Local dose-dense chemotherapy for triple-negative breast cancer via minimally invasive implantation of 3D printed devices

Dose-dense chemotherapy is the preferred first-line therapy for triple-negative breast cancer(TNBC),a highly aggressive disease with a poor prognosis.This treatment uses the same drug doses as conventional chemotherapy but with shorter dosing intervals,allowing for promising clinical outcomes with intensive treatment.However,the frequent systemic administration used for this treatment results in systemic toxicity and low patient compliance,limiting therapeutic efficacy and clinical benefit.Here,we report local dose-dense chemotherapy to treat TNBC by implanting 3D printed devices with timeprogrammed pulsatile release profiles.The implantable device can control the time between drug releases based on its internal microstructure design,which can be used to control dose density.The device is made of biodegradable materials for clinical convenience and designed for minimally invasive implantation via a trocar.Dose density variation of local chemotherapy using programmable release enhances anti-cancer effects in vitro and in vivo.Under the same dose density conditions,device-based chemotherapy shows a higher anticancer effect and less toxic response than intratumoral injection.We demonstrate local chemotherapy utilizing the implantable device that simulates the drug dose,number of releases,and treatment duration of the dose-dense AC(doxorubicin and cyclophosphamide)regimen preferred for TNBC treatment.Dose density modulation inhibits tumor growth,metastasis,and the expression of drug resistance-related proteins,including p-glycoprotein and breast cancer resistance protein.To the best of our knowledge,local dose-dense chemotherapy has not been reported,and our strategy can be expected to be utilized as a novel alternative to conventional therapies and improve anti-cancer efficiency.

Effectiveness of a theory-based tailored mHealth physical activity intervention for women undergoing chemotherapy for breast cancer:A quasi-experimental study

Objectives:This study aimed to explore the effectiveness of the theory-based tailored mHealth physical activity(PA)intervention among patients with breast cancer undergoing chemotherapy.Methods:A quasi-experimental study design was adopted.A total of 60 breast cancer patients were selected from two tertiary hospitals in Shanghai and Hangzhou City from September 2019 to August 2021.According to the admission order,30 patients werefirst included in the control group,followed by 30 patients in the intervention group.A smartphone application(app)named“Breast Care”was developed based on social cognitive theory,self-efficacy theory,and the theory of planned behavior.The app integrated various functions,including information browsing,PA monitoring and feedback,symptom reporting,and social interaction.Patients in the intervention group received three months of personalized online PA guidance in addition to routine care.The control group received routine care.Baseline and post-intervention investigations after three months were conducted in two groups using the Short Form of International Physical Activity Questionnaire,the Hospital Anxiety and Depression Scale,and the Functional Assessment of Cancer TherapydBreast cancer.Results:After three months of intervention,compared to the control group,breast cancer patients in the intervention group showed significant improvements in walking,moderate PA,and overall PA(P<0.05).Compared to the baseline data,breast cancer patients in the intervention group had significant improvements in walking and overall PA after three months(P<0.05),whereas the control group experienced significant declines in walking,moderate PA,and overall PA after three months(P<0.05).There were statistically differences between the two groups in scores for anxiety,overall quality of life,and its dimensions,such as physical well-being,emotional well-being,and additional breast cancer well-being(P<0.05).Conclusions:The theory-based tailored mHealth PA intervention has demonstrated a positive impact on promoting PA behavior change and emotional management among breast cancer patients.The‘Breast Care’app integrated various practical behavior change strategies,offering valuable guidance for personalized remote rehabilitation support for cancer patients.

