Breast Cancer In Remission Research Articles

Stereotyped visual aura as early manifestation of a relapsed breast cancer with isolated brain metastasis

Breast cancer brain metastasis often leads to various ocular symptoms. We herein present a case in which an intermittently stereotyped visual aura served as the initial presentation of isolated brain metastasis in a patient with breast cancer in remission. No one has previously reported this unusual presentation. The patient, a 40-year-old woman with a history of Stage 3 breast carcinoma, presented one year after her initial diagnosis with a complaint of intermittent visual disturbances in the left side of her visual field in both eyes for three months. The symptoms consisted of intermittent episodes of flashing lights in a zig-zag pattern within her left lower visual field. Each episode lasted several minutes, with complete resolution between them. Initially, these episodes occurred 2–4 times per week, but over time, they became more frequent, eventually resulting in a persistent visual field loss. An eye examination revealed a dense left homonymous quadrantanopia. Magnetic resonance imaging revealed an enhanced, heterogeneous mass in the right occipital lobe. Surgical excision confirmed a metastatic carcinoma originating from the breast. Despite stereotactic radiosurgery, the visual field defect persisted for more than a year. This case highlights the importance of recognizing stereotyped visual auras as potential indicators of metastatic tumour involvement in the visual pathway.

Associations between HIV infection status, psychosocial factors, and adjuvant endocrine therapy adherence among South African women with early-stage breast cancer.

We aimed to evaluate for associations between HIV status, psychosocial factors, and adjuvant endocrine therapy (AET) adherence in South African (SA) women with estrogen receptor positive (ER+) breast cancer (BC). We enrolled South African women with early-stage ER + BC in remission and prescribed tamoxifen or an aromatase inhibitor to the prospective observational study. We performed AET pill counts at enrollment, 12 weeks, and 24 weeks, and calculated adherence ratios of pills consumed between visits to days between visits. Women completed questionnaires on social support, attitude towards medication, health literacy, self-efficacy, mental health, and AET toxicity. We collected household wealth data. We used hierarchical linear (HLM) and structural equation modelling (SEM) to compare adherence ratios between women with and without HIV while adjusting for psychosocial factors. We collected adherence data from 239 women, 63 (26.4%) with co-morbid HIV. Comparing women with and without HIV, median AET adherence ratio was 0.88 vs 0.89, respectively (HLM p = 0.31). In our SEM model for the full cohort, mental health, healthcare savvy, and side effect burden latent variables were not significantly associated with adherence. In the subgroup of women living with HIV, lower SES quintile (β 0.04, SE 0.02, p = 0.08) and poorer mental health (β -0.02, SE 0.01, p = 0.10) showed trends toward association with adherence. HIV status is not predictive of AET adherence among SA women with ER + BC, though decreasing SES status and increasing mental health symptoms are marginally associated with adherence in women with BC and HIV.

Associations between HIV infection status, psychosocial factors, and adjuvant endocrine therapy adherence among South African women with early-stage breast cancer.

522 Background: South African (SA) women living with comorbid estrogen receptor positive (ER+) breast cancer (BC) and HIV have higher mortality than other SA women with ER+ BC. We aimed to evaluate for associations between HIV status, psychosocial factors, and adjuvant endocrine therapy (AET) adherence as a potential contributor to this disparity. Methods: From Chris Hani Baragwanath Hospital, Johannesburg, we enrolled adult women with stage I-III ER+ BC in remission and currently prescribed tamoxifen or an aromatase inhibitor to a prospective cohort study. We performed AET pill counts at enrollment, 12 weeks, and 24 weeks, and calculated adherence ratios from the difference in pills between visits divided by the number of days between visits. Women completed questionnaires on sources of social support, beliefs about medication, health literacy, and self-efficacy at enrollment and questionnaires about mental health (depression, anxiety, and acute stress) symptom burden and AET-related side effects at the 12- and 24-week visits. We also collected household wealth data and clinical data on BC and HIV. AET adherence ratios were compared between women with and without comorbid HIV using Wilcoxon rank sum testing. We also used structural equation modeling techniques to refine and evaluate an a priori model of AET adherence with latent variables for mental health, socioeconomic (SES) status, healthcare savvy, and AET side effect burden and subgroup analyses of the resulting model in women with and without HIV. Results: Between April 26, 2022, and July 11, 2023, we enrolled 239 women, 63 (26.4%) of whom had co-morbid HIV. Adherence data was available from 106 women at 12 and 24 weeks, from 22 women at 12 weeks only, and from 111 women at 24 weeks only. Comparing women with and without HIV, median AET adherence ratio was 0.88 vs 0.89, respectively (p = 0.65). Our final model of AET adherence achieved good fit (comparative fit index = 0.96, RMSEA 90% CI: 0.03-0.06). In the full cohort, SES quintile showed a trend towards association with AET adherence (β 0.02, SE 0.01, p=0.09); mental health, healthcare savvy, and side effect burden latent variables were not significantly associated with adherence. In the subgroup of women living with HIV, SES quintile (β 0.04, SE 0.02, p=0.08) and mental health (β -0.02, SE 0.01, p=0.10) showed trends toward association with adherence; these relationships did not persist for women without HIV. Conclusions: HIV status is not predictive of AET adherence among SA women with ER+ BC, but in women with both diagnoses, decreasing SES status and increasing mental health symptoms trended towards an association with decreased adherence. Interventions to improve the mental health of SA breast cancer patients living with HIV may promote AET adherence.

