Santa Paula Hospital (SPH) is a hospital in Santa Paula, California, United States. The hospital is a campus of the Ventura County Medical Center. SPH has 145 full-time employees, 30 shared patient beds, and 19 private patient rooms.
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.
Infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB) are associated with high morbidity and mortality. Treatment guidelines from national and international infectious disease societies recommend the use of new antimicrobials as first-line therapy; however, few studies compare the use of these new drugs within the Brazilian reality. The objective of this study was to analyze risk factors associated with 30-day mortality in patients with CR-GNB infections. This was a multicenter retrospective cohort study including patients over 17 years of age admitted to ten centers in four states—São Paulo, Bahia, Maranhão, and Espírito Santo—from January 2022 to December 2023, who received at least 48 hours of effective antibiotic therapy for CR-GNB infections. Patients with polymicrobial infections were excluded. The outcome analyzed was death within 30 days after infection. Bivariate and multivariate analyses were performed using Cox regression, and proportional hazards were assessed using Schoenfeld residual plots. Variables with p < 0.1 in bivariate analysis were included in the multivariate model; those that reduced −2 log-likelihood or had p ≤ 0.05 were retained in the final model. A total of 294 patients were included, with a median age of 61 years (20–89). Most isolates were Enterobacterales (62.2%), followed by P. aeruginosa (20.7%) and A. baumannii (17.0%). In 162 patients (55.1%), the pathogen was isolated from blood; the most common infection site was the lung (33% – 98), followed by primary bloodstream infection (32% – 94). The median SOFA score was 5 (0–17), and 30-day mortality was 55.1% (162). Variables associated with 30-day mortality in the final model were male sex (HR 1.91, p = 0.002), age in years (HR 1.02, p = 0.005), Charlson score (HR 1.12, p = 0.002), urinary focus (HR 0.30, p = 0.01), Enterobacterales infection (HR 1.78, p = 0.01), SOFA score (HR 1.15, p < 0.001), time to effective antibiotic therapy (HR 0.94, p = 0.02), closed focus of infection (HR 0.35, p = 0.02), CR-GNB isolated from tracheal secretion (HR 1.66, p = 0.02), and ascitic fluid (HR 3.21, p = 0.03). Treatment according to international guidelines was marginally protective (HR 0.70, p = 0.09). In conclusion, CR-GNB infections are associated with high mortality, and patient- and disease-related factors, as well as time to effective therapy, were more important than antimicrobial choice.
BACKGROUND:Information about integrated care for patients with atrial fibrillation (AF) in low- and middle-income countries is scarce. METHODS:We analyzed multicentre data from 699 patients with AF treated in São Paulo, Brazil. ABC compliance was defined as (1) adequate anticoagulation ('A' component); (2) controlled AF symptoms ('B' component); and (3) comorbidities treatment ('C' component). We built logistic regression models to identify characteristics associated with ABC compliance. RESULTS:Mean age was 69.4 ± 14.4 years (45.8% women; 57.4% from private healthcare). Compliance with ABC pathway, and with the 'A,' 'B' and 'C' components occurred in 20.9%, 42.3%, 81.7% and 50.1% of the participants, respectively. Lack of ABC compliance was associated with female sex (adjusted odds ratio [aOR]: 1.66; p = 0.015), intermediate (aOR: 3.37; p < 0.001) and high (aOR: 9.17; p < 0.001) bleeding risk. Patients with AF treated in public units had worse performance for the 'A' component (aOR: 2.50; p < 0.001) and better performance for the 'C' component (aOR: 0.49; p < 0.001) compared to those using private healthcare. CONCLUSIONS:Compliance with the ABC pathway in São Paulo, Brazil was low. Lack of ABC compliance was more common in women and individuals with high bleeding risk. We found a mixed pattern of ABC compliance in public and private units.
Background: Stress experienced without a clearly identifiable precipitating event may involve altered engagement of neural circuits responsible for emotional salience, cognitive regulation, and physiological stress processing. Objective: To characterize regional brain activation during an ambiguous stress condition and examine its associations with perceived stress and salivary cortisol in adults. Methods: This cross-sectional task-based functional magnetic resonance imaging study included 60 adults aged 18–50 years from the Islamabad–Rawalpindi region. Perceived stress was assessed using the PSS-10, anxiety and depressive symptoms using HADS, and physiological assessment included resting heart rate and morning salivary cortisol. Participants underwent 3-Tesla functional magnetic resonance imaging during an ambiguous stress-induction task incorporating social-evaluative uncertainty and cognitive interference. Regional BOLD responses were evaluated in the amygdala, anterior cingulate cortex (ACC), prefrontal cortex, hippocampus, and insula. Pearson correlations and independent-samples t-tests were applied. Results: Mean ACC activation was 0.91 ± 0.25%, followed by amygdala activation at 0.84 ± 0.22%. PSS-10 scores correlated positively with amygdala activation (r=0.46, p=0.001) and ACC activation (r=0.41, p=0.002) and inversely with prefrontal activation (r=−0.31, p=0.017). Cortisol correlated positively with ACC activation (r=0.39, p=0.003). Females demonstrated higher amygdala activation than males (0.92 ± 0.20% vs 0.78 ± 0.21%; p=0.014). Conclusion: Perceived stress under uncertain conditions was associated with differential engagement of limbic, cingulate, and prefrontal regions, with convergent associations across subjective, biochemical, and neural measures. These findings represent cross-sectional neural correlates and should not be interpreted as causal or predictive biomarkers