Ki-67 Change in Anthracyline-containing Neoadjuvant Chemotherapy Response in Breast Cancer

Objective Anthracycline-containing regimens are irreplaceable in neoadjuvant chemotherapy(NAC)for breast cancer(BC)at present.However,30% of early breast cancer(EBC)patients are resistant to anthracycline-containing chemotherapy,leading to poor prognosis and higher mortality.Ki-67 is associated with the prognosis and response to therapy,and it changes after NAC.Methods A total of 105 BC patients who received anthracycline-containing NAC were enrolled.Then,the optimal model of Ki-67 was selected,and its predictive efficacy was analyzed.Immunohistochemistry(IHC)was used to determine the estrogen receptor(ER),progesterone receptor(PR),and human epidermal growth factor receptor 2(HER-2)status and Ki-67 level.Fluorescent in situ hybridization(FISH)was used to verify the HER-2 when the IHC score was 2+.Results The post-NAC Ki67 level after treatment with anthracycline drugs was lower than pre-NAC Ki-67(19.6%±23.3%vs.45.6%±23.1%,P<0.001).Furthermore,patients with the Ki-67 decrease had a border line higher pathological complete response(pCR)rate(17.2%vs.0.0%,P=0.068),and a higher overall response rate(ORR)(73.6%vs.27.8%,P<0.001),when compared to patients without the Ki-67 decrease.The ΔKi-67 and ΔKi-67%were valuable markers for the prediction of both the pCR rate and ORR.The area under the curve(AUC)for ΔKi-67 on pCR and ORR was 0.809(0.698-0.921)and 0.755(0.655-0.855),respectively,while the AUC for ΔKi-67% on pCR and ORR was 0.857(0.742-0.972)and 0.720(0.618-0.822),respectively.Multivariate logistic regression model 1 revealed thatΔKi-67 was an independent predictor for both pCR[odds ratio(OR)=61.030,95% confidence interval(CI)=4.709-790.965;P=0.002]and ORR(OR=10.001,95%CI:3.044-32.858;P<0.001).Multivariate logistic regression model 2 revealed thatΔKi-67%was also an independent predictor for both pCR(OR=408.922,95%CI=8.908-18771.224;P=0.002)and ORR(OR=5.419,95%CI=1.842-15.943;P=0.002).Conclusions The present study results suggest thatΔKi67 andΔKi67%are candidate predictors for anthracycline-containing NAC response,and that they may provide various information for further systematic therapy after surgery in clinical practice.

Correlation and predictive value of pathological complete response and ultrasound characteristic parameters in neoadjuvant chemotherapy for breast

BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression,it alone is insufficient for enhancing the quality of life for patients.AIM To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy(NAC).METHODS Employing a case-control study design,this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022.According to the Miller-Payne grading system,the pathological response,i.e.efficacy,of the NAC in the initial breast lesion after NAC was evaluated.Of these,59 patients achieved a pathological complete response(PCR),while 119 did not(non-PCR group).Ultrasound characteristics prior to NAC were compared between these groups,and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches.RESULTS In the PCR group,the incidence of posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II were significantly lower compared to the non-PCR group(P<0.05).The area under the curve values for predicting NAC efficacy using posterior echo attenuation,lesion diameter,and Alder grade were 0.604,0.603,and 0.583,respectively.Also,rates of pathological stage II,lymph node metastasis,vascular invasion,and positive Ki-67 expression were significantly lower in the PCR group(P<0.05).Logistic regression analysis identified posterior echo attenuation,lesion diameter≥2.0 cm,Alder blood flow grade≥II,pathological stage III,vascular invasion,and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients(P<0.05).CONCLUSION While ultrasound characteristics such as posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II exhibit limited predictive value for NAC efficacy,they are significantly associated with poor response to NAC in breast cancer patients.

Evaluation of the efficacy of neoadjuvant chemotherapy for intermediate and advanced breast cancer by 3.0T MR and ultrasound combined with tumour markers

