhang, Yuying Liu, Musheng Zeng, Chuanbo Xie","doi":"10.1007/s10549-024-07569-3","DOIUrl":"https://doi.org/10.1007/s10549-024-07569-3","url":null,"abstract":"<p><strong>Objective: </strong>Blood macrophage Apo10 and TKTL1 detection is a novel, noninvasive cancer screening approach, but its relevance in breast cancer remains uncertain. We compared the potential diagnostic value of Apo10 and TKTL1 with commonly used tumor markers in differentiating breast cancer patients.</p><p><strong>Methods: </strong>Physical examination and blood sample data from breast cancer patients who did not receive surgery or chemotherapy (retrospective; breast cancer group) and those with benign breast nodules and completely healthy subjects (prospective; control group) were collected from October 2020 to July 2022 at Sun Yat-sen University. Descriptive statistics and receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUROC) was calculated to compare the diagnostic efficiency of Apo10 and TKTL1 with conventional biomarkers (carcinoembryonic antigen [CEA], cancer antigens [CA-125, CA-199, CA-153]) in differentiating breast cancer from healthy breasts and benign breast nodules.</p><p><strong>Results: </strong>From October 2020 to July 2022, 153 breast cancer patients (primarily early-stage disease: n = 113 (73.9%) stage I/II) and 153 control participants (benign breast nodules, n = 56; healthy, n = 97) were included in this study. The breast cancer subtypes were mainly invasive ductal carcinoma (92.8%), with a few cases of DCIS (5.9%), infiltrating lobular carcinoma (0.7%), and mucinous carcinoma (0.7%). Notably, Apo10, TKTL1, and Apo10 + TKTL1 (APT) levels were significantly greater in the cancer group than in the control group (P < 0.001), demonstrating high diagnostic value (AUC = 0.901, 0.871, 0.938) that surpassed CA-125, CA-199, CA-153, and CEA. In a subgroup analysis excluding stage III patients, APT-based breast cancer screening was minimally affected, with the AUROC (0.933-0.938) varying by ≤ 1%.</p><p><strong>Conclusion: </strong>Compared with conventional biomarkers, Apo10, TKTL1, and APT showed superior early-stage breast cancer screening efficacy, potentially emerging as a promising marker for discriminating breast cancer from healthy breasts and nontumoral lesions.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inference of genetic ancestry from a multi-gene cancer panel in Colombian women with cancer.","authors":"Yina T Zambrano-O, Alejandro Mejía-Garcia, P Daniela Morales, Hsuan Megan Tsao, Laura Rey-Vargas, Wendy Montero-Ovalle, Carlos A Huertas-Caro, M C Sanabria-Salas, Julián Riaño-Moreno, Juliana L Rodriguez, Carlos A Orozco, Liliana Lopez-Kleine, I King Jordan, Silvia J Serrano-G","doi":"10.1007/s10549-024-07557-7","DOIUrl":"https://doi.org/10.1007/s10549-024-07557-7","url":null,"abstract":"<p><strong>Introduction: </strong>Cancer health disparities among racial and ethnic populations significantly burden health systems due to unequal access to early detection, treatment, and healthcare resources. These disparities lead to worse outcomes and increased costs from delayed diagnoses, advanced treatments, and prolonged care. Genetic differences can also influence cancer susceptibility and treatment response, thus analyzing genetic ancestry is essential for uncovering genetic factors that may contribute to these disparities. Utilizing data from clinical multigene cancer panels to infer genetic ancestry offers a valuable approach to understand population structure and the impact of individual ancestries in development of complex diseases.</p><p><strong>Aim: </strong>To evaluate the accuracy of global ancestry inference using genetic markers from the TruSight™ Hereditary Cancer Panel, which was used to investigate hereditary cancer syndromes in a cohort of 116 female cancer patients at the Colombian National Cancer Institute. Additionally, to compare these results with genetic ancestry estimations from traditional genome-wide markers.</p><p><strong>Results: </strong>Our results demonstrate a strong correlation between global genetic ancestry inferred with markers captured from TruSight^TM panel (4785 markers) and Whole Genome Sequencing (WGS, 8 million markers in admixed populations. The correlation values were 0.96 (p < 0.0001) for the Native American and European ancestry components, and 0.99 (p < 0.0001) for the African ancestry fraction. Genetic ancestry mean proportions in the Colombian cohort were 45.7%, 46.2%, and 8.11% for the European, the Native American, and the African components, respectively.</p><p><strong>Conclusion: </strong>This study demonstrates the accuracy of ancestry inference from clinical panel data offering a promising approach for understanding cancer health disparities in admixed populations.