Critically ill patients with acute leukemia often require an intensive care unit (ICU) admission. As major therapeutic advances have been made during the last decades, the aim of this study was to assess temporal trends in ICU mortality, and identify prognostic factors to inform clinician decision-making. We conducted an individual participant data meta-analysis of studies including adults with acute leukemia admitted to the ICU. Patients with a history of allogeneic hematopoietic stem cell transplantation were excluded. Mixed-effects logistic regression models, accounting for center of ICU admission as a random variable, evaluated factors associated with ICU mortality, with particular focus on year of ICU admission, age (> 65 years) and invasive mechanical ventilation. A total of 2003 patients from 55 ICUs across 19 countries were included (median age 58 years [IQR 44–67]; 72
Neurocritical care (NCC) education involves integrating knowledge and skills into various complex areas. While the USA, Canada, and Europe regulate didactic core training for medical residencies and fellowships, the quantity and quality of these training programs in Brazil remain unclear. To assess how NCC training is currently integrated into neurology and intensive care residency programs in Brazil. A cross-sectional survey composed of 27 multiple-choice and short-answer questions was distributed by email to professionals registered in national congresses and medical organizations. Data regarding exposure to NCC training, duration, supervision, infrastructure, and self-perceived competencies were analyzed. A total of 208 responses from 82 centers across 14 Brazilian states were included. Respondents were primarily neurologists (58.2%) and intensivists (28.2%). Only 50.5% reported receiving NCC training during residency, typically lasting more than 4 weeks. Training predominantly occurred in intensive care units with 5 to 20 beds, supervised by intensivists. However, exposure to specialized skills was limited: 23% to transcranial Doppler, 21% to electroencephalogram (EEG) interpretation, and 24% to multimodal neuromonitoring. Confidence in managing complex cases was suboptimal, with 56% reporting confidence in postcardiac arrest care, 47% in refractory intracranial hypertension, and 40% in spinal cord trauma. Neurocritical care education in Brazil is heterogeneous and remains at an early stage of development. Most residents receive limited exposure to advanced neurocritical skills, resulting in low confidence to independently manage highly complex conditions. Standardized, competency-based training programs are urgently needed to enhance professional preparedness and potentially improve patient outcomes in NCC.
Special histological types (SHT) of triple-negative breast cancer (TNBC) exhibit distinct biological behavior and treatment responses. However, due to their rarity, patients with SHT are underrepresented in clinical trials. We aimed to evaluate the effectiveness of pembrolizumab (P) combined with neoadjuvant chemotherapy (NCT) in patients with SHT of TNBC. We analyzed data from patients with TNBC and SHT enrolled in the Neo-Real/GBECAM-0123 study—a multicenter, real-world study including patients treated with neoadjuvant P+NCT across ten cancer centers since July 2020. Effectiveness outcomes included pathologic complete response (pCR) and event-free survival (EFS). Of the 727 patients included to date in the Neo-REAL study, 646 (88.9%) had TNBC of no special type (NST), 51 (7%) SHT, 4 (0.6%) undifferentiated, and 26 (3.6%) unknown histology. Among the SHT group, 20 metaplastic, 16 lobular, and 15 other subtypes (9 apocrine, 3 micropapillary, 2 neuroendocrine, and 1 medullary). Patients with lobular, metaplastic, and other SHT tumors were older than those with NST (median ages: 58, 51, 49, and 44 years, respectively; p = 0.001). Grade 3 tumors were more frequent in NST (76%) and metaplastic (84%) subtypes than in lobular (50%) and other SHT tumors (50%) (p = 0.019). A high Ki-67 index (≥50%) was also more common in NST tumors (76%) compared to metaplastic (52%), lobular (53%), and other SHT tumors (36%) (p < 0.001). Tumor stage distribution was similar across groups. Disease progression during P+NCT was significantly higher in the metaplastic group (33%) compared to NST (3%) and lobular tumors (0%) (p = 0.001). However, all but one patient with progression in the metaplastic group underwent surgery. pCR and EFS rates are presented in the Table. pCR rates were markedly lower in metaplastic