Objective:To evaluate the efficacy of neoadjuvant chemotherapy before and after neoadjuvant chemotherapy for intermediate and advanced breast cancer using 3.0T MR and ultrasound in combination with tumour markers(CEA,CA-153,CA125),and to provide therapeutic references for the clinicians,so as to better satisfy the needs of treatment for intermediate and advanced breast cancer patients.Methods:The team collected 30 patients who were diagnosed with intermediate and advanced breast cancer by biopsy and received neoadjuvant chemotherapy,and divided them into sensitive and insensitive groups according to the MP grading of postoperative pathological results.The team retrospectively analysed the changes in the values of serum CEA,CA-153,and CA 125 before and after the neoadjuvant chemotherapy,the changes in the average ADC of the lesions before and after the observation by MRI,and the changes in the volume and size of lesions before and after the observation by ultrasonography to assess the effects of neoadjuvant chemotherapy individually,and the results of neoadjuvant chemotherapy were evaluated individually.The effect of neoadjuvant chemotherapy was assessed independently.Each of the above was evaluated independently,and the accuracy of each item was calculated by comparing the evaluation results with the pathological examination results,and the accuracy of the single item was compared with the accuracy of the three combined tests to determine whether the combined evaluation was more consistent.Results:All three examination and testing methods can achieve high accuracy,and the combined evaluation of the three is more accurate than the evaluation of the single way,and the difference is statistically significant(P<0.05).Conclusion:In neoadjuvant chemotherapy for breast cancer patients,the combined assessment of MR,CDFI and tumour markers can more comprehensively and accurately assess the effect of ADC,and more accurately guide the clinical treatment and determine the prognosis.

Application Progress of Ultrasound Radiomics in the Evaluation and Prediction of Neoadjuvant Chemotherapy for Breast Cancer

Breast cancer is a malignant tumor with the highest incidence in women. In recent years, the incidence of breast cancer has shown an increasing trend, especially in younger patients, which seriously threatens the life and health of women. In order to improve the treatment effect of breast cancer, neoadjuvant chemotherapy has become a reliable strategy to cooperate with surgical treatment and improve the prognosis of advanced breast cancer, which is conducive to quickly and accurately curbing the growth of cancer cells, controlling the patients’ condition, reducing their pain, and improving the cure rate of breast cancer patients. This paper analyzes the development history of ultrasound radiomics, explores its application in the evaluation and prediction of neoadjuvant chemotherapy for breast cancer, and clarifies the research results of multimodal ultrasound radiomics in the analysis of high-order characteristics of breast cancer tumors and the evaluation of tumor heterogeneity, so as to provide references for the clinical treatment of breast cancer.

Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Intrinsic Wave Velocity Propagation:A Novel Parameter for Assessing the Effect of Anthracycline Chemotherapy Agents on Cardiac Diastolic Function in Breast Cancer Patients

Objective Anthracycline chemotherapeutic agents have significant cardiotoxicity.The present study emphasized the effect of anthracycline chemotherapy drugs on left ventricular(LV)myocardial stiffness in breast cancer patients by measuring the intrinsic wave velocity propagation(IVP),and evaluating the potential clinical value of IVP in detecting early LV diastolic function impairment.Methods A total of 68 newly diagnosed breast cancer patients,who were treated with anthracycline-based chemotherapy,were analyzed.Transthoracic echocardiography was performed at baseline(T0),and after 1,2,3,4 and 8 chemotherapeutic cycles(T1,T2,T3,T4 and T5,respectively).Then,the IVP,LV strain parameters[global longitudinal strain(GLS),longitudinal peak strain rate at systole(LSRs),longitudinal peak strain rate at early diastole(LSRe),longitudinal peak strain rate at late diastole(LSRa),and the E/LSRe ratio],and conventional echocardiographic parameters were obtained and further analyzed.A relative reduction of>15%in GLS was considered a marker of early LV subclinical dysfunction.Results Compared to the T0 stage,IVP significantly increased at the T1 stage.However,there were no significant changes in GLS,LSRs,or LSRe between the T0 and T1 stages.These parameters significantly decreased from the T2 stage.LSRa started to significantly decrease at the T5 stage,and the E/LSRe ratio started to significantly increase at the T3 stage(all P<0.05).At the T0 stage,IVP(AUC=0.752,P<0.001)had a good predictive value for LV subclinical dysfunction after chemotherapy.Conclusions IVP is a potentially sensitive parameter for the early clinical assessment of anthracycline-related cardiac diastolic impairment.

