The first results of ASTER 70s were presented at the 2022 ASCO annual meeting and have been accepted for publication in the Lancet. After a median follow-up of 8 years, women aged 70 years and older who underwent surgery for luminal breast cancer did not derive any significant benefit in overall survival from adjuvant chemotherapy added to hormonotherapy when selected based on a high-risk genomic grade index (GGI) tumour. However, the acceptability of chemotherapy may vary with age. We report here the acceptability of chemotherapy in women randomized to receive chemotherapy (4 cycles of anthracycline- or taxane-based chemotherapy administered every 3 weeks) in addition to hormonotherapy, as assessed using a self-administered questionnaire designed based on a previous experience in a similar setting (GERICO 06 trial). After the last cycle of chemotherapy, patients were asked ‘to what extent the treatment was acceptable given the absolute additional benefit of 7.5% in terms of cure sought with chemotherapy”, as stated in the patient information sheet and informed consent form, and the main reason if they found the treatment unacceptable. They were also asked whether they would recommend such treatment to relatives or close friends facing a similar situation. The questionnaires were then administered then yearly for 4 years. Of the 1,969 women screened for tumour GGI between April 2012 and May 2016, 58 (2.9%) withdrew their consent before GGI results and randomisation, while 1,089 (55%) with high-risk GGI tumours were randomized between chemotherapy and no chemotherapy. Of the 541 (49.7%) assigned to chemotherapy, 111 (20.5%) did not receive it for the following reasons: 23 (20.7%) refused chemotherapy, 22 (19.8%) withdrew consent, 8 (7.2%) for medical reasons, and 58 (52.3%) for unknown reasons. Of the 430 patients (79.5%) who started chemotherapy [44 (10.2%) stopped before the fourth cycle], 299 (69.5%) completed the first acceptability questionnaire at the end of chemotherapy, with 266 (95.3%) and 13 (4.7%) rating the chemotherapy experience acceptable and unacceptable, respectively, an assessment that was strongly associated with the occurrence of a serious adverse event during chemotherapy (15% and 46%, respectively, p<0.05). In addition, 242 (94.2%) said they would recommend the treatment to relatives if they were in the same situation. These rates remained stable over time until the fourth year of follow-up. Patient and tumour characteristics, quality of life scores at baseline, overall survival and invasive disease-free survival did not differ between patients who completed the acceptability questionnaire and those who did not. Factors reducing the acceptability of chemotherapy over time (from acceptable à not acceptable versus stable acceptable since the first post-chemotherapy assessment) were advanced age, a high Lee score (4-year mortality estimation) and low IADL. At baseline, low role functioning, low cognitive or social functioning, pain, dyspnoea, and loss of appetite had some impact on the acceptability of chemotherapy. It is difficult to assess the acceptability of a treatment, which depends largely on its safety and, consequently, its intensity in relation to increasing frailty with age. The acceptability of chemotherapy appears also to be influenced by factors such as age and quality of life, which must be taken into account when developing hypotheses in clinical trials, especially in elderly subjects. E. Brain, J. Henriques, F. Rollot, O. Mir, E. Bourbouloux, O. Rigal, J. M. Ferrero, S. Kirscher, D. Allouache, V. d'Hondt, A. M. Savoye, X. Durando, F. P. Duhoux, L. Venat Bouvet, E. Blot, J. L. Canon, H. Bonnefoi, T. Roque, J. Lemonnier, A. Latouche, M. Lacroix-Triki, D. Vernerey. Acceptability of adjuvant chemotherapy in women aged 70 and older after surgery for ER-positive HER2-negative breast cancer selected with a high genomic grade index: results from the ASTER 70s/Unicancer trial [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 PS3-09-11.
BackgroundBlocking programmed cell death protein 1 (PD-1) has become a standard cancer immunotherapy, increasingly used in kidney, liver, or heart transplant recipients who develop skin cancer or hepatocellular carcinoma, despite the increased risk of graft failure or rejection. The mechanism of action of PD-1 blockade relies on stimulating CD8+ T cell activity, but its impact on humoral immunity in general and on alloimmunization in particular remains uncertain.ObjectiveThe aim of this study was to investigate the impact on anti-PD-1 treatment on alloimmunization.MethodsThe effect of anti-PD-1 treatment on the generation of anti-HLA (Human Leucocyte Antigen) antibodies was investigated in 72 patients with non-small cell lung cancer vaccinated with an allogeneic plasmacytoid dendritic cell line (PDC*line; six weekly injections), with or without pembrolizumab administered every three weeks. The kinetics and functionality of the anti-HLA generated were analyzed.ResultsThe results show that 51.4% of the patients developed anti-HLA antibodies, primarily dependent on the vaccine dose. In 60% of cases, the antibody response appeared after the sixth injection, peaked after one month, and then gradually declined over two years. Anti-HLA class II antibodies appeared earlier than class I antibodies. Functional assays demonstrated complement-dependent cytotoxicity against allogeneic B lymphocytes and PDC*line cells in the serum of some patients, with no difference related to treatment. PD-1 blockade did not alter the magnitude, kinetics, or cytotoxic potential of the vaccine-induced humoral response. ConclusionThese results indicate that, during allogeneic human vaccination, PD-1 signaling exerts a limited effect on antibody production and effector function, suggesting a more complex regulatory role in humoral immunity than previously thought.