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase II study of MEK inhibitor trametinib alone and in combination with AKT inhibitor GSK2141795/uprosertib in patients with metastatic triple negative breast cancer.","authors":"Vishnu Prasath, Hinda Boutrid, Robert Wesolowski, Mahmoud Abdel-Rasoul, Cynthia Timmers, Maryam Lustberg, Rachel M Layman, Erin Macrae, Ewa Mrozek, Charles Shapiro, Kristyn Glover, Mark Vater, G Thomas Budd, Lyndsay Harris, Claudine Isaacs, Claire Dees, Charles M Perou, Gary L Johnson, Andrew Poklepovic, Helen Chen, Miguel Villalona-Calero, William Carson, Daniel G Stover, Bhuvaneswari Ramaswamy","doi":"10.1007/s10549-024-07551-z","DOIUrl":"https://doi.org/10.1007/s10549-024-07551-z","url":null,"abstract":"<p><strong>Purpose: </strong>While MEK inhibitors demonstrated activity in metastatic triple negative breast cancer (mTNBC) preclinical studies, preclinical, and clinical studies implicate rapid development of resistance limiting clinical benefit. The purpose of this study was to determine response rate for Trametinib alone and in combination with Uprosertib in patients with mTNBC previously treated with chemotherapy.</p><p><strong>Methods: </strong>This was an open-label, two-part, phase II, single-arm, multicenter study. Patients first received Trametinib monotherapy (2 mg daily; Part I) then at progression transitioned to Trametinib (1.5 mg) plus Uprosertib (50 mg; Part II).</p><p><strong>Results: </strong>Between October 2013 and January 2017, 37 patients were enrolled to Part I. Subsequently, 19 patients entered Part II. Of the 37 patients receiving Trametinib monotherapy, 2 patients achieved partial response (PR) for an ORR of 5.4% (2/37) and an additional 6/37 (16.2%) achieved stable disease (SD). The clinical benefit rate (PR+SD) for patients receiving monotherapy was 21.6% (8/37). Of the 19 patients in Part II, 3 patients achieved PR for an ORR to Part II of 15.8% (3/19) and an additional 3 achieved SD. Median progression-free survival (PFS) was 7.7 weeks for Part I and 7.8 weeks for Part II. Circulating tumor DNA (ctDNA) clearance at C2D1 of Trametinib monotherapy was associated with improved PFS and overall survival.</p><p><strong>Conclusion: </strong>In patients with mTNBC, Trametinib monotherapy demonstrated limited efficacy and addition of Uprosertib was associated with numerically greater objective responses but no difference in PFS. Translational analyses suggest ctDNA clearance as a potential early biomarker of response.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of body composition in neurological and hematologic toxicity in a retrospective analysis of 120 breast cancer patients undergoing neoadjuvant chemotherapy: the COMBOTOX study.","authors":"A Di Leone, A Filippone, C Maggiore, M M Rossi, C Rossi, A Di Micco, Luana Forcina, A Franco, L Ionta, A Fabi, I Paris, L Scardina, A M Sanchez, P C Pafundi, G Franceschini, R Masetti, S Magno","doi":"10.1007/s10549-024-07553-x","DOIUrl":"https://doi.org/10.1007/s10549-024-07553-x","url":null,"abstract":"<p><strong>Purpose: </strong>Neoadjuvant chemotherapy (NAC) has a well-established role in locally advanced or chemoresponsive breast cancers (BC). Chemotherapic regimens are effective when patients receive the optimal doses. Toxicities are common in overweight/obese patients but may occur also in normal weight counterparts. This leads to delays, reductions, or discontinuation of treatment, with impact on outcomes. Current dosing is based on body weight and predicted Body Surface Area (BSA). These parameters do not take into consideration the individual variations of fat mass (FM) and fat-free mass (FFM) that affect pharmacokinetics. Assessment of body composition (BoCo), rather than Body Mass Index (BMI), could help to better plan chemotherapy and reduce drug-related toxicities. Our aim was to analyze the correlations between body weight, anthropometric measures, BoCO, and toxicities related to NAC in non-metastatic BC patients.</p><p><strong>Methods: </strong>This is a retrospective observational cohort study that includes 120 consecutive BC patients undergoing NAC, enrolled between May 2018 and December 2020. All patients received an evaluation of anthropometric parameters (height, weight, waist and hip circumference, BMI) and an assessment of BoCo using Segmental Multi-Frequency-Bioelectrical Impedance Analysis.</p><p><strong>Results: </strong>A logistic regression models confirmed that a higher FM was associated with a higher rate of neurological and hematologic toxicities in protocols containing Platinum. Moreover, patients with a low FFM% have a higher risk for hematologic toxicity in protocols containing Platinum.