Breast Cancer in a Supernumerary Breast at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital: About a Case

Accessory or ectopic breast tissue is an anomaly in the development of the breast. It is a rare condition that occurs along the embryological mammary line. In less than 1% of all breast cancers, supernumerary breast cancer is reported, with the axillary location being the most common in 60% to 90% of cases. Cancerous degeneration of this supernumerary breast tissue can pose a dual diagnostic and therapeutic problem. We report the case of locally advanced adenocarcinoma in a right supernumerary breast. This is a 75-year-old, grand-multiparous, postmenopausal, and known hypertensive patient on treatment. Family history was remarkable for brain cancer in her sister and oesophageal cancer in her mother. She consulted for a mass in the right axillary cavity on supernumerary breast evolving for a year. Clinical examination revealed a large, fixed, budding and haemorrhagic-ulcerated mass of the right axilla, with long axis measuring about 15 cm. There was as wella supernumerary breast on the left, but without particularity. A soft tissue ultrasound showed a large hypoechoicmass in the right axillary region of 116 mm with areas of central necrobiosis. Morphologically, the breasts were normal. A breast MRI revealed a subcutaneous mass in the right axillary cavity with skin ulceration and satellite lymphadenopathy. The extension assessment revealed liver metastases, and a biopsy of the mass revealed a breast adenocarcinoma. The case was the subject of a multidisciplinary consultation meeting following which a wide excision of the mass was indicated. The histo-pathology analysis results of the surgical specimen were in favour of a triple negative papillary adenocarcinoma. After a post-operative multidisciplinary consultation meeting, adjuvant chemotherapy was indicated. The development of supernumerary breasts depends on hormones, just like normal breasts. Breast cancer in accessory breast tissue is quite rare with the incidence being 6%. The most common pathology is invasive carcinoma (50% - 75%). It is usually located in the armpit (60% - 70%) although it can be present in other less common locations such as the inframammary region (5% - 10%) and rarely the thighs, perineum, groin and the vulva. Since accessory axillary breast tissue is not considered during breast screening examination, it is necessary for clinicians to be aware of this entity and associated pathologies. Their preventive excision in women at high risk can also be considered.

Research progress in tumor angiogenesis and drug resistance in breast cancer

Angiogenesis is considered a hallmark pathophysiological process in tumor development. Aberrant vasculature resulting from tumor angiogenesis plays a critical role in the development of resistance to breast cancer treatments, via exacerbation of tumor hypoxia, decreased effective drug concentrations within tumors, and immune-related mechanisms. Antiangiogenic therapy can counteract these breast cancer resistance factors by promoting tumor vascular normalization. The combination of antiangiogenic therapy with chemotherapy, targeted therapy, or immunotherapy has emerged as a promising approach for overcoming drug resistance in breast cancer. This review examines the mechanisms associated with angiogenesis and the interactions among tumor angiogenesis, the hypoxic tumor microenvironment, drug distribution, and immune mechanisms in breast cancer. Furthermore, this review provides a comprehensive summary of specific antiangiogenic drugs, and relevant studies assessing the reversal of drug resistance in breast cancer. The potential mechanisms underlying these interventions are discussed, and prospects for the clinical application of antiangiogenic therapy to overcome breast cancer treatment resistance are highlighted.

Personalized Perioperative Care for a Patient with a 10-Year-Old Postpartum Old Thrombus after Neoadjuvant Therapy for Breast Cancer

Breast cancer is one of the most common malignant tumors in women, and has become the main cause threatening women’s health. A case of breast cancer with neoadjuvant chemotherapy was discharged after active treatment and nursing.

