Neoadjuvant Research Articles

A pilot study incorporating HER2-directed dendritic cells into neoadjuvant therapy of early stage HER2+ER- breast cancer

Type 1 dendritic cell vaccines targeting HER2 (HER2-DC1) reinvigorates antitumor immunity which correlates with neoadjuvant therapy response. A pilot trial (clinicaltrials.gov,NCT03387553,1/2/2018) using HER2-DC1 pre-neoadjuvant therapy evaluated feasibility/safety and pathologic response rates/immunogenicity. Stage II-III ER-HER2+ breast cancer patients prescribed neoadjuvant docetaxel/carboplatin/trastuzumab/pertuzumab (TCHP) were enrolled. HER2-DC1 (2×107 cells/vaccine) was given for 3 weeks prior to chemotherapy intranodal (IN) 1x/week (Arm A), IN 2x/week (Arm B), and 2x/week alternating intratumoral (IT) and IN (Arm C). HER2 ELISPOT counts (EHC) and immunofluorescence analysis of biopsies were performed. Six patients enrolled in Arms A and B, 18 patients in Arm C. Neoadjuvant HER2-DC1 demonstrated no unexpected safety signals. Pathologic complete response rates (pCR) across arms A, B, C were 42.8%, 66.6%, and 72.7%. Intranodal HER2-DC1 increased EHC, but IT + IN HER2-DC1 reduced EHC, possibly due to increased T cell tumor trafficking. Immunofluorescence showed increased T cell infiltration following IT + IN injections. Additional IT HER2-DC1 investigation is warranted.

Neoadjuvant treatment with immune checkpoint inhibitors in patients with melanoma: A real-life retrospective study.

Neoadjuvant treatment with ipilimumab and nivolumab has shown efficacy in melanoma patients with nodal metastases in clinical trials. Real world data on neoadjuvant therapies is lacking. This study investigates the effectiveness of neoadjuvant therapy in a real-world setting and included all melanoma patients who received combined anti-CTLA4/PD1 immunotherapy prior to resection. Pathologic and radiologic responses as well as treatment-related adverse events were assessed, and recurrence-free survival (RFS) was compared between patients with major pathologic response (mPR) and patients without mPR. In total, 24 patients were analyzed, including patients with distant metastases and patients with prior adjuvant treatment. Median follow-up was 21.5months. Upon histologic assessment, mPR was achieved in 50% (12/24) of the patients, including two patients with lung metastases and three patients who progressed after prior adjuvant anti-PD1 therapy. Radiologic response after neoadjuvant treatment correlated with mPR. No patient with mPR relapsed during follow-up (median RFS not reached) compared to six out of 12 patients without mPR (median RFS = 13months, p=0.005). Neoadjuvant treatment with ipilimumab and nivolumab is effective in real-world patients with different melanoma subtypes, different stages of disease and even advanced primary tumor.

Oncological outcomes of breast-conserving surgery versus mastectomy following neoadjuvant chemotherapy in a contemporary multicenter cohort

To evaluate local recurrence (LR), distant recurrence (DR) and death in non-metastatic patients undergoing breast-conserving surgery (BCS) or mastectomy following current neoadjuvant chemotherapy (NAC) regimens. Patients submitted to NAC in 2013–2023 were evaluated (n = 365; mastectomy: 165; BCS: 200). More mastectomy patients were over 70 years old (12.7% versus 7%; p = 0.02) and had T4b tumors (16.4% versus 4.5%; p = 0.0003), whereas more BCS patients had node-negative axilla (42% versus 31.5%; p = 0.02). After a mean follow-up of 65 months (range: 4-124), LR and DR were similar in the mastectomy and BCS groups (4.8% versus 5.0%; p = 0.95 and 10.9% versus 9%; p = 0.58, respectively). More deaths occurred in the mastectomy group (8.5% versus 3%; p = 0.03). Ten-year LR-free survival was higher in the BCS group (98.5% versus 95%; HR: 3.41; 1.09–10.64; p = 0.03), while 10-year DR-free survival was similar in both groups (91% BCS versus 89% mastectomy, HR: 1.25; 0.65–2.42; p = 0.4). Overall survival was better in the BCS group (97% versus 91.5%; HR: 2.62; 1.06–6.69; p = 0.03). Estimated 10-year disease-free survival, stratified according to tumor stage, showed no significant difference except for T4 disease, for which the risk was greater in the mastectomy group (94.5% versus 81.8%; HR: 2.86, 1.54–5.30, p = 0.0008). In the multivariate analysis, T3/T4 staging (OR: 4.37, 1.03–21.91; p = 0.04) and axillary dissection (OR: 5.11, 1.14–35.52; p = 0.04) were associated with LR in the BCS group. In this cohort of patients receiving contemporary NAC, BCS proved to be a safe alternative to mastectomy following treatment with NAC, even in cases of locally advanced BC.

