Patients with triple-negative breast cancer (TNBC) who achieve pathologic complete response (pCR) to neoadjuvant systemic therapy have favorable survival, while those with residual disease have high recurrence risk. Stromal tumor infiltrating lymphocytes (sTILs) and TNBC-DX both predict pCR in TNBC. Whether these 2 biomarkers provide complementary information has not been tested. We evaluated sTILs and TNBC-DX in TNBC patients treated with docetaxel-carboplatin (TCb) on the MMJ-CAR-2014-01 study (NCT01560663) or TCb plus pembrolizumab (TCb+Pem) on the NeoPACT trial (NCT03639948). sTILs and TNBC-DX independently predicted pCR in patients treated with TCb+Pem. Patients with sTILs ≥ 30% and a TNBC-DX pCR-high genomic score achieved a pCR rate of 91.3% with TCb+Pem. An integrated classification incorporating sTILs and TNBC-DX identified approximately 40% of the NeoPACT cohort with a pCR rate exceeding 85%. The integrated classification was prognostic for event-free survival in patients treated with TCb+Pem. Integrating sTILs and TNBC-DX may facilitate chemoimmunotherapy escalation and de-escalation trials.
BACKGROUND/PURPOSE:Chyle leakage (CL) after pancreaticoduodenectomy (PD) remains an underestimated complication with a consistent incidence. This expert survey analyzed its occurrence from anatomical and surgical perspectives. METHODS:A structured survey was distributed to 57 surgeons from 10 countries, with extensive experience in open and minimally-invasive pancreatectomy. RESULTS:Most experts reported CL incidence as: open ≥ laparoscopic, open > robotic, and laparoscopic = robotic. They identified three major anatomical pitfalls: (i) the transverse mesocolon on the ventral side of the superior mesenteric artery and vein (SMA/SMV), (ii) the meso-jejunum on the dorsal side of the SMA/SMV, and (iii) the fusion fascia of Treitz on the ventral side of the inferior vena cava (IVC). For lymphatic dissection and control, energy devices were favored across all approaches, whereas ligation was more common in open PD and clipping more frequent in robotic PD. Opinions on the optimal dissection plane at the fusion fascia of Treitz varied: along the pancreatic surface (21%), within the fascia (31%), or exposing the IVC (38%). CONCLUSIONS:Expert opinions suggest that the incidence of CL after PD does not differ significantly between open and minimally invasive approaches. Consensus emerged regarding common anatomical pitfalls, which may inform strategies for prevention.
ABSTRACT Background Multidomain health indicators, including chronic disease indicators, risk behaviors, health habits, depressive symptomatology, disability indicators, and healthcare‐access indicators, may be interconnected through complex patterns of conditional association. Network analysis provides an exploratory framework for estimating such interdependencies without implying causality or clinically confirmed comorbidity patterns. Objective To estimate the network structure of conditional associations among selected ENDES health‐related indicators in an analytic sample of Peruvian adults from 2021 to 2023, and to descriptively explore sex‐specific patterns. Methods A secondary analysis was conducted using ENDES 2021–2023 data. A total of 92,101 respondents aged 18 years or older who completed the Health Questionnaire module and had complete data for the selected variables were included. Twenty‐one indicators selected a priori from five domains—chronic disease indicators, behavioral risks, health habits, disability/depressive symptomatology, and healthcare‐access/anthropometric context—were modeled using a mixed graphical model. Bootstrapped edge‐weight accuracy and Expected Influence stability diagnostics were added. Sex‐specific networks were examined descriptively, without a formal Network Comparison Test. Results The overall network showed positive conditional associations among smoking indicators and alcohol consumption, among disability indicators, and between age and hypertension, diabetes, visual disability, and motor disability. Negative conditional associations were observed between daily smoking and both health insurance coverage and fruit consumption, as well as between depressive symptomatology and fruit‐based indicators. In sex‐specific networks, men showed a descriptively denser disability‐related clustering than women, but these visual differences were not inferentially tested. Conclusions Selected multidomain ENDES health‐related indicators were conditionally interconnected in the analytic sample. Findings should be interpreted as exploratory and hypothesis‐generating and do not imply causality, directionality, nationally weighted network estimates, statistically confirmed sex differences, or clinically confirmed comorbidity patterns.