Impact of Relative Dose Intensity (RDI) on Survival in Non-Metastatic Breast Cancer: Nigerian Experience

Background: This study was initiated to determine practices patterns in adjuvant chemotherapy for non-metastatic breast cancer and to examine the relationship between received dose intensity (RDI) and survival in patients with breast cancer Nigeria. Methods: Our study was a retrospective analysis of patients with breast cancer recruited from 2012 and 2015. A total of 204 patients were initially entered into the study, 102 were lost to follow-up leaving 102 patients who were suitable for the survival analysis. Survival time was calculated from 106 days, the scheduled end of chemotherapy. Results: The total average RDI for patients was 74%. Over the 204 patients that were reviewed, 144 (70.6%) had some reduction of RDI. This subgroup had an average RDI of 63%. On average, 79% of the intended dose of chemotherapy was given. The time to completion of chemotherapy was 1.33 times that specified by the protocol. Dose delays an overall reduction was mainly attributed to intolerability and financial constraints. Survival by RDI showed a significant decrease in survival rate for patients with RDI of >49% (Hazard Ratio = 3.473, 95% CI 1.21 - 9.91, P = 0.020);RDI of 50% - 59% (Hazard Ratio = 3.916, 95% CI 1.01 - 15.18, P = 0.048);RDI of 60% - 69% (Hazard Ratio = 4.462, 95% CI 1.65 - 12.03, P = 0.003) compared with patients who received an RDI of 100%. Although associated with poorer prognosis, there were no significant changes in the survival rate for patients with RDI of 70% - 79% (Hazard Ratio = 1.667, 95% CI 0.56 - 4.96, P = 0.359);RDI of 80% - 89% (Hazard Ratio = 1.620, 95% CI 0.47 - 5.53, P = 0.441);RDI 90% - 99% (Hazard Ratio = 1.590, 95% CI 0.53 - 4.73, P = 0.405) compared with patients who received an RDI of 100%. Conclusion: This study provides evidence that decreased RDI of <70% in non-metastatic breast cancer patients is strongly associated with decreased overall survival.

Quality of life and survival analyses of breast cancer cases treated with integrated traditional Chinese and Western medicine

BACKGROUND Breast cancer(BC)is the second leading cause of tumor-related mortality after lung cancer.Chemotherapy resistance remains a major challenge to progress in BC treatment,warranting further exploration of feasible and effective alternative therapies.AIM To analyzed the quality of life(QoL)and survival of patients with BC treated with integrated traditional Chinese and Western medicine(TCM-WM).METHODS This study included 226 patients with BC admitted to the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine between February 2018 and February 2023,including 100 who received conventional Western medicine treatment(control group)and 126 who received TCM-WM treatment(research group).The total effective rate,side effects(alopecia,nausea and vomiting,hepatorenal toxicity,and myelosuppression),QoL assessed using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire(EORTC QLQ-C30),1-year overall survival(OS),recurrence and metastasis rates,and serum inflammatory factors[interleukin(IL)-6,IL-10,and tumor necrosis factor alpha]were comparatively analyzed.RESULTS The research group showed statistically better overall efficacy,EORTC QoL-C30 scores,and 1-year OS than the control group,with markedly lower side effects and 1-year recurrence and metastasis rates.Moreover,the posttreatment levels of serum inflammatory in the research group were significantly lower than the baseline and those in the control group.CONCLUSION Overall,TCM-WM demonstrated significantly improved therapeutic efficacy while ensuring drug safety in BC,which not only improved patients’QoL and prolonged survival,but also significantly inhibited the inflammatory response.

Advances in the Diagnosis and Treatment of Appendiceal Mucinous Neoplasms

Primary appendiceal neoplasms represent a relatively low percentage of all gastrointestinal cancers. A subset of these neoplasms, those of epithelial origin, are characterised by the production of a considerable amount of mucus, which is referred to as appendiceal mucinous neoplasms (AMN). Appendiceal mucinous neoplasms (AMN) have a low incidence, are easily misdiagnosed, depend on postoperative examination for confirmation of the diagnosis, are prone to form a “diagnosis”, and have a high incidence of the disease. Furthermore, they are prone to form peritoneal pseudomyxoma peritonei (PMP), are controversial in surgical decision-making, are prone to recurring after surgery alone, and are tricky to manage clinically. In this paper, we review the pathological characteristics, diagnosis and treatment of appendiceal mucinous tumours in the light of recent literature reports, with a view to providing certain references for the clinical diagnosis and treatment of this disease. .