ESM1 suppresses LncRNA GAS5/miR-23a-3p/PTEN axis to promote the cisplatin-chemotherapy resistance of ovarian cancer cells via activating the PI3K/AKT pathway

BackgroundCisplatin chemotherapy is an important treatment for advanced ovarian cancer (OC). However, the development of cisplatin resistance greatly limits the survival time of OC patients. Endothelial cell-specific molecule 1 (ESM1) has been found to be an important proto-oncogene promoting OC, but its mediating OC cisplatin resistance remains unknown.MethodsWe used quantitative polymerase chain reaction (qPCR) to measure transcription levels of ESM1, Growth arrest specific transcript 5 (GAS5), miR-23a-3p, and Phosphatase And Tensin Homolog (PTEN). A double luciferase reporter gene assay confirmed the direct binding of GAS5 to miR-23a-3p and miR-23a-3p to PTEN mRNA. The effects of ESM1, GAS5, miR-23a-3p, and PTEN on OC cisplatin resistance were tested with an Half Maximal Inhibitory Concentration (IC50) assay. Flow cytometry was used to assess the effects of ESM1, GAS5, and miR-23a-3p on cisplatin-induced OC apoptosis. Changes in apoptosis-related proteins and PI3K/AKT-related proteins were analyzed with western blot (WB).ResultsESM1 inhibits the levels of GAS5 and PTEN but increases miR-23a-3p. ESM1 and miR-23a-3p promote OC cisplatin resistance. GAS5 and miR-23a-3p promote cisplatin sensitivity for OC cells. Moreover, the main molecular mechanism is the ESM1/GAS5/miR-23a-3p/PTEN/PI3K/Akt signaling axis.ConclusionESM1 promotes OC cisplatin resistance by activating the Phosphoinositide-3-Kinase (PI3K)/AKT Serine/Threonine Kinase (Akt) signaling pathway through the GAS5/miR-23a-3p/PTEN signaling axis. This suggests that prescriptive ESM1 regulates key downstream molecular mechanisms via non-coding RNA and can be used before neoadjuvant chemotherapy in OC is initiated.

Research trends of neoadjuvant therapy in lung cancer: a bibliometric analysis

BackgroundLung cancer is the most prevalent malignancy worldwide. Only a fraction of early-stage patients undergo radical surgery; however, many still experience recurrence and metastasis within 5 years postoperatively (approximately 30–75%). Neoadjuvant therapy has revolutionized the treatment approach for lung cancer, with a growing number of clinical trials investigating this modality. This study provides a comprehensive analysis of neoadjuvant therapy in lung cancer, intending to guide future research.MethodTo extract literature on neoadjuvant therapy for lung cancer published in the Web of Science Core Collection, spanning January 1, 2004, to December 31, 2023. Utilizing software tools including VOSviewer, CiteSpace, and GraphPad Prism to conduct bibliometric analysis and visualization studies on countries, institutions, journals, authors, co-cited references, and keywords in this field.ResultsA sum of 6,085 research publications from 84 countries were analyzed, with the United States leading in publications on neoadjuvant therapy for lung cancer. The institution that publishes the most articles is the University of Texas System. The most published journal is Annals of Thoracic Surgery, while the most frequently co-cited journal is Journal of Clinical Oncology. Eight of the top ten co-cited references concern immune checkpoint inhibitors(ICIs). Keyword burst analysis indicates that the current research focuses and trends mainly center around four areas: ICIs, clinical trials, efficacy, and non-small cell lung cancer (NSCLC).ConclusionsThis is the first bibliometric study of neoadjuvant therapy in lung cancer. Over the past two decades, interest in this field has steadily increased, particularly since 2017. The United States is the largest contributor and has the highest number of publications in this field. Immune checkpoint inhibitors, clinical trials, efficacy, and NSCLC are hotspots in neoadjuvant therapy for lung cancer, both now and in the foreseeable future.

