The Breast : official journal of the European Society of Mastology
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Metaplastic breast cancers: Genomic profiling, mutational burden and tumor-infiltrating lymphocytes.
Metaplastic breast cancer (MPBC) is a rare subtype that accounts for <1% of all breast cancers. Although these are typically "triple negative," they are relatively chemotherapy-refractory compared to conventional triple negative invasive breast cancers with more aggressive features and an overall poor prognosis. MPBC is a heterogeneous group of tumors that are enriched for TP53 and PIK3CA mutations, and have been found to have high PD-L1 expression though the mechanisms underlying its immunogenicity remain unclear. We perform comprehensive genomic profiling in the largest MPBC dataset (n = 192) to date and assess for other potential biomarkers of immune response.
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During the last two decades the number of breast implants used in aesthetic, oncologic and risk reducing surgery has increased substantially mainly due to the improvement and confirmed safety of these devices. Since identification of the first case of anaplastic large cell lymphoma associated with a breast implant (BIA-ALCL) 20 years ago, there has been an increase in the number of reports of this very rare disease, demonstrating a clear association with breast implants. ⋯ We hereby present the current published knowledge about the link between BIA-ALCL and implant surface texture and a review of current regulatory and professional body advice across Europe, which may enable a better understanding of this rare disease, how to manage and ultimately prevent it. We conclude by giving EUSOMA recommendation, towards the unnecessary change in attitudes towards implant based surgery, according to the most recent available published evidence as long as patients are properly informed about the risk of BIA-ALCL.
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Palbociclib is a selective cyclin-dependent kinase (CDK) 4/6 inhibitor approved for use in postmenopausal women with hormone receptor-positive, human epidermal growth factor 2-negative (HR+/HER2-) advanced/metastatic breast cancer (ABC/MBC). Palbociclib has proven benefits in phase III placebo-controlled studies; however, real-world outcome data are lacking. The Ibrance Real World Insights (IRIS) study evaluated palbociclib use in patients with HR+/HER2- ABC/MBC in the real-world setting in the US, Argentina, and Germany. Here we describe results for the US patient subgroup. ⋯ In this first real-world assessment of clinical outcomes in US patients with HR+/HER- ABC/MBC, treatment with palbociclib in combination with AI or fulvestrant demonstrated favorable effectiveness in terms of progression-free and survival rates. Ongoing studies are needed to deliver mature clinical outcome data beyond 12/24 months in the real-world setting.
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Metastatic or advanced breast cancer (mBC/ABC) remains incurable despite many different systemic treatment options. Hormone receptor positive (HR+) disease represents the most common subtype in both early and advanced disease. A better understanding of the biology of this BC subtype, in particular regarding potential mechanisms of endocrine resistance, has led to the development of CDK4/6 inhibitors. ⋯ Overall survival (OS) has been reported so far only in 2 out of 7 trials as first line therapy and the difference did not reach statistical significance. In this article we review the biology of CDK signaling pathway and its inhibitors, preclinical and clinical data of all three investigated selective CDK4/6 inhibitors and their toxicity. We also discuss how these agents are being included in current international guidelines and future directions for these agents in other subtypes of breast cancer, in both advanced disease and early-stage disease.
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Fertility and pregnancy-related issues are major concerns for young breast cancer patients. Limited data are available on physicians' knowledge, attitudes and practice in these fields. ⋯ Further educational initiatives are needed to improve physicians' knowledge and adherence to available guidelines when addressing fertility and pregnancy-related issues in young breast cancer patients.