Systemic oncological therapy in breast cancer patients on dialysis

The advancement of renal replacement therapy has significantly enhanced the survival rates of patients with end-stage renal disease(ESRD)over time.How-ever,this prolonged survival has also been associated with a higher likelihood of cancer diagnoses among these patients including breast cancer.Breast cancer treatment typically involves surgery,radiation,and systemic therapies,with ap-proaches tailored to cancer type,stage,and patient preferences.However,renal replacement therapy complicates systemic therapy due to altered drug clearance and the necessity for dialysis sessions.This review emphasizes the need for opti-mized dosing and administration strategies for systemic breast cancer treatments in dialysis patients,aiming to ensure both efficacy and safety.Additionally,ch-allenges in breast cancer screening and diagnosis in this population,including soft-tissue calcifications,are highlighted.

Eribulin in breast cancer:Current insights and therapeutic perspectives

Eribulin is a non-taxane synthetic analogue approved in many countries as thirdline treatment for the treatment of patients with metastatic breast cancer.In addition to its mitotic property,eribulin has non-mitotic properties including but not limited to,its ability to induce phenotypic reversal of epithelial to mesenchymal transition,vascular remodelling,reduction in immunosuppressive tumour microenvironment.Since approval,there has been a surge in studies investigating the application of eribulin as an earlier-line treatment and also in combination with other agents such as immunotherapy and targeted therapy across all breast cancer sub-types,including hormone receptor positive,HER2 positive and triple negative breast cancer,many demonstrating promising activity.This review will focus on the application of eribulin in the treatment of metastatic breast cancer across all subtypes including its role as an earlier-line agent,its toxicity profile,and potential future directions.

Guidelines for diagnosis and treatment of advanced breast cancer in China(2022 edition)

Breast cancer is the most common cancer among women worldwide.It has been estimated that about 416000 new cases and over 117000 deaths of breast cancer occurred in China in 2020.Among the new cases of breast cancer diagnosed each year,3-10%have distant metastasis at the time of initial diagnosis.In addition,approxi-mately 30%of patients with early-stage breast cancer may eventually experience recurrence or metastases.The 5-year survival rate of patients with advanced breast cancer is only 20%with a median overall survival of 2-3 years.Although advanced breast cancer remains incurable at present,new therapeutic options and multidisci-plinary treatment could be utilized to alleviate symptoms,improve quality of life,and prolong patients’survival.The choice of treatment regimens for patients with advanced breast cancer is very important,and the optimal treatment strategy beyond the first-and second-line therapy is often lacking.Herein,the China Advanced Breast Cancer Guideline Panel discussed and summarized recent clinical evidence,updated the guidelines for the diag-nosis and treatment of advanced breast cancer based on the 2020 edition,and formulated the“Guidelines for diagnosis and treatment of advanced breast cancer in China(2022 edition)”for clinicians’reference.

Symptom Experience and Quality of Life in Colorectal Cancer Patients Undergoing Chemotherapy-A Secondary Publication

Objective:To evaluate symptom experience and quality of life(QoL)and to identify the predictors of QoL among colorectal cancer patients undergoing chemotherapy.Methods:A cross-sectional study was conducted on 107 colorectal cancer patients at a university-affiliated hospital between June 1 and July 30,2021.Functional Assessment of Cancer Therapy-Colorectal(FACT-C)and Memorial Symptom Assessment Scale-Short Form(MSAS-SF)were used to assess symptom experience and QoL of these patients.Data were analyzed using Pearson’s correlation,t-test,ANOVA,and hierarchical multiple regression.Results:The mean QoL score for colorectal cancer patients was 88.78±20.08.The most frequently experienced physical and psychological symptoms were numbness/tingling and worrying.Physical and psychological symptoms have a significant negative association with QoL.Perceived economic status was significantly associated with QoL in patients’general characteristics.The regression analyses showed that high psychological symptoms(β=-0.63,P<0.001),middle perceived economic status(β=-0.22,P=0.009),and low perceived economic status(β=-0.36,P<0.001)were statistically significant in predicting patients’low QoL.Conclusion:Symptom experience and QoL are essential variables that should be acknowledged when delivering health care to colorectal cancer patients.More attention to the reduction and comprehensive symptom management of psychological distress could improve QoL among colorectal cancer patients.