Efficacy and Safety of Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer: A Systematic Review and Network Meta-Analysis of RCTs

Introduction: Muscle-invasive bladder cancer (MIBC) is a highly aggressive malignancy associated with significant mortality. Neoadjuvant chemotherapy (NAC) has shown improved outcomes by reducing tumor burden and eradicating micrometastases prior to surgery. While platinum-based chemotherapy remains the standard, novel regimens incorporating immune checkpoint inhibitors have emerged, necessitating further investigation into their clinical benefits. Among these, durvalumab in combination with gemcitabine and cisplatin (GC-D) has gained attention for its potential efficacy in MIBC. However, its comparative effectiveness and safety relative to other NAC regimens remain unclear. Methods: This systematic review and network meta-analysis adhered to PRISMA guidelines and included randomized controlled trials (RCTs) for evaluating NAC in MIBC patients without metastatic disease. Comprehensive searches were conducted in PubMed, Embase, Cochrane Library, and Web of Science till December 2024. The primary outcome was the pathological complete response (pCR), while the secondary outcomes included overall survival (OS) and adverse events (AEs). Results: Seven RCTs involving 2,529 patients were analyzed. The GC-D achieved the highest pCR rate, with an odds ratio (OR) of 50.6 (95% confidence interval [CI]: 2.7, 927.1) compared to radical cystectomy alone, also outperforming gemcitabine plus cisplatin (GC) (OR 1.5; 95% CI: 1.1, 1.9). As per the 3-year OS, GC-D demonstrated superior outcomes, surpassing GC (OR 0.61; 95% CI: 0.48, 0.78). The AE profiles of GC-D and dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) were comparable to GC, with no significant increase in Grade 3-5 AEs (GC-D: OR 1.08; 95% CI: 0.82, 1.42; ddMVAC: OR 1.27; 95% CI: 0.50, 3.26). Conclusion: GC-D demonstrates superior pCR rates and OS while maintaining comparable safety to other NAC regimens, establishing it as a promising treatment option for MIBC. However, alternative regimens remain essential for patients for whom GC-D is not applicable.

MR Imaging Features Predictive of Pathologic Complete Response and Survival Outcomes for Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy.

This study aims to evaluate the predictive value of MRI features for pathologic complete response (pCR) and survival outcomes in patients with breast cancer (BC) undergoing neoadjuvant chemotherapy (NAC). A retrospective analysis was conducted on 168 BC patients treated with NAC between 2018 and 2022. Pre-NAC breast MRI scans were evaluated for enhancement patterns, time-intensity curve (TIC), peritumoral edema, and background enhancement. Both pre- and post-NAC MRIs were assessed for Epeak %, mean apparent diffusion coefficient (ADC) value, and ADC ratio (mean ADC of lesion/contralateral normal breast parenchyma). Survival outcomes were analyzed using Kaplan-Meier and Cox regression models. pCR was achieved in 34% of patients. MRI demonstrated a sensitivity of 74% and a specificity of 86% in predicting pCR, with an overall accuracy of 82%. The post-NAC percentage of initial peak enhancement (Epeak) was significantly lower in the pCR group (P < 0.001). Multivariate analysis identified a pre-NAC Epeak ≤ 96 (hazard ratio [HR]: 6.26, P < 0.001) and a post-NAC Epeak > 188 (HR: 18.40, P < 0.001) as independent risk factors for disease-free survival. Additionally, a lower pre-NAC ADC ratio (≤0.65) was associated with poorer overall survival (HR: 2.8, P: 0.041). Pre-NAC peritumoral edema, background enhancement, and TIC were not significant predictors of survival outcomes. MRI features, including Epeak % and ADC ratio, are important predictors of pCR and survival outcomes in BC patients undergoing NAC. Incorporating these biomarkers into clinical practice may improve treatment planning and optimize patient outcomes.

