Objectives To explore effects of adjuvant endocrine therapy (ET) among women with early-stage hormone receptor positive breast cancer aged 70+ years, with comorbidities or experiencing polypharmacy. Methods Women diagnosed with breast cancer in 2006-2022 were identified from the Te Rēhita Mate Ūtaetae – Breast Cancer Foundation National Register in New Zealand. Patients with pathological stage I-III, hormone receptor positive disease, and had surgery within 1 year after diagnosis were included. All-cause survival, breast cancer-specific survival and disease-free survival were explored between women with adjuvant ET and women without using Kaplan-Meier methods, after propensity score matching on key factors. Results Only half patients completed 5 years of adjuvant ET, and the rate declined with cancer stage. Women with stage I cancer aged 70+ years, with comorbidities or experiencing polypharmacy had excellent relapse-free survival and breast-cancer specific survival but poor all-cause survival. The 10-year all-cause mortality rate (26.1%-37.2%) were more than 10 times the breast cancer-specific mortality rate (0.7%-3.2%) and more than three times the cancer relapse rate (6.0%-10.3%). Among these women, no significant difference was found in all-cause survival, breast cancer-specific survival or disease-free survival between those receiving and not receiving adjuvant ET. Conclusions Women with stage I hormone receptor-positive breast cancer who were older, had comorbidities or polypharmacy showed excellent breast cancer-specific and disease-free survival but poorer all-cause survival. These patients with stage I cancer may derive limited benefit from adjuvant ET with high competing mortality. Further research should be performed to verify these findings.
Radiopharmaceutical therapy has been adopted with success in malignancies such as prostate cancer and neuroendocrine tumors. This approach often combines a diagnostic agent to measure and assess target availability prior to administering a parenteral radiotherapeutic agent against the same target. Emerging evidence and ongoing research suggest that this approach could have a beneficial impact in breast cancer treatment, with a number of different breast cancer-specific or tumor microenvironment targets. There are several agents under investigation, with the majority in early-phase trials. This narrative review will provide a brief introduction to radiopharmaceutical imaging and therapy for breast cancer, discuss emerging therapeutic targets under investigation in breast cancer, and discuss challenges with the implementation of radiopharmaceuticals in breast cancer.
Isolated locoregional recurrence (ILRR) of breast cancer (BC) is associated with a poor prognosis and a high risk of distant metastasis (DM) and death. As ILRR occurs in around 0.5-1.5% of BC patients annually, and the overall prevalence of primary BC is high, the absolute number of ILRR BC patients is substantial. Diagnosing a second BC event can be challenging, particularly distinguishing between a true recurrence (TR) and a second primary (SP). This distinction is clinically relevant, as TRs are associated with a poorer prognosis, especially when presenting as regional recurrences, and require a more challenging therapeutic approach compared to SPs.The radiologic work-up of suspected BC recurrence depends on the tumor location (breast, chestwall, or regional), clinical presentation, prior treatment characteristics, and should include systemic staging given the substantial risk of synchronous distant metastases. Robust scientific evidence and guidelines on locoregional and systemic treatment of ILRR of BC are lacking. Consequently, ILRR management currently relies on expert opinion, and therefore may vary between institutions. This review aims to provide an overview of current knowledge on definition, diagnostic workup, staging, locoregional treatment, and systemic treatment of ILRR. Furthermore, ongoing clinical research and future research perspectives to improve the diagnostic work-up and multimodality treatment of patients with ILRR will be outlined.
Some patients with HER2-positive metastatic breast cancer (MBC) achieve prolonged disease control with first-line anti-HER2-based therapy, but associated clinical features remain poorly characterized in real-world populations.We conducted a retrospective study using the Epidemiological Strategy and Medical Economics (ESME) MBC cohort, including 18 French comprehensive cancer centers. Women with HER2-positive MBC who initiated first-line anti-HER2–based therapy between January 2008 and December 2021 and had at least 3 years of follow-up were eligible. Exceptional responders had no documented progression within 3 years. A secondary analysis evaluated factors associated with remaining progression-free at 5 years. Multivariable logistic regression with bootstrap cross-validation was used.Among 4307 eligible patients, 1016 (23.6%) were exceptional responders. Of 765 evaluable at 5 years, 523 (68.4%) remained progression-free. Factors associated with a lower likelihood of exceptional response included hormone receptor–negative (HR-) disease, a disease-free interval of 6–24 months, ≥3 metastatic sites, visceral metastases, and central nervous system involvement. First-line treatment with chemotherapy, trastuzumab, and pertuzumab was associated with exceptional response. Among exceptional responders, HR-disease, grade III tumors and first-line chemotherapy plus trastuzumab and pertuzumab were associated with progression-free at 5-year, whereas visceral metastases were associated with lower odds. Model discrimination was moderate (AUC 0.72 and 0.64, respectively).Nearly one quarter of patients remained progression-free for at least 3 years, and more than two thirds of those evaluable remained progression-free at 5 years. Clinical variables alone had limited predictive value, supporting the need for molecular and immune biomarkers to better identify this subgroup.