(180) Female Sexuality of Tunisian Women with Treated Breast Cancer

Abstract Introduction Breast cancer is a major health problem. Several treatment strategies are used to treat it such as lumpectomy or mastectomy surgery, chemotherapy, radiotherapy, and hormone therapy, which leads us to ask the following question: what impact does breast cancer and its treatments have on female sexuality? Objective The aims of our study were to assess the sexuality of Tunisian women with breast cancer in remission, and to determine the prevalence and nature of sexual dysfunction in this population. Methods We carried out a descriptive cross-sectional study, involving women aged under 60, followed up for treated non-metastatic breast cancer currently in remission, and having a regular sexual partner during the last month. Outpatients in the surgery and radiotherapy department of the "Salah-Azaiez" Institute were interviewed using a questionnaire including a validated Arabic version of FSFI (Female sexual function desire). Our study was carried out throughout a period of 3 months, from January 1st, 2023 to March 31st, 2023, this period allowed us to collect our necessary data. Results We included 120 women in our study. The majority were between 40 and 49 years with an average of 46.53. One-third (33.3%) had a university degree and 16.7% were senior executives. More than half of our population (56.7%) were menopausal and 12% were smokers. 85% of the women had children, and only 36% had breastfed their children exclusively. Half of the women had discovered the disease at stage II, and 52% of them had discovered it during breast self-examination. Surgical treatment was radical in 61.7% of women and conservative in 38.3%. Thus, 75% of the population had undergone chemotherapy, 93.3% had undergone radiotherapy and 71.7% were receiving hormone therapy. Only 5% of our study population had a sexual dysfunction prior to the disease and 78% of women had reported a change in their sex life after breast cancer, with the frequency of intercourse as the main parameter affected. Among the most common sexual complaints were decreased or absent sexual desire in 68.1% of cases, lack of sexual initiative (74.4%), vaginal dryness (48.9%), and dyspareunia (42.6%). The majority of interviewed women (83.3%) had presented with global sexual dysfunction, i.e. a total FSFI score ≤26.55 and the areas most affected were pain, lubrication, and orgasm. Radical surgical treatment, chemotherapy, and hormone therapy were significantly associated with impaired female sexuality (respectively p=0.0036; p=0.047 and p=0.001). Conclusions Our study highlighted the impact of breast cancer treatment on women's sex lives. Healthcare providers should acquire the necessary skills in order to explore female sexual disorders and suggest suitable management. Disclosure No.

CDH2-microRNA Axis Provides Insights into Sustained Breast Cancer Dormancy in the Bone Marrow Niche

Despite long-term remission of breast cancer (BC), cancer resurgence remains a clinical issue. This issue is mostly due to BC cells (BCCs) being able to survive in dormancy for decades. This is particularly relevant to the bone marrow (BM) where the dormant BCCs survive as cancer stem cells (CSCs). The BM niche maintains BCCs in dormancy, and also mediates dedifferentiation of BCCs to CSCs. Since dormancy can occur at any time during the disease, including decades before clinical diagnosis, it is important to understand how these cells survive to allow for the development of safe treatments. Dormant BCCs establish gap junctional intercellular communication (GJIC) with BM niche such as fibroblasts and mesenchymal stem cells (MSCs). GJIC requires connexin 43 (Cx43) but cannot be a safe target since this connexin is also important for hematopoietic function. This study focused on N-cadherin (CDH2) because it facilitates Cx43-mediated GJIC between BCCs and BM niche cells. We found Cx43 and CDH2 mutually regulated their gene expression. Cloning of the 5′ regulatory regions of CDH2 unraveled DNA sequences as possible elements of repressor and activator transcription. We identified potential transcription factors (TFs) that could regulate CDH2 and showed how miRNAs that could cross GJIC might be responsible for regulating the TFs. The axis developed by CDH2 and miRNAs provide insights into how CDH2 is maintained at low level to sustain BC dormancy. The findings, together with previous findings, provide avenues for therapeutic intervention to safely reverse and target dormant BCCs in the BM niche.