Repeat Diagnostic Laparoscopy After Chemotherapy is Useful in Patient Selection for Conversion to Cytoreductive Surgery for Initially Unresectable Colorectal and Appendiceal Peritoneal Metastases: A Retrospective Cohort Study.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) enable effective management of colorectal and appendiceal peritoneal metastases (CAPM) despite high morbidity. This study aimed to evaluate the role of repeat diagnostic laparoscopy (rDL) after systemic ± intraperitoneal chemotherapy in the management of initially unresectable CAPM. This retrospective cohort study included 70 consecutive patients with CAPM who underwent initial diagnostic laparoscopy (iDL). Patients with inoperable or equivocal CAPM underwent chemotherapy followed by rDL to assess the treatment response and possibility of conversion to CRS and HIPEC. Cytoreductive surgery was deemed feasible for 29 patients and unlikely or equivocal for 41 patients based on iDL. Of the 29 resectable patients, 24 successfully underwent CRS and HIPEC after neoadjuvant chemotherapy. Among the 41 patients initially considered unresectable, 16 were deemed operable based on rDL after chemotherapy, and CRS and HIPEC were achieved for 14 patients (conversion). The median peritoneal cancer index was significantly reduced after chemotherapy for the 14 "conversion" patients, from 16 based on iDL to 11 based on rDL (p < 0.05). The conversion rate was 34% (14/41), with a 5-year survival rate of 14%. Treatment with CRS and HIPEC was achieved for 38 of 45 patients deemed operable based on either iDL or rDL (worst-case estimated positive predictive value, 84%). Diagnostic laparoscopy is useful in predicting the likelihood of achieving CRS for patients with CAPM. Despite inoperability based on iDL, patients should be considered for rDL after chemotherapy to assess the possibility of conversion to CRS and HIPEC.

The prognosis prediction value of CD69+ CD8+ tissue-resident memory T cell as a novel indicator of pathologic complete response heterogeneity following different neoadjuvant therapy regimen in esophageal squamous cell carcinoma

BackgroundImproving pathological complete response (pCR) rate is currently the main goal of neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (LA-ESCC). However, improved pCR rates do not consistently translate into better prognosis, likely due to regimen-specific pCR heterogeneity. We investigated this heterogeneity and potential biomarkers between two common neoadjuvant regimens.MethodsWe included 445 LA-ESCC patients from four centers, with 228 receiving neoadjuvant chemoradiotherapy (nCRT) and 217 undergoing neoadjuvant chemotherapy combined with immunotherapy (nICT). Propensity score matching ensured group comparability. We assessed pCR rates and their associations with overall survival (OS), disease-free survival (DFS), and recurrence patterns. Immune-related biomarkers were investigated through RNA sequencing and immune infiltration analysis, then validated via multiplex immunofluorescence staining.ResultsOverall, pCR was associated with significantly higher DFS (HR = 0.3 [0.18–0.5], P < 0.01) and OS (HR = 0.19 [0.08–0.41], P < 0.01) compared to non-pCR. The nICT group had a lower pCR rate than the nCRT group (27.2% vs. 42.9%) but demonstrated comparable prognosis and reduced distant metastasis. Among pCR patients, DFS was significantly better in the nICT group (HR = 0.2 [0.05–0.86], P = 0.031), with a trend toward improved OS. Immune analysis revealed increased CD8 + T cell infiltration, particularly CD69 + CD8 + tissue-resident memory T cells (TRM), in the nICT pCR group. The proportion of CD69 + CD8 + TRM cells was significantly linked to improved DFS (P = 0.016) and OS (P = 0.015), suggesting they may be superior prognostic markers compared to pCR rates.ConclusionsThe pCR obtained from different neoadjuvant treatments has distinct prognostic outcomes. The CD69 + CD8 + TRM, as a potential prognostic predictor, warrants further investigation.