El cáncer de pulmón de células no pequeñas (CPCNP) continúa siendo una de las principales causas de mortalidad por cáncer a nivel mundial. La identificación de mutaciones accionables, en especial en el gen del receptor del factor de crecimiento epidérmico (EGFR), ha modificado de manera sustancial el abordaje terapéutico de esta enfermedad. Los Inhibidores de tirosina quinasa (TKI) han demostrado mejoras consistentes en supervivencia libre de progresión y supervivencia global frente a la quimioterapia convencional. No obstante, la resistencia adquirida se desarrolla en la mayoría de los casos, ya sea por mutaciones secundarias, activación de vías alternativas como MET o HER2, o transformación histológica. En los últimos años, el manejo del CPCNP con mutación EGFR ha evolucionado hacia estrategias más complejas que incluyen combinaciones en primera línea, esquemas de intensificación con quimioterapia y el uso de anticuerpos biespecíficos. Asimismo, se han desarrollado terapias dirigidas específicas para mutaciones no frecuentes, como las inserciones del exón 20, y recientemente los anticuerpos fármaco-conjugados han ampliado las alternativas terapéuticas en el escenario pososimertinib. El objetivo de esta revisión es actualizar el estado actual del tratamiento del CPCNP avanzado con mutación EGFR y discutir las estrategias emergentes orientadas a superar los mecanismos de resistencia.
Carriers of pathogenic BRCA1 and BRCA2 variants often develop breast cancers with distinct pathological features, frequently associated with more aggressive phenotypes such as triple-negative tumors. Previous studies have reported greater benefit from neoadjuvant chemotherapy and higher rates of pathological complete response in this population. To evaluate the response to neoadjuvant therapy and survival outcomes in breast cancer patients with germline BRCA1/2 variants compared with those with wild-type phenotypes. Women ≤45 years with breast cancer were included in the hereditary cancer protocol at INEN between 2013 and 2020. Genetic testing was performed at the City of Hope (COH). We selected patients who had received neoadjuvant treatment. A total of 105 patients were analyzed, including 45 with germline BRCA1/2 variants and 60 wild-type. Most patients received standard chemotherapy with anthracyclines and weekly taxanes (85%), while only a minority (12%) had access to carboplatin due to policy and approval restrictions. The median age was 40 years and comparable between groups, as all participants belonged to the hereditary breast cancer screening program. No significant differences were observed in pathological complete response (pCR) between BRCA variant carriers and wild-type patients, although a correlation was noted between pCR and the triple-negative subtype (p=0.053). In terms of survival, BRCA1 carriers showed poorer outcomes, with a hazard ratio of 2.5 and a median overall survival of 6.9 years, while BRCA2 carriers had a median survival of 11.6 years, comparable to wild-type patients whose median survival has not yet been reached. It is likely that the suboptimal pCR rates in BRCA mutation carriers were influenced by the limited use of carboplatin, a drug shown in other studies to significantly improve response rates. In this cohort of 105 breast cancer patients, BRCA1 carriers had worse overall survival (median 6.9 years, HR 2.5) compared with BRCA2 and wild-type patients, despite similar pCR rates. Pathological complete response was mainly associated with the triple-negative subtype. Limited access to carboplatin likely contributed to suboptimal responses in BRCA mutation carriers, underscoring the need for broader availability of platinum-based therapy. N. Valdiviezo, I. Otoya, P. Mora, J. Herzog, L. Reynaga, S. Neciosup, C. Calle, S. Casavilca, K. Roque, Z. Morante, H. Fuentes, C. Castañeda, T. Vidaurre, V. Acuña, M. Falla, J. Galarreta, S. Gruber. Impact of Germline BCRA variants in the neoadjuvant treatment [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 PS5-04-21.