Expression Significance of Estrogen Receptor ER-α36 in Breast Cancer Treated by Chemotherapy: A Meta-Analysis.

Estrogen receptor (ER) is a molecular marker and target for diagnosing and treating breast cancer (BC). ER-α36, a novel estrogen receptor subtype, involved in the proliferation, differentiation, metastasis, and invasion of tumor cells. It is closely linked to the progression of various cancers. Therefore, studying ER is of high significance in treating BC. In this study, we will investigate the changes in the expression level of ER-α36 in patients with BC treated by chemotherapy through meta-analysis, so as to evaluate the clinical value of ER-α36 in the prognosis of BC treated by chemotherapy. English databases such as PubMed, Web of Science, Embase, and The Cochrane Library were searched to retrieve the articles published from the establishment of the database to April 2023. The keywords included chemotherapy, neoadjuvant chemotherapy, breast cancer, estrogen receptor alpha, and ER-α36. Five suitable studies, encompassing 636 patients, were ultimately selected. The meta-analysis results revealed that, following the chemotherapy, the analysis of ER-α36 positive cases yielded an Odds Ratio (OR) of 0.42, a 95% confidence interval (CI) of 0.28-0.64 (Z = 4.00, P < 0.0001). Additionally, the analysis of cases exhibiting remission in BC demonstrated an OR of 2.22 (95% CI = 1.40-3.50, Z = 3.40, P = 0.0007). Compared to patients receiving single chemotherapy agents or those untreated with chemotherapy, the combined use of multiple chemotherapy drugs can significantly reduce the levels of ER-α36 in BC patients, enhancing the remission rate of BC. ER-α36 can serve as a critical indicator for assessing the prognosis of BC following chemotherapy.

Latissimus dorsi flap in breast reconstruction following radical mastectomy and prophylactic subcutaneous mastectomy in the same patient: Case report

One of the most common surgical treatment options for breast cancer is radical mastectomy, which affects the quality of life of patients in remission and their psychological state. One of the solutions to this problem is the use of skin and muscle flaps from other anatomical areas, in particular the back, for plastic reconstruction of the breast after radical mastectomy. The study aimed to present the practical implementation of reconstruction of both breasts in the remote period of radical mastectomy in a patient in remission of breast cancer using a skin and muscle flap of the broadest back muscle in combination with an implant. The patient, who met the criteria for participation in the study, had previously undergone a radical mastectomy of the right breast for direct indications along with radiotherapy. Delayed breast reconstruction within the study was performed 6 years after the planned right-sided mastectomy. The first surgical intervention included marking the back and breast area, excision and harvesting of the flap, preparation of the implantation site and its placement with the implant. Three months after the operation, she underwent a prophylactic mastectomy of the left breast based on molecular genetic testing with immediate reconstruction using the second flap of the broadest back muscle. The surgery was performed using a perimammary approach. Due to the available dissection, various anatomical configurations of the flap, and low-variability vascular anatomy, the latissimus dorsi flap is an adequate choice of material for the reconstruction of radical postmastectomy interventions. The final result of bilateral use of the flap for breast reconstruction after mastectomy is in favour of restoration of the anatomical tissue defect and a satisfactory aesthetic option, without complications in the form of seromas, haematomas, or pain. The result has a positive impact on the quality of life of a patient in remission of breast cancer

A Case of Multiple Bone Fractures Mimicking Bone Metastases in a Patient with Breast Cancer in Remission

We present the case of an 88-year-old female patient who was admitted to our department due to major asthenia. The patient had a medical history of hypertension, diabetes, and Alzheimer's disease. In 1984, she was diagnosed with right breast cancer and had undergone surgery followed by chemotherapy and radiotherapy, achieving a stable remission. However, her recent clinical presentation raised concerns about possible disease recurrence. This case report highlights the importance of thorough evaluation and multidisciplinary discussions in reaching an accurate diagnosis.