Pathologic response rates in HER2-low versus HER2-zero early breast cancer patients receiving neoadjuvant therapy: a systematic review and meta-analysis

BackgroundCurrently, the primary methods for detecting HER2 expression levels are immunohistochemistry (IHC) and in situ hybridization (ISH), with the traditional standard being a HER2-positive score of 3 + accompanied by ERBB2 gene amplification detected through ISH. However, a new entity has recently emerged: HER2-low, defined as HER2 IHC 1 + or 2 + with negative ISH. HER2-low breast cancer, representing 45–60% of all HER2-negative tumors, has distinct biological characteristics and uncertain responses to conventional HER2-targeted therapies. Recent studies suggest varied clinical outcomes, highlighting the need for further investigation into the impact of HER2-low status on treatment efficacy and prognosis.ObjectiveThis meta-analysis evaluates the difference in complete pathological response (pCR), disease-free survival (DFS), and overall survival (OS) between HER2-low and HER2-zero phenotypes.MethodsWe systematically searched the main databases PubMed, Scopus, and Web of Science for articles evaluating women in neoadjuvant therapy expressing HER2-low and HER2-zero. We computed odds ratios (ORs) or hazard ratios (HRs) using DerSimonian and Laird random-effect models for all endpoints, with 95% confidence intervals (CIs). We assessed the heterogeneity using I2 statistics. R, version 4.2.3, was used for statistical analyses.Results38 studies totaling 70,104 patients were included. The HER2-low group accounted for 61.3% of patients while HR + status represented 52.4% in the whole research. In 67,839 women, the pCR was analyzed, which in the overall cohort analysis favored the HER2-zero group (OR 0.84; 95% CI 0.78–0.90; p = 0.000005; I2 = 15%). Subgroup analyses for triple-negative breast cancer (TNBC) and HR + patients also favored HER2-zero expression, with an OR of 0.91 (95% CI 0.83–1.0; p < 0.041; I2 = 12%) and 0.75 (95% CI 0.70–0.81; p < 0.000001; I2 = 0%), respectively. In the multivariate analysis across all patients, both DFS and OS outcomes were significantly favorable for the HER2-low expression group, with HR 0.8317 (95% CI 0.7036–0.9832; p = 0.031) for DFS and HR 0.806 (95% CI 0.663–0.979; p = 0.03) for OS.ConclusionBased on our findings, HER2-zero status is associated with a significantly higher pathological complete response (pCR) rate compared to HER2-low in early-stage breast cancer, and other survival outcomes. These results suggest that HER2-zero should be considered a prognostic factor in early-stage breast cancer and taken into account in neoadjuvant treatment planning and future clinical research.

Voxel-level radiomics and deep learning for predicting pathologic complete response in esophageal squamous cell carcinoma after neoadjuvant immunotherapy and chemotherapy

BackgroundAccurate prediction of pathologic complete response (pCR) following neoadjuvant immunotherapy combined with chemotherapy (nICT) is crucial for tailoring patient care in esophageal squamous cell carcinoma (ESCC). This study aimed to...

The Predictive Value of Interim 18F-FDG-PET/CT in Predicting Pathological Response to Neoadjuvant Therapy in Locoregionally Advanced Oesophageal Cancer Patients

The Predictive Value of Interim 18F-FDG-PET/CT in Predicting Pathological Response to Neoadjuvant Therapy in Locoregionally Advanced Oesophageal Cancer Patients

Residual cancer burden (RCB) profiling of post neoadjuvant therapy breast cancer resections in a tertiary cancer care hospital

Residual cancer burden (RCB) profiling of post neoadjuvant therapy breast cancer resections in a tertiary cancer care hospital

MRI navigation surgery for T4b rectal cancer using multiple minimally invasive surgical approaches

BackgroundThese days, various surgical techniques such as trans-anal, trans-perineal total mesorectal excision, and transvaginal natural orifice transluminal endoscopic surgery have been utilized with flexibility, which was not possible before the laparoscopic era.MethodsFrom January 2014 to January 2023, 40 cases of c(yc)T4b rectal cancer underwent local curative surgery laparoscopically at Kansai Medical University Hospital. In 25 consecutive cases, we adopted multiple approaches (trans-anal total mesorectal excision, transvaginal natural orifice transluminal endoscopic surgery, trans-perineal total mesorectal excision, or prone position first abdominoperineal excision) to remove the deepest part of the tumor indicated by MRI last as the specimen-oriented surgery. The remaining 15 patients underwent top-to-bottom surgery based on standard surgery. The primary endpoint was the local recurrence rate of the specimen-oriented surgery group compared to that of the standard surgery group.ResultsThe specimen-oriented surgery group had a median follow-up of 3.9 (0.4–7.4) years with no local recurrence, while the standard surgery group had a median follow-up of 1.5 (0.7–3.7) years with 5 of 15 patients (33%) experiencing more local recurrence than specimen-oriented surgery group (p = 0.005). Comparison of the local recurrence ( +) and ( −) groups showed significant differences in pCRM positive rate, neoadjuvant therapy, tumor size, and approach (specimen-oriented surgery vs. standard surgery) in univariate analysis (p < 0.05). Still, no significant differences were found in the multivariate analysis.ConclusionsIn the laparoscopic setting, local cure of c(yc)T4b rectal cancer requires a different strategy than open surgery, and specimen-oriented surgery may be a promising procedure.