tumors compared to NST and lobular subtypes. With a median follow-up of 22 months, 83 events of disease recurrence or death were recorded. Lobular and metaplastic tumors were associated with significantly lower 2-year EFS compared to NST. These differences remained significant in a multivariable Cox regression including tumor grade and stage. Patients with SHT of TNBC had worse outcomes with neoadjuvant pembrolizumab plus chemotherapy compared to those with NST tumors. Metaplastic carcinoma was associated with lower pCR and a trend tower lower EFS rates. Although lobular carcinoma had pCR rates similar to NST, an unfavorable EFS was also observed in this group. These results underscore the urgent need for developing new tailored therapeutic strategies for these rare and aggressive subtypes of TNBC. R. Barroso-Sousa, L. Testa, P. Mandó, M. C. Tavares, N. C. Nunes, G. Cordoba, F. Waisberg, F. C. Balint, I. M. de Sousa, M. O. Andrade, M. C. Gouveia, F. Madasi, J. Bines, R. P. Ferreira, D. D. Rosa, C. L. Santos, M. R. Monteiro, Z. S. de Souza, D. Assad-Suzuki, C. dos Anjos, D. M. Gagliato, A. U. Gomes, B. M. Zucchetti, A. Ferrari, M. L. de Brito, M. F. Monteiro, P. A. Signorini, N. J. Gomes, C. Gallina, S. Sanches, P. M. Hoff, M. Estevez-Diz, R. C. Bonadio. Rare but Resistant: Neoadjuvant Chemoimmunotherapy in Special Histological Subtypes of Triple-Negative Breast Cancer — Insights from the Neo-Real/GBECAM-0123 Study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-07-04.
In hormone receptor-positive (HR+) breast cancer, anthracycline-free chemotherapy regimens—most commonly the TC regimen (docetaxel and cyclophosphamide)—have been widely adopted, particularly for early-stage, node-negative disease. However, certain HR+ patients, such as those with higher genomic risk, may still benefit from anthracycline-based chemotherapy. This study aimed to evaluate real-world treatment practices in an intermediate- to high-risk population, specifically patients with grade 3 tumors. We retrospectively reviewed records of patients with early-stage HR+ grade 3 breast cancer treated between 2018 and 2025 across a Brazilian cancer network. Eligible patients had received systemic therapy (neoadjuvant or adjuvant) for early-stage disease. Patients were categorized by chemotherapy regimen into anthracycline-based and anthracycline-free groups. We used logistic regression to assess the odds of receiving an anthracycline-based regimen based on clinical and demographic features. Event-free survival (EFS) was estimated using the Kaplan-Meier method, and factors associated with EFS were evaluated using Cox regression. A total of 215 patients were included; 92 (42.8%) received anthracycline-based and 123 (57.2%) received anthracycline-free chemotherapy. Patients were more likely to receive anthracycline-based regimens if they were younger, premenopausal, had higher T or N stage, or had a Ki-67 index ≥ 20%. The distribution of these characteristics and their associated odds ratios (ORs) are shown in the Table (reference categories: age ≥ 50 years, postmenopausal, T1, N0, Ki-67 < 20%). Nearly half of the anthracycline group (46.7%) received the regimen as neoadjuvant therapy, whereas almost all patients in the anthracycline-free group (97.6%) were treated in the adjuvant setting. With a median follow-up of 23 months, 15 patients experienced disease recurrence or death. The 2-year EFS was 97.1% in the anthracycline group and 97.4% in the anthracycline-free group. In multivariable Cox regression adjusting for age and stage, there was no significant difference in EFS between the groups (HR 1.51, 95% CI 0.44-5.16; P = 0.508). In this real-world cohort, anthracycline-based chemotherapy was more frequently used in patients with higher-risk features, including younger age and more advanced stage. No difference in short-term EFS was observed between patients who received anthracycline and those who did not, although the analysis is limited by the small sample size, low event rate, and relatively short follow-up. We plan to expand the cohort and extend follow-up to further investigate this question. L. G. Torres, J. Bines, L. Testa, D. Negrini, V. Petry, A. C. Baptista, C. R. Victor, W. A. Lima, R. Naves, C. A. Cavalcanti, L. Holland, P. H. Divino, M. Nogueira, J. d. Bessa, R. Colombo Bonadio. Indications and Outcomes of Anthracycline-Based Regimens for Early-Stage Grade 3 Hormone Receptor-Positive Breast Cancer in a Real-World Scenario [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-10-05.