Loeys-Dietz syndrome is an autosomal dominant connective tissue disorder within the spectrum of syndromic heritable thoracic aortic disease. We report three young women with Stanford type B aortic dissection in the setting of confirmed Loeys-Dietz syndrome or suspected heritable thoracic aortic disease. Presentations included pregnancy-associated acute dissection, chronic post-dissection thoracoabdominal aneurysmal degeneration, and acute complicated dissection with visceral and lower-limb malperfusion. Management required individualized combinations of medical therapy, endovascular repair, hybrid staging, and open thoracoabdominal reconstruction. These cases support early genetic assessment, multidisciplinary aortic care, and lifelong whole-aorta surveillance.
INTRODUCTION:Informal caregivers are essential to the care of older adults with cancer but may experience strain. We identified patient factors associated with burden in informal caregivers of older adults with cancer and described geriatric assessment (GA)-based recommendations for informal caregivers with burden. MATERIALS AND METHODS:This cross-sectional study included older adults (≥70 years) with cancer and a geriatric risk profile (G8 ≤ 14/17) from three centres in Belgium. All participants underwent a GA and received GA-based recommendations. Informal caregivers completed the 12-item Zarit Burden Interview (ZBI-12). Data were collected using a case report form. Logistic regression identified factors associated with significant caregiver burden (ZBI-12 ≥ 10). RESULTS:Between July 2012 and Jun 2015, of 900 eligible patients, 349 informal caregivers completed the ZBI-12; 149 (42.7%) reported significant caregiver burden (ZBI-12 ≥ 10). In univariate analysis, poorer Eastern Cooperative Oncology Group performance status (ECOG-PS 3-4; OR 2.27, 95% CI 1.41-3.70), higher activities of daily living (ADL) score (OR 1.09, 95% CI 1.02-1.15), longer Timed Up and Go test time (OR 1.04, 95% CI 1.00-1.07), higher patient fatigue score (OR 1.13, 95% CI 1.05-1.22), lower instrumental activities of daily living (iADL) score (OR 0.78, 95% CI 0.71-0.86), lower Mini-Mental State Examination score (OR 0.92, 95% CI 0.74-0.98), lower Mini Nutritional Assessment Short-Form score (OR 0.90, 95% CI 0.83-0.97), and greater comorbidity burden (OR 1.13, 95% CI 1.02-1.26) were associated with increased caregiver burden. In multivariable analysis, decreased iADL (OR 0.79, 95% CI 0.71-0.87) and increased patient fatigue (OR 1.11, 95% CI 1.02-1.19) were independent predictors of caregiver burden. Among informal caregivers with significant burden, the most common GA-based recommendations were nutritional counselling (113 [77.4%]) and medication adjustments (41 [28.1%]). DISCUSSION:Decreased ability to perform iADL and increased patient fatigue were independently associated with caregiver burden in older adults with cancer and should be considered in oncogeriatric assessment. GA-based recommendations, particularly nutritional support and medication review, provide actionable targets to support this population.
INTRODUCTION:Although breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a T-cell lymphoma, is well characterized, recent reports have highlighted B-cell lymphomas associated with breast implants, a less understood and distinct entity. OBJECTIVE:This systematic review aimed to investigate breast implant-associated B-cell lymphomas (BIA-BCL) by analyzing their clinical presentation, diagnostic workup, histopathology, management, and prognosis. METHODS:A comprehensive literature search was performed in the PubMed, Cochrane, Embase, and Google Scholar databases following the PRISMA guidelines. Studies reporting B-cell lymphomas linked to breast implants were included. Additionally, a new case of diffuse large B-cell lymphoma (DLBCL) related to breast implants was added. RESULTS:Twenty-seven studies describing 37 patients were identified; our case raised the total to 38. Eleven B-cell lymphoma subtypes were found, predominantly diffuse large B-cell lymphoma (n=27). Implant texture was smooth in 5 cases, with an average latency of 17 years post-implantation. Common symptoms included contracture (n=23) and pain (n=22), co-occurring in 16 patients. Preoperative imaging was performed in 24 patients and a biopsy or fluid collection in 12, enabling diagnosis before surgery in 11 cases. Treatments varied: 3 patients received medical therapy only and 21 received surgery without further treatment. CONCLUSION:BIA-BCLs are a heterogeneous group distinct from BIA-ALCL, occurring with smooth and textured implants. DLBCL is the most frequent subtype. Given the limited data, en bloc excision of the implant and surrounding capsule is recommended as the first-line treatment. Larger studies are needed to refine diagnosis and management.