</p><p><strong>Conclusion: </strong>A routine assessment of BoCo, in addition to evaluation of anthropometric measures and BMI, could allow to personalize chemotherapy doses, in order to reduce chemotherapy-related toxicities.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pexidartinib and standard neoadjuvant therapy in the adaptively randomized I-SPY2 trial for early breast cancer.","authors":"Hope S Rugo, Mike Campbell, Christina Yau, A Jo Chien, Anne M Wallace, Claudine Isaacs, Judy C Boughey, Hyo S Han, Meredith Buxton, Julia L Clennell, Smita M Asare, Katherine Steeg, Amy Wilson, Ruby Singhrao, Jeffrey B Matthews, Jane Perlmutter, W Fraser Symmans, Nola M Hylton, Angela M DeMichele, Douglas Yee, Laura J Van't Veer, Donald A Berry, Laura J Esserman","doi":"10.1007/s10549-024-07555-9","DOIUrl":"https://doi.org/10.1007/s10549-024-07555-9","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated the small-molecule receptor tyrosine kinase-inhibitor of colony-stimulating factor-1 receptor pexidartinib in the stage II/III breast cancer in the I-SPY2 platform trial.</p><p><strong>Methods: </strong>I-SPY2 is an adaptive platform trial that features multiple arms of experimental agents administered on a background of standard neoadjuvant therapy with paclitaxel and adriamycin/cyclophosphamide, followed by definitive surgery. The adaptive randomization engine preferentially assigns patients based upon cumulative performance of each agent in a given breast cancer subtype based on hormone receptor and HER2 receptor status. The study endpoint is pathologic complete response.</p><p><strong>Results: </strong>A total of 9 participants were randomized to receive pexidartinib with neoadjuvant paclitaxel before enrollment was halted due to a serious adverse event of vanishing bile duct syndrome. No participants received a full course of the study drug.</p><p><strong>Conclusion: </strong>Although there remains interest in agents targeting CSF-1, hepatic toxicity appears to be a limiting factor for their use in early breast cancer.</p><p><strong>Trial registration: </strong>NCT01042379 ( www.</p><p><strong>Clinicaltrials: </strong>gov/ct2/show/NCT01042379 ).</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, treatment patterns, and mortality for patients with breast cancer during the first year of the COVID-19 pandemic: a population-based study.","authors":"José Pablo Leone, Julieta Leone, Michael J Hassett, Rachel A Freedman, Jorge Avila, Carlos T Vallejo, Nabihah Tayob, Sara M Tolaney, Nancy U Lin","doi":"10.1007/s10549-024-07562-w","DOIUrl":"https://doi.org/10.1007/s10549-024-07562-w","url":null,"abstract":"<p><strong>Purpose: </strong>The COVID-19 pandemic created significant disruptions in the diagnosis and treatment of breast cancer (BC). Several public health measures were taken with limited evidence on their potential impact. In this observational study, we sought to compare the incidence of BC, treatment patterns, and mortality during 2020 versus 2018 and 2019.</p><p><strong>Methods: </strong>Using the Surveillance, Epidemiology, and End Results program, we identified 37,834 patients with ductal carcinoma in situ (DCIS) and 199,594 with invasive BC between 2018 and 2020. We assessed age-adjusted incidence rates of DCIS and invasive BC as cases per 100,000, treatment patterns, and mortality in 2020 versus 2018 and 2019.</p><p><strong>Results: </strong>From 2019 to 2020, the incidence of female DCIS decreased from 36.4 to 31.0, and the incidence of female invasive BC decreased from 184.2 to 166.6. Among females, the relative reductions in incidence from 2019 to 2020 were 14.8% for DCIS, 12.1% for stage I, 5.8% for stage II, 2.6% for stage III, and 1.9% for stage IV. Comparing 2020 to 2018-2019 in invasive BC, we observed significant changes in treatment patterns with decreased use of surgery or radiation and increased use of chemotherapy. The 12-month mortality rates were 4.49%, 4.37%, and 4.57% for 2018, 2019 and 2020, respectively. In the Cox model, there were no significant differences in mortality between patients diagnosed in 2020 versus 2018 or 2019.</p><p><strong>Conclusions: </strong>During 2020, the incidence of BC decreased significantly. There were reductions in surgery and radiation use, but not in chemotherapy. Although vaccines were largely unavailable and COVID-19 treatments were in development, we saw no differences in 12-month mortality in 2020 versus prior years. The impact on BC-specific outcomes requires further follow-up.