Artificial intelligence analysis of CCNG1 expression in tumors: A novel biomarker in development for anti-CCNG1 targeted therapy.

e15083 Background: Metastatic cancer is associated with an invariably fatal outcome. Therefore, innovative therapies are urgently needed. Although expanded access for DeltaRex-G, a tumor targeted retrovector encoding a CCNG1 inhibitor gene, is on-going for an intermediate-size (n = up to 40) population of advanced sarcoma and pancreatic cancer, more data is needed to identify patients who are likely to benefit from DeltaRex-G gene therapy. In this study, we retrospectively analyzed CCNG1 expression in archived tumors of patients who were previously treated with DeltaRex-G and who are active candidates for DeltaRex-G therapy. Methods: Archived formalin-fixed paraffin embedded (FFPE) tumor specimens (n = 58) from patients with solid malignancies who are actively followed at the Cancer Center of Southern California were collected, processed, and subjected to RNA sequencing. Briefly, RNA-seq libraries were sequenced to generate 50 million reads that were aligned using Kallisto v0.42.4 to GENCODE v23 transcripts with default parameters. Only protein-coding, IGH/K/L- and TCR-related transcripts were retained for downstream processing, resulting in 20,062 protein coding genes. Gene expression was quantified as transcripts per million (TPM) and log2-transformed (Goldman et al., 2020). A gene expression level is presented as low/medium/high depending on the expression level of a such gene in patients of the reference cohort. Low = &lt; 17%; Medium = 17%-83%; High = &gt; 83%. Results: Thirty-two male and 26 female subjects, ages ranging from 16 to 86 years were studied. Forty-nine (84.4%) patients had sarcoma, 3 (5.2%) had urothelial carcinoma, 2 (3.5%) had breast carcinoma, 2 (3.5%) had pancreatic cancer, 1 (1.7%) had Sertoli cell tumor, 1 (1.7%) had adenocarcinoma of appendix. Eleven (19%) tumors showed high CCNG1 expression, 44 (76%) tumors had medium expression, and 3 (5.2%) tumors had low CCNG1 expression. Of note, the tumor of one 14-year survivor with metastatic pancreatic adenocarcinoma in sustained remission had 24 % CCNG1 expression, one 3-year survivor with metastatic chondrosarcoma metastatic to lung with stable disease had 74% CCNG1 expression, one 2-year survivor with early stage HR+ HER2+ breast cancer in remission had 23% CCNG1 expression, and one 2-year survivor with early stage triple negative breast cancer in remission had 74% CCNG1 expression. Conclusions: Taken together, these data indicate that (1) Medium to high CCNG1 expression was found in 95% of tumors studied, and (2) Patients with medium CCNG1 expression who received DeltaRex-G had clinical benefit and are alive in sustained remission or with stable disease 2-14 years from DeltaRex-G treatment initiation, and (3) Prospective studies are warranted to correlate CCNG1 expression level and response to DeltaRex-G therapy.

Abstract P2-11-06: Plasma assay of methylated DNA markers (MDM) detects patients with metastatic breast cancer (MBC) compared to healthy controls and treated breast cancer patients with no evidence of disease