Early prediction of pathological outcomes to neoadjuvant chemotherapy in breast cancer patients using automated breast ultrasound

Objective： Early assessment of response to neoadjuvant chemotherapy （NAC） for breast cancer allows therapy to be individualized. The optimal assessment method has not been established. We investigated the accuracy of automated breast ultrasound （ABUS） to predict pathological outcomes after NAC. Methods： A total of 290 breast cancer patients were eligible for this study. Tumor response after 2 cycles of chemotherapy was assessed using the product change of two largest perpendicular diameters （PC） or the longest diameter change （LDC）. PC and LDC were analyzed on the axial and the coronal planes respectively. Receiver operating characteristic （ROC） curves were used to evaluate overall performance of the prediction methods. Youden＇s indexes were calculated to select the optimal cut-off value for each method. Sensitivity, specificity, positive and negative predictive values （PPV and NPV） and the area under the ROC curve （AUC） were calculated accordingly.Results： ypT0/is was achieved in 42 patients （14.5%） while ypT0 was achieved in 30 patients （10.3%） after NAC. All four prediction methods （PC on axial planes, LDC on axial planes, PC on coronal planes and LDC on coronal planes） displayed high AUCs （all〉0.82）, with the highest of 0.89 [95% confidence interval （95% CI）, 0.83-0.95] when mid-treatment ＆BUS was used to predict final pathological complete remission （pCR）. High sensitivities （85.7%-88.1%） were observed across all four prediction methods while high specificities （81.5%-85.1%） were observed in two methods used PC. The optimal cut-off values defined by our data replicate the WHO and the RECIST criteria. Lower AUCs were observed when mid-treatment ABUS was used to predict poor pathological outcomes. Conclusions：ABUS is a useful tool in early evaluation of pCR after NAC while less reliable when predicting poor pathological outcomes.

Efficacy and safety of trastuzumab combined with chemotherapy for first-line treatment and beyond progression of HER2-overexpressing advanced breast cancer

Objective： To observe the efficacy and safety of trastuzumab combined with chemotherapy in patients with human epidermal growth factor receptor 2 （HER2）-overexpressing advanced breast cancer. Methods： A total of 90 patients with HER2-overexpressing advanced breast cancer were enrolled in this study. All patients were diagnosed with ductal invasive breast cancer by pathological analysis, and were aged between 31-73 years with a median of 51 years. HER2-positivity was defined as 3（＋） staining in immunochemistry or amplification of fluorescence in situ hybridization （FISH, ratio ≥2.0）. Trastuzumab was administered in combination with chemotherapy as first-line treatment and beyond progression as a second- line, third-line, and above treatment in 90, 34, 14, and 6 patients, respectively. The chemotherapy regimen was given according to normal clinical practice. The response rate was evaluated every two cycles, and the primary endpoints were progression-free survival （PFS） and overall survival （OS）. Survival curves were estimated by using Kaplan-Meier graphs and were compared by using log-rank test statistics. Multivariate analysis was done using Cox＇s proportional hazards regression model, and the level of significance was P〈0.05. Results： All 90 patients received at least one dose of trastuzumab, and efficacy could be evaluated in 85 patients. The median follow-up was 50 months. In total, 72 （80.00%） patients had visceral metastasis, and 43 （47.78%） patients had progressed after one or more extensive chemotherapy regimens for metastatic diseases. The median PFS for first-line trastuzumab was 10 months （range, 2-59 months）, and the median OS after metastasis or initially local advanced disease was 22 months （range, 2-1 16 months）. Conclusions： Trastuzumab combined with chemotherapy was active and well-tolerated as a first-line treatment and even beyond progression in HER2-overexpressing advanced breast cancer as a second-line or third-line treatment. However, its efficacy is certainly less beyond this point.