Analysis of the safety and feasibility of sleeve resection under UniVATS after neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type non-small cell lung cancer

ObjectiveTo investigate the safety and feasibility of sleeve resection under Uni-VATS following neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type non-small cell lung cancer(NSCLC).MethodsWe analyzed 10 cIIB-IIIB NSCLC patients who underwent sleeve lung resection under single-port thoracoscopy from December 2022 to August 2023 after receiving platinum-based chemotherapy combined with albumin paclitaxel and programmed cell death protein-1 (PD-1) inhibitor drugs. Perioperative clinical data, side effects during neoadjuvant therapy, operation time, intraoperative blood loss, conversion rate to open thoracotomy, postoperative duration of chest tube placement, postoperative drainage volume, postoperative complications, and tumor outcomes were recorded.ResultsThis study included 10 patients. The preoperative clinical staging distribution was as follows: Stage IIB, 1 case; Stage IIIA, 5 cases; and Stage IIIB, 4 cases. Imaging evaluation after neoadjuvant therapy revealed that none of the patients achieved complete remission, whereas partial remission and stable disease were observed in 7 cases and 3 cases, respectively. All patients successfully underwent surgery, of which 2 patients required conversion to open thoracotomy (conversion rate, 20%) and 8 patients underwent single-port thoracoscopic minimally invasive surgery. Notably, 2 patients underwent sleeve resection of the right upper lobe, 2 patients underwent sleeve resection of the right middle and lower lobes, 2 patients underwent sleeve resection of the left upper lobe, and 4 patients underwent sleeve resection of the left lower lobe. The average operation time was 236 ± 87.7 min, the average intraoperative blood loss was 168 ± 62.5 mL, the average duration of chest tube placement was 5 days, the average total drainage volume was 1012 ± 464 mL, and the average hospitalization duration was 7 days. One patient developed encapsulated pleural effusion after surgery and underwent computed tomography (CT)-guided puncture drainage. At the 3-month and 6-month follow-up visits, no patient reported any particular discomfort, and chest radiography and CT revealed no abnormalities or signs of tumor recurrence.ConclusionSleeve resection after neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type NSCLC under single-port thoracoscopy is safe and feasible and provides short-term postoperative benefits for patients.

Integrating immunotherapy in the treatment of resectable gastric cancer: Are we on the right track?

Integrating immunotherapy in the treatment of resectable gastric cancer: Are we on the right track?

Pentose Phosphate Recycling driven by Gli1 contributes to chemotherapy resistance in Cancer Cells.

Pentose Phosphate Recycling driven by Gli1 contributes to chemotherapy resistance in Cancer Cells.

Short-term mortality in older (≥70years) patients with early breast cancer treated with neo-/adjuvant chemotherapy: A Swedish nationwide retrospective population-based study.

