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.
Tumor-infiltrating lymphocytes (TILs) are established prognostic and predictive biomarkers in early-stage triple-negative breast cancer (eTNBC). The addition of pembrolizumab to neoadjuvant chemotherapy (NAC) has demonstrated improved outcomes in this setting (KEYNOTE-522 trial). The role of TIL levels in this context needs to be further explored. The Neo-Real / GBECAM-0123 study is a retrospective multicenter cohort including patients (pts) with stage II-III TNBC treated with pembrolizumab plus NAC across institutions in Brazil and Argentina since 2020. Baseline stromal TILs were assessed on pre-treatment biopsies according to international guidelines and categorized as <30%, 30-49%, or ≥50%. Associations with pCR and event-free survival (EFS) were evaluated using logistic and Cox regression models, respectively. A total of 248 pts were included (median age: 44 years; 70.8% with stage II disease). TILs <30%, 30-50%, and ≥50% were observed in 72.6%, 12.9%, and 14.5% of pts, respectively. In multivariable logistic regression including TILs, Ki-67 index, clinical stage, tumor grade, and number of neoadjuvant pembrolizumab cycles, both TILs ≥50% (OR 6.96, 95% CI 1.88-25.65, P=0.004) and Ki-67 ≥50% (OR 4.88, 95% CI 2.31-10.32, P<0.001) were strongly associated with pCR. Nearly all pts with both high TILs and high Ki-67 achieved pCR (Table). With a median follow-up of 24 months, pts with pCR had significantly higher 2-year EFS compared to those with residual disease (95.9% vs. 76.5%, P<0.001). In the multivariable Cox model, pCR and clinical stage remained independent predictors of EFS, whereas TILs were not. Pts who achieved pCR had an 80% lower risk of recurrence or death compared to those with residual disease (HR 0.20, 95% CI 0.07-0.54, P=0.002). Conversely, pts with stage III disease had significantly worse EFS compared to those with stage II (HR 3.68, 95% CI 1.58-8.53, P=0.002).Among pts with pCR, 2-year EFS was 97.0% in TILs < 30%, 95.2% in TILs 30-50% (HR 1.26, 95% CI 0.12-12.42, P=0.839), and 93.2% in TILs ≥50% (HR 1.74, 95% CI 0.28-10.53, P=0.544). Among those with residual disease, 2-year EFS was 73.3% in TILs < 30%, 90% in TILs 30-50% (HR 0.33, 95% CI 0.04-2.51, P=0.288), and 100% in TILs ≥50% (HR 1.39e-15, 95% CI NA, P=1.000; analysis limited by small number of pts in this group of TILs ≥50% with residual disease). In this real-world cohort of pts with eTNBC treated with the KEYNOTE-522 regimen, high baseline TILs and Ki-67 index were strongly associated with higher pCR rates. These findings support the role of TILs as a relevant biomarker for treatment response. Long-term outcomes were primarily driven by pathologic response and disease stage, underscoring the importance of achieving pCR. R. C. Bonadio, M. C. Tavares, F. C. Balint, G. Ferreira, C. dos Anjos, D. Gagliato, M. L. de Brito, D. Assad-Suzuki, D. D. Rosa, N. J. Gomes, N. C. Nunes, L. Testa, M. Rigesti, V. Baro, I. M. de Sousa, M. O. Andrade, M. Gouveia, F. Madasi, J. Bines, R. P. Ferreira, C. L. Santos, M. Tavares, M. Monteiro, Z. S. de Souza, A. U. Gomes, B. M. Zucchetti, A. Ferrari, M. F. Monteiro, P. A. Signorini, A. Aguilar, S. Sanches, P. G. Hoff, M. Estevez-Diz, R. Barroso-Sousa. The Relationship Between Tumor-Infiltrating Lymphocytes (TILs), Pathologic Complete Response, and Event-Free Survival in Patients with Early-Stage Triple-Negative Breast Cancer Treated with KEYNOTE-522 regimen 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 PS4-07-10.