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomised trial comparing 6-monthly adjuvant zoledronate with a single one-time dose in patients with early breast cancer.","authors":"Arif Ali Awan, Carol Stober, Gregory R Pond, Igor Machado, Lucas Clemons, Henry Conter, Demetrios Simos, Sukhbinder Dhesy-Thind, Mihaela Mates, Vikaash Kumar, John Hilton, Marie-France Savard, Dean Fergusson, Lisa Vandermeer, Mark Clemons","doi":"10.1007/s10549-024-07443-2","DOIUrl":"10.1007/s10549-024-07443-2","url":null,"abstract":"<p><strong>Purpose: </strong>While adjuvant bisphosphonate use in early breast cancer (EBC) is associated with improvements in breast cancer-specific outcomes, questions remain around optimal bisphosphonate type, dose and scheduling. We evaluated a single zoledronate infusion in a prospective randomised trial.</p><p><strong>Methods: </strong>Postmenopausal patients with EBC were randomised to receive a single infusion of zoledronate (4 mg IV) or 6-monthly treatment for 3 years. Outcomes measured were; Quality of Life (QoL; EQ-5D-5L), bisphosphonate-related toxicities, including acute phase reactions (APRs), recurrence-free survival (RFS), bone metastasis-free survival (BMFS) and overall survival (OS).</p><p><strong>Results: </strong>211 patients were randomized to either a single infusion (n = 107) or six-monthly treatment (n = 104). After 3 years of follow up there were no significant differences between the arms for QoL and most toxicity endpoints. APRs following zoledronate occurred in 81% (171/211) of patients (77.6% in single infusion arm and 84.6% in the 6-monthly group). While the frequency of APRs decreased over 3 years in the 6-monthly arm, they still remain common. Of 34/104 (32.7%) patients who discontinued zoledronate early in the 6-monthly treatment group, the most common reason was APRs (16/34, 47%). At the 3 year follow up, there were no differences between arms for RFS, BMFS or OS.</p><p><strong>Conclusion: </strong>A single infusion of zoledronate was associated with increased patient convenience, less toxicity, and lower rates of treatment discontinuation. Despite the common clinical impression that APRs decrease with time, this was not observed when patients were specifically questioned. While the study is not powered for non-inferiority, longer-term follow-up for confirmation of RFS and OS rates is ongoing.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"523-533"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragmentation of care in breast cancer: greater than the sum of its parts.","authors":"Hadley D Freeman, Linnea C Burke, Ja'Neil G Humphrey, Ashley J Wilbers, Halley Vora, Rhami Khorfan, Naveenraj L Solomon, Jukes P Namm, Liang Ji, Sharon S Lum","doi":"10.1007/s10549-024-07442-3","DOIUrl":"10.1007/s10549-024-07442-3","url":null,"abstract":"<p><strong>Introduction: </strong>Fragmentation of care (FC, the receipt of care at > 1 institution) has been shown to negatively impact cancer outcomes. Given the multimodal nature of breast cancer treatment, we sought to identify factors associated with FC and its effects on survival of breast cancer patients.</p><p><strong>Methods: </strong>A retrospective analysis was performed of surgically treated, stage I-III breast cancer patients in the 2004-2020 National Cancer Database, excluding neoadjuvant therapy recipients. Patients were stratified into two groups: FC or non-FC care. Treatment delay was defined as definitive surgery > 60 days after diagnosis. Multivariable logistic regression was performed to identify factors predictive of FC, and survival was compared using Kaplan-Meier and multivariable Cox proportional hazards methods.</p><p><strong>Results: </strong>Of the 531,644 patients identified, 340,297 (64.0%) received FC. After adjustment, FC (OR 1.27, 95% CI 1.25-1.29) was independently associated with treatment delay. Factors predictive of FC included Hispanic ethnicity (OR 1.04, 95% CI: 1.01-1.07), treatment at comprehensive community cancer programs (OR 1.06, 95% CI: 1.03-1.08) and integrated network cancer programs (OR 1.55, 95% CI: 1.51-1.59), AJCC stage II (OR 1.06, 95% CI 1.05-1.07) and stage III tumors (OR 1.06, 95% CI: 1.02-1.10), and HR + /HER2 + tumors (OR 1.05, 95% CI: 1.02-1.07). Treatment delay was independently associated with increased risk of mortality (HR 1.23, 95% CI 1.20-1.26), whereas FC (HR 0.87, 95% CI 0.86-0.88) showed survival benefit.</p><p><strong>Conclusions: </strong>While treatment delay negatively impacts survival in breast cancer patients, our findings suggest FC could be a marker for multispecialty care that may mitigate some of these effects.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"511-521"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}