There are substantial differences in the utilization of chemotherapy between younger and older patients, mainly due to the higher risk for adverse events among older patients. Short-term mortality after chemotherapy could reveal fatal side effects of treatment. The aim of this study was to explore the impact of treatment setting (neoadjuvant vs. adjuvant) and different chemotherapeutic agents on short-term mortality among older patients with early breast cancer. The population-based, national, research database BCBaSe 3.0 was used as a data source to identify older (≥70years old) patients with stage I-III breast cancer, diagnosed between 2008 and 2019, who received neoadjuvant or adjuvant chemotherapy. Primary outcome was short-term mortality defined as death due to any cause within one year after breast cancer diagnosis. Multivariable logistic regression analysis was applied to investigate the impact of treatment setting and different chemotherapeutic agents (anthracycline-based vs. taxane-based vs. sequential anthracyclines and taxanes) on outcome, adjusted for potential confounders. In total, 4,072 older patients were treated with neoadjuvant or adjuvant chemotherapy and median age was 73years (quartile [Q]1-Q3; 71-75). The one-year mortality rate was 1.5% (95% confidence interval [CI]: 1.2-1.9% [63 of 4072 patients]). Risk factors independently associated with one-year mortality were older age, larger tumor size, positive nodal status, presence of triple negative breast cancer, and use of neoadjuvant as compared to adjuvant chemotherapy (odds ratio [OR]: 2.00, 95% CI: 1.04-3.84). No association was found between type of chemotherapeutic regimen and one-year mortality. Median time to death was 7 months (interquartile range: 5-9). The reason for death was mainly classified as breast cancer-related (neoadjuvant: 78%, n=14; adjuvant: 49%, n=22), followed by potential treatment-related deaths (neoadjuvant: 11%, n=2; adjuvant: 27%, n=12). The short-term mortality rate at first year after diagnosis among older (≥70years) patients with breast cancer was relatively low. The higher risk among patients treated with neoadjuvant chemotherapy could be attributed to residual confounding and deserves further evaluation. The low risk of potential treatment-associated death suggests that chemotherapy in this respect is safe, and older patients should not be disqualified for this treatment.

Prognostic role of STMN1 expression and neoadjuvant therapy efficacy in breast cancer

Purposebreast cancer is common and highly malignant, currently, STMN1 was found to be associated with several human malignancies. The purpose of this study is to investigate STMN1 expression in breast cancer and explore its role in disease progression and its interaction with neoadjuvant therapy efficacy.Methodswe analyzed the tissue STMN1 mRNA expression in BC tissue samples from 105 patients received with neoadjuvant therapy using qPCR between 2019 and 2022.ResultsStatistical analysis showed that a high expression of STMN1 before neoadjuvant chemotherapy (NACT) was a trend positively related to non-pCR in the ITT (Intention to Treat) population, while in patients with paclitaxel or docetaxel regimens, before-NACT STMN1 expression was obviously higher in non-pCR (failure to achieve pathologically complete response) patients. Additionally, compared to pCR, high expression of STMN1 after NACT was obviously related to non-pCR. Interestingly, Kaplan-Meier analysis demonstrated that patients with mid-high STMN1 expression before and post-NACT had a poorer PFS to compared to those with low expression.ConclusionsSTMN1 is the potential biomarker of NACT and prognosis for breast cancer.

Effect of Helicobacter pylori infection on survival outcomes of patients undergoing radical gastrectomy after neoadjuvant chemotherapy: a multicenter study in China

BackgroundNeoadjuvant chemotherapy (NAC) has been confirmed to improve the prognosis of patients with advanced gastric cancer (AGC). However, no study has investigated whether Helicobacter pylori (HP) infection affects the postoperative survival of patients who receive NAC.MethodsThis retrospective cohort study included 307 patients with AGC who underwent laparoscopic radical gastrectomy after NAC at three hospitals in China between January 1, 2016, and April 31, 2020. Cox regression was used to assess prognostic factors for survival. Kaplan–Meier was used for survival analysis.ResultsThe HP + and the HP- group included 141 and 166 cases. The 3-year overall survival (OS) and disease-free survival (DFS) of the HP + group were significantly better than the HP- group (3-year OS: 75.9% vs. 60.2%, 3-year DFS: 70.2% vs. 52.3%; All P < 0.001). For the HP + group, ypTNM Stage III (HR, 4.00; 95% CI, 1.11–14.39; P = 0.034), NAC ≥ 4 cycles (HR, 0.43; 95% CI, 0.20–0.90; P = 0.026), and adjuvant chemotherapy (AC) ≥ 4 cycles (HR, 0.20; 95% CI, 0.09–0.48; P < 0.001) are independent prognostic factors for OS. In the cohort of HP + patients who received ≥ 4 cycles of NAC, the prognosis of patients who received ≥ 4 cycles of AC after surgery was better than that of patients who received < 4 cycles of AC (3-year OS: 92.5% vs 71.4%; P = 0.042).ConclusionsFollowing NAC, HP + patients with AGC exhibit better prognosis than that of HP- counterparts. For potentially resectable HP + AGC patients, radical surgery following ≥ 4 cycles of NAC with ≥ 4 cycles of sequential AC might be recommended to improve survival.