Abstract Objective: Aberrantly methylated DNA may be used to detect minimal residual disease or early recurrence in breast cancer. As a 1st step, we aimed to develop an MDM panel to delineate between healthy women, stage I-III breast cancer in remission with no evidence of disease (NED), and metastatic breast cancer (MBC). Methods: We prospectively enrolled patients into 3 groups: healthy controls (adult females with a normal mammogram in past 12 months with no history of breast cancer), NED [stage I-III breast cancer with no clinical evidence of recurrence 6 months - 3 years post-treatment (adjuvant endocrine therapy allowed)], and MBC (collected either at initial diagnosis of untreated metastatic disease or radiographic progression). DNA was extracted from 6 mL of plasma derived from blood collected in LBgard tubes (Exact Sciences Corp., San Diego CA), and was bisulfite-treated and assayed by target enrichment long-probe quantitative amplified signal (TELQASTM) method for a panel of 15 previously identified MDMs [Table], normalized by the control gene, B3GALT6. Areas under the receiver operating characteristic curve (AUC) were calculated for each MDM to assess discrimination of MBC from other groups. With 60 patients per group, we had greater than 80% power to detect a difference of 0.20 from the null AUC of 0.7. Results: We tested samples from 60 MBC (10 untreated, 50 recurrent), 60 NED, and 60 healthy women. The median age was 63 (IQR, 55-72) and was not different between groups. The NED group was all hormone-receptor (HR) positive, with 47 (78%) being human epidermal growth factor receptor 2 negative (HER2-) and 13 (22%) HER2+; 48 (80%) were stage I and 9 (15%) were N+. The MBC group had 35 (58%) patients with HR+/HER2- tumors, 11 (18%) HR+/HER2+, and 6 (10%) HR-/HER2-, 4 (7%) HR-/HER2+, with 4 (7%) unknown. Of the 41 MBC whose original stage and nodal status were known 9 (22%) were stage I and 22 (54%) were N+. The markers were able to discriminate between MBC and NED patient samples with AUCs from 0.97 to 0.72. AUCs for 10/15 MDMs (ITPRIPL1, EMX1, C17orf64, OSR2, TRIM67, CHST2, IFFO1, TRH, FAM59B, and MPZ) were &amp;gt;0.90. No difference in MDMs was observed between the healthy and NED groups. Conclusions: MDMs, assayed from plasma, appear highly discriminant for metastatic breast cancer cases in comparison to control patients with NED or healthy controls. Further clinical validation of this MDM panel in a larger cohort is warranted. Table 1. Plasma MDM discrimination of metastatic breast cancer (MBC) from healthy controls and previously treated breast cancer patients with no evidence of disease (NED) Citation Format: Karthik V. Giridhar, Fergus J. Couch, Jason P. Sinnwell, Seth W. Slettedahl, William R. Taylor, Douglas W. Mahoney, Patrick H. Foote, Maria C. O’Connell, Mariah J. Robran, Mary E. Devens, Anna M. Gonser, Nicole Larson, Karen A. Doering, Kelli N. Burger, Michael Kaiser, Hatim Allawi, Kathryn Ruddy, Janet Olson, John B. Kisiel. Plasma assay of methylated DNA markers (MDM) detects patients with metastatic breast cancer (MBC) compared to healthy controls and treated breast cancer patients with no evidence of disease [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-11-06.

The Role of Nomogram Based on the Combination of Ultrasound Parameters and Clinical Indicators in the Degree of Pathological Remission of Breast Cancer.

The mortality rate of breast cancer (BC) ranks first among female tumors worldwide and presents a trend of younger age, which poses a great threat to women's health and life. Neoadjuvant chemotherapy (NAC) for breast cancer is defined as the first step of treatment for breast cancer patients without distant metastasis before planned surgical treatment or local treatment with surgery and radiotherapy. According to the current NCCN guidelines, patients with different molecular types of BC should receive neoadjuvant chemotherapy (NAC), which can not only achieve tumor downstaging, increase the chance of surgery, and improve the breast-conserving rate. In addition, it can identify new genetic pathways and drugs related to cancer, improve patient survival rate, and make new progress in breast cancer management. To explore the role of the nomogram established by the combination of ultrasound parameters and clinical indicators in the degree of pathological remission of breast cancer. A total of 147 breast cancer patients who received neoadjuvant chemotherapy and elective surgery in the Department of Ultrasound, Nantong Cancer Hospital, from May 2014 to August 2021 were retrospectively included. Postoperative pathological remission was divided into two groups according to Miller-Payne classification: no significant remission group (NMHR group, n = 93) and significant remission group (MHR group, n = 54). Clinical characteristics of patients were recorded and collected. The multivariate logistic regression model was used to screen the information features related to the MHR group, and then, a nomogram model was constructed; ROC curve area, consistency index (C-index, CI), calibration curve, and H-L test were used to evaluate the model. And the decision curve is used to compare the net income of the single model and composite model. Among 147 breast cancer patients, 54 (36.7%) had pathological remission. Multivariate logistic regression showed that ER, reduction/disappearance of strong echo halo, Adler classification after NAC, PR + CR, and morphological changes were independent risk factors for pathological remission (P < 0.05). Based on these factors, the nomogram was constructed and verified. The area under the curve (AUC) and CI were 0.966, the sensitivity and specificity were 96.15% and 92.31%, and the positive predictive value (PPV) and negative predictive value (NPV) were 87.72% and 97.15%, respectively. The mean absolute error of the agreement between the predicted value and the real value is 0.026, and the predicted risk is close to the actual risk. In the range of HRT of about 0.0∼0.9, the net benefit of the composite evaluation model is higher than that of the single model. H-L test results showed that χ 2 = 8.430, P=0.393 > 0.05. The nomogram model established by combining the changes of ultrasound parameters and clinical indicators is a practical and convenient prediction model, which has a certain value in predicting the degree of pathological remission after neoadjuvant chemotherapy.