Introdução: A participação paterna durante a gestação é reconhecida como elemento fundamental para a promoção da saúde materna, neonatal e familiar, mas ainda enfrenta barreiras culturais, institucionais e socioeconômicas. Objetivo: Este estudo teve como objetivo identificar por meio da literatura os benefícios da presença paterna no período gestacional. Métodos: Trata-se de uma Revisão Integrativa da Literatura, conduzida nas fontes de informação Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Banco de dados de Enfermagem (BDENF), Medical Literature Analysis and Retrieval System Online (MEDLINE) via U.S. National Library of Medicine (PubMed), incluindo estudos publicados entre 2020 e 2025, nos idiomas português, inglês ou espanhol. Foram selecionados oito artigos que atenderam aos critérios de inclusão, analisados por meio do Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires para organização e categorização dos dados. Resultados: Os estudos contemplaram diferentes contextos geográficos, abrangendo países da África, Oceania e América do Sul. Os principais benefícios relatados incluem apoio emocional e segurança à gestante, fortalecimento do vínculo familiar, empoderamento feminino e melhora nos indicadores de saúde materno-infantil. Barreiras recorrentes envolveram estereótipos de gênero, inflexibilidade laboral, ausência de competência cultural nos serviços de saúde e pouca abertura institucional para a inclusão do pai. Conclusões: Conclui-se que a valorização da paternidade ativa no pré-natal é estratégica para o cuidado integral e para a equidade de gênero, demandando reestruturação dos serviços de saúde e ações de sensibilização profissional. Palavras-chave: Comportamento Paterno; Efeito Paterno; Paternidade; Gravidez; Gestação; Enfermagem.
For early-stage triple-negative breast cancer (TNBC), the KEYNOTE-522 trial established neoadjuvant pembrolizumab plus chemotherapy (CT), followed by adjuvant pembrolizumab, as the standard of care. Nevertheless, uncertainties remain on how to integrate this regimen with other adjuvant therapies such as capecitabine or olaparib. This study evaluated real-world treatment patterns and safety of adjuvant therapies following neoadjuvant chemoimmunotherapy. The Neo-Real study includes patients with TNBC treated with neoadjuvant pembrolizumab plus CT in Brazil and Argentina. This study describes real-world adjuvant treatment patterns and safety; survival outcomes are not reported in this analysis. Among 726 patients included, 692 underwent surgery, and 62.9
CDK4/6 inhibitors have significantly changed altered the natural history of HR+/HER2− metastatic breast cancer, leading to substantial improvements in progression-free and overall survival. These drugs are generally well tolerated, with manageable toxicity profiles. However, rare dermatologic adverse events may be underreported and poorly understood. In this study, we describe case series of patients who developed vitiligo-like lesions during treatment with ribociclib or abemaciclib. A total of eight women with HR+/HER2− metastatic breast cancer receiving ribociclib (n=7) or abemaciclib (n=1), all in combination with endocrine therapy (aromatase inhibitor or fulvestrant), developed well-demarcated depigmented lesions consistent with vitiligo-like lesions. None had a prior history of autoimmune or dermatologic disease. Dermatologic evaluations and lesion photographs were obtained. In two cases, skin biopsies revealed pigmentary incontinence and chronic perivascular mononuclear infiltrate.Cutaneous changes developed within a median of 8 months (minimum 6 and maximum 24 months) after treatment initiation. The lesions were asymptomatic, hypopigmented, and primarily involved the face, neck, and upper limbs. No systemic symptoms were reported. Dermatological evaluation ruled out other differential diagnoses and suggested an immune-mediated mechanism. In one patient, treatment was permanently discontinued after two years due to cutaneous toxicity from vitiligo-like lesions, with sustained oncologic response; another patient had a temporary 3-month drug interruption due to lesion worsening, after which the skin changes stabilized. All patients were treated with topical corticosteroids, resulting in partial improvement. Complete lesion regression was observed in the patient who discontinued therapy; three patients had stable lesions while continuing medication; others showed partial regression after treatment change due to disease progression. The most common skin toxicities associated with ribociclib and abemaciclib include rashes and dermatitis (10-20%). Vitiligo-like reactions are rare. CDK4/6 inhibitors may affect the proliferation of keratinocyte precursors, compromising the secretion of melanocyte-supporting cytokines. Treatment-induced melanocyte apoptosis may contribute to depigmentation. Additionally, ultraviolet radiation-induced melanocyte damage may trigger immune responses, highlighting the importance of sun protection. However, the underlying pathophysiology remains unclear. This case series highlights a potentially underrecognized cutaneous adverse event associated with CDK4/6 inhibitors (ribociclib and abemaciclib). Oncologists should be aware of vitiligo-like reactions as part of the toxicity spectrum of these agents. It is important to point out that this is not a life-threatening condition but it can affect appearance, specially of the face, causing burden for patients. Early recognition and collaborative management with dermatology can allow continuation of cancer therapy without compromising treatment outcomes or quality of life. Further studies are needed to better understand this phenomenon. R. M. Borges, M. C. Gouveia, C. Giro, M. Aisen, L. C. Oliveira, N. J. Gomes, A. C. Ferrari, T. G. Rivelli, M. S. Neto, M. L. Brito, R. B. Sousa, K. P. Sacardo, B. M. Zucchetti. Vitiligo-like Lesions Associated with CDK4/6 Inhibitors in Metastatic HR+/HER2− Breast Cancer: Multiple case reports from a Brazilian experience [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 PS1-05-03.