Photothermic therapy with cuttlefish ink-based nanoparticles in combination with anti-OX40 mAb achieve remission of triple-negative breast cancer.

Immunostimulatory monoclonal antibodies (IS-mAb) have been proven to enhance the therapeutic effectiveness of various anticancer therapy. In the present investigation, we launched a separate combinational therapy for the treatment of triple-negative breast cancer (TNBC) using cuttlefish ink-based nanoparticles (CINPs) for photothermal therapy (PTT) and anti-OX40 antibody. Our goal was to increase the therapeutic response to the disease. CINPs were characterized by their physicochemical properties, which revealed that they had a hydrodynamic diameter ranging from 128 to 148nm, a negative surface charge, and a high photothermal conversion efficiency under both in vitro and in vivo settings. In TNBC model, we evaluated the therapeutic effectiveness of the following groups: CINP-PTT+anti-OX40 Ab (G1), CINPs-PTT (G2), CINPs+anti-OX40 Ab (G3), anti-OX40 (G4) or PBS (G5). In each case, we assessed the efficacy of these groups against one another. The intratumor administration of all of the substances and therapies was performed. CINP-PTT+anti-OX40 Ab and CINP+anti-OX40 Ab (particularly CINP-PTT+anti-OX40 Ab) induced significant tumor regression in treated (breast) and non-treated (flank) tumor, and completely inhibited lung metastasis, thereby inducing a higher survival rate in mice in comparison to CINP-PTT, anti-OX40 Ab, or PBS. This was the case because in CINPs-treated tumors, particularly those treated with CINPs-PTT, intratumoral injection of CINPs increased the frequency of OX40, CD8 double-positive T cells. CINPs improved the conversion of the macrophage phenotype from M2 to M1 in vitro, which is significant from an immunological point of view. In addition, anti-OX40 Ab combined with CINPs or, more specifically, CINPs-PPT produced a larger frequency of preexisting and newly formed tumor-specific CD8 T cells, as well as an enhanced frequency of CD8 T cells infiltrating non-treated tumors, in comparison to respective monotherapies. When the data were taken into consideration as a whole, it seemed that CINPs-based PTT may effectively enhance the antitumor response effectiveness of anti-OX40 Ab.

Axillary recurrence after neoadjuvant chemotherapy: a retrospective study

Introduction: The justification for this study emerged from the need to evaluate the performance of axillary lymphadenectomy in patients with positive sentinel lymph nodes who underwent neoadjuvant chemotherapy. Axillary lymph node dissection is an invasive and potentially morbid procedure designed to achieve complete remission of breast cancer and prevent unnecessary radical surgery. With the omission of the axillary lymphadenectomy, surgical complications are avoided including lymphedema, stress is decreased, and the quality of life improves in these patients. This study aimed to evaluate axillary recurrence in breast cancer patients undergoing neoadjuvant chemotherapy after the omission of radical axillary lymph node dissection in patients with positive sentinel lymph nodes. Methods: A retrospective study was conducted with ten patients from a clinic specializing in cancer diagnosis and treatment in Teresina (PI), Brazil, diagnosed with breast cancer from January 1998 to February 2021. These patients had positive sentinel lymph nodes and did not undergo axillary node dissection after neoadjuvant chemotherapy. Results: The median patient age at diagnosis was 52 years. All of them had clinical axillary involvement and received neoadjuvant chemotherapy regimen with doxorubicin, cyclophosphamide, and paclitaxel. In addition, they all received adjuvant radiotherapy in the postoperative period and the mean number of sentinel lymph nodes (SLN) removed was two. At a median follow-up of 39.5 months, there was no axillary recurrence and 90% of the patients were alive. Conclusions: At a median follow-up of 39.5 months none of the patients presented axillary recurrence.

Retracted: Analysis of Adjuvant Chemotherapy on Pathological Remission of Breast Cancer.

[This retracts the article DOI: 10.1155/2021/5440154.].

Secondary Gerstmann syndrome, a case report

IntroductionGerstmann syndrome is a rare neurological disorder that consist primarily of 4 neuropsychological signs that include acalculia (impairment in performing calcultaions), digital agnosia (dificulty discriminating their own fingers), agraphia (impairment or dificulty to write by hand); and left-right disorientation (impairment of distinguishing left from right.ObjectivesPresentation of a case report of a patient with Gertsmann syndrome secondary to breast cancer metastasis.MethodsWe analyze the case of a 79 years-old female with a history of breast cancer in remission, with a severe depressive episode of 8 months of evolution, dysphoria, apathy, decrease in the ability to carry out basic activities of daily life, acute personality changes and sleep disruption. 15 days previous to the first examination the patient suffers gait disturbances, falling from her own height, memory impairment, suicide ideation and nomination aphasia.ResultsAt the examination we encounter digital agnosia, acalculia, agraphia, right-left disorientation, right hemiparesis. MRI are taken founding 3 tumor lesions in the left and right frontal lobe, 2 solid lesions with a necrotic appearance in the right parietal lobe, one of them in the angular gyrus of the parietal cortex. CT scan found a solid tumor-like lesion in the left pulmonary apex. CA-125 antigen 429.5 U/mL. She was sent to continue her treatment with oncology, receiving radiotherapy.ConclusionsThe psychiatric abnormalities secondary to Gerstmann syndrome make the relatives of this patient seek psychiatric care, requiring multidisciplinary work to reach an accurate diagnosis. Gerstmann syndrome is a rare neurological condition that can mimic lots of other clinical pictures.DisclosureNo significant relationships.

Albumin nanoparticle containing a PI3Kγ inhibitor and paclitaxel in combination with α-PD1 induces tumor remission of breast cancer in mice.

Immunomodulators that remodel the tumor immunosuppressive microenvironment have been combined with anti-programmed death 1 (α-PD1) or anti-programmed death ligand 1 (α-PDL1) immunotherapy but have shown limited success in clinical trials. However, therapeutic strategies to modulate the immunosuppressive microenvironment of lymph nodes have been largely overlooked. Here, we designed an albumin nanoparticle, Nano-PI, containing the immunomodulators PI3Kγ inhibitor (IPI-549) and paclitaxel (PTX). We treated two breast cancer mouse models with Nano-PI in combination with α-PD1, which remodeled the tumor microenvironment in both lymph nodes and tumors. This combination achieved long-term tumor remission in mouse models and eliminated lung metastases. PTX combined with IPI-549 enabled the formation of a stable nanoparticle and enhanced the repolarization of M2 to M1 macrophages. Nano-PI not only enhanced the delivery of both immunomodulators to lymph nodes and tumors but also improved the drug accumulation in the macrophages of these two tissues. Immune cell profiling revealed that the combination of Nano-PI with α-PD1 remodeled the immune microenvironment by polarizing M2 to M1 macrophages, increasing CD4+ and CD8+ T cells, B cells, and dendritic cells, decreasing regulatory T cells, and preventing T cell exhaustion. Our data suggest that Nano-PI in combination with α-PD1 modulates the immune microenvironment in both lymph nodes and tumors to achieve long-term remission in mice with metastatic breast cancer, and represents a promising candidate for future clinical trials.

Extracellular matrix remodeling in anthracycline-induced cardiotoxicity: What place on the pedestal?

ObjectiveTo evaluate the role of matrix metalloproteinases (MMP)-2 and 9 and the gene polymorphisms of MMP-2 (rs243865) and MMP-9 (rs3918242) in the course of anthracycline-induced cardiotoxicity (AIC) in women without previous cardiovascular diseases (CVD) during 24-months. MethodsA total of 114 women (47.0 [44.0; 52.0] years old) with AIC of NYHA class I-III who received doxorubicin for breast cancer were enrolled. ResultsAfter 24 months patients had breast cancer remission and were divided into 2 groups: group 1 comprised women with adverse course of AIC (n = 54), group 2 comprised those without it (n = 60). Serum levels of MMP-2 were higher by 8% (p = 0.017) MMP9 by 18.4% (p < 0.001) in group 1 than in group 2. In group 1 the levels of MMP-2 increased (p < 0.001) from 376.8 (329.5; 426.7) to 481.4 (389.8; 518.7) pg/mL, and MMP-9 increased (p < 0.001) from 23.6 (21.4; 24.6) to 26.0 (23.3; 27.0) pg/mL at 24 months. In group 2 the both MMP-2 and MMP-9 level decreased at 24 months. Based on ROC-analysis, the levels of MMP2 ≥ 388.2 pg/mL (AUС = 0.64; р = 0.013) and MMP-9 ≥ 21.25 pg/mL (AUС = 0.9; р < 0.001) were identified as predictors for adverse course of AIHF. The presence of C/C genotype of MMP2 (OR = 4.76; p = 0.029) and C/C genotype of MMP-9 (OR = 15.2; p < 0.0001) were related with adverse course of AIHF and higher levels of MMP-2 and MMP-9. ConclusionGene polymorphisms of MMP-2 (rs243865) and MMP-9 (rs3918242) and serum levels of MMP-2 and MMP-9 levels in women without previous CVD were associated with adverse course of AIC during 24 months.

Analysis of Adjuvant Chemotherapy on Pathological Remission of Breast Cancer.

With the continuous development of the concept of diagnosis and treatment, the current industry's treatment model has developed into a multidisciplinary comprehensive treatment. That is, in view of the pathological characteristics and clinical stages of breast cancer, corresponding methods such as surgery, chemotherapy, endocrine therapy, radiotherapy, and biological targeted therapy are adopted to provide comprehensive treatment of patients with multiple disciplines. This paper combines experimental research to research and analyze the degree of pathological remission of breast cancer by adjuvant chemotherapy and combines investigation and analysis and group trials to study and explore the effect of adjuvant chemotherapy. Moreover, this paper fully considers the patient's response to neoadjuvant chemotherapy and compares the changes in tumor cell abundance before and after chemotherapy to observe the response of the patient's primary tumor to chemotherapy at a microscopic level. Therefore, this study has made a relatively objective and accurate evaluation of the chemotherapy efficacy of tumor tissues, which can provide a reference for subsequent related research.

Health related quality of life measured by in Tunisian female patients with breast cancer

Abstract Background Breast cancer is a worldwide public health issue. In Tunisia It is the leading cause of cancer mortality and morbidity and accounts for 20-25% of malignant tumors in women in all age groups. There is limited information about the long-term quality of life (QOL) in disease-free breast cancer survivors Aim To assess the quality of life of women with breast cancer in remission. Methods A cross-sectional study was conducted among women with breast cancer, treated at the maternity ward of the University Hospital Farhat Hached in Sousse during the period from January 1, 2013 to December 31; 2017. The patients were surveyed 24 to 60 months after their cancer diagnosis. The quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer supplementary measure (QLQ-BR23). Results 100 breast cancer patients were recruited with a mean age of 52 ± 8 years. The mean Global Health Status was 77.5 (SD = 25.5). From the QLQ-C30, the mean score in the functioning scale was highest for ‘social functioning' (93; SD = 16.3), while the mean score in the symptom scale was highest for ‘Pain' (39, SD = 20.5). From the QLQ-BR23, the mean score for functioning scale was highest for ‘Sexual Pleasure' (88.33; SD = 21.9) while the mean score in the symptom scale was highest for ‘upset by hair loss' (56; SD = 15.2). The global health Status was significantly associated with professional category; health condition; age and type of treatment. Conclusions The results of the present study demonstrated the importance of a global therapeutic management that specifically targets the physical and psychological needs of breast cancer survivors. Improving doctor-patient communication has a central role during clinical approach to ensure the success of diagnostic and treatment strategies. Key messages Importance of a global therapeutic management tha target the quality of Life of cancer patients. Improving doctor-patient communication has a central role during clinical approach to ensure the success of diagnostic and treatment strategies.

Prolonged Thrombin Time in Asymptomatic Patient with Hypo Dysfibrogememia Tucson

A 61 years female patient with known diagnosis of the breast cancer in remission for more than 10 years has Renaud’s disease. During her work up for lupus and lupus anticoagulant which both were negative a prolonged thrombin time was noted which was done by mistake. She has no history of bleeding or thrombosis and last recent surgery was 5 years ago for spinal stenosis and was uncomplicated. Her clinical examination is normal without evidence of any spontaneous bruises but colder hands. The thrombin time was greater than 125 seconds on two different occasions and correction of it by addition of normal plasma was down to 56 seconds and was thus incomplete. Her prothrombin time and PTT were normal and there was no evidence of FDP or D-Dimers. There was no evidence of circulating heparins. The fibrinogen level was normal. The para proteinmia was excluded by normal serum protein electrophoresis and by immunofixation . Thus it is felt that this patient has dysfibrinogenemia or hypo dysfibrinogenemia without bleeding or thrombotic complication. The literature review shows approximately 55% of dysfibrinogenemia patients do not have bleeding or thrombotic complications.