Although neoadjuvant PD-1 inhibitors combined with chemotherapy are promising for locally advanced gastric cancer (LAGC), pathological complete response (pCR) rates remain suboptimal. This multicenter retrospective study (January 2020-September 2024) evaluated the synergistic potential of adding apatinib to the neoadjuvant framework of PD-1 inhibitors plus SOX chemotherapy (PA-SOX) versus the doublet regimen (P-SOX). From a multi-institutional cohort of 449 patients, 1:1 propensity score matching (PSM) was employed to yield 102 well-balanced pairs. The PA-SOX regimen demonstrated a significantly superior primary endpoint, achieving a pCR rate of 17.6% compared to 6.9% in the P-SOX group (p = 0.031; FDR-adjusted p = 0.036). This pathological advantage was further reflected in significantly higher major pathological response (MPR; 38.2% vs. 15.7%, p < 0.001) and objective response rates (ORR; 62.7% vs. 33.3%, p < 0.001). Survival analysis demonstrated improved 2-year overall survival (82.4% vs. 69.9%; HR = 0.32, 95% CI: 0.15-0.66; p = 0.001) and disease-free survival (71.1% vs. 41.7%; HR = 0.35, 95% CI: 0.22-0.57; p < 0.001). Safety profiles were manageable, with no significant increase in Grade 3-4 adverse events (p = 0.503) or postoperative morbidity (p = 0.718), supported by a standardized preoperative washout protocol. Multivariate analysis confirmed PA-SOX as an independent protective factor for survival. In conclusion, these retrospective findings suggest that adding apatinib to the neoadjuvant immunochemotherapy backbone may optimize pathological responses and enhance short-term survival for LAGC with a tolerable safety profile; however, the durability of these survival benefits warrants validation in large-scale, randomized phase III trials.

Accurate models for predicting pathological complete response (pCR) after neoadjuvant therapy (NAT) are increasingly needed in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). In the present study, a nomogram was developed to estimate the probability of achieving a pCR in this population. Clinical data were retrospectively and prospectively collected from patients with HER2-positive BC at three time points: Before NAT, after the first cycle of neoadjuvant targeted therapy and after the completion of NAT before surgery. Logistic regression analysis was performed to identify independent predictors of pCR, and these variables were used to construct a predictive model and corresponding nomogram. Model performance was evaluated using calibration curves, decision curve analysis, receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC), with retrospective data and prospective data used for internal and external validations, respectively. Logistic regression analysis of the retrospective cohort identified eight predictors associated with pCR, which were incorporated into a concise nomogram. Internal validation demonstrated good calibration and strong predictive performance, with an AUC value of 0.886 (P<0.001), sensitivity of 0.822 and specificity of 0.818. External validation further confirmed the excellent discriminatory ability of the model, yielding an AUC value of 0.961 (P<0.001), sensitivity of 1.000 and specificity was 0.875. Overall, this nomogram, which integrates multiple clinically relevant factors, may serve as a useful tool for predicting post-NAT pCR in patients with HER2-positive BC and may support more precise treatment decision-making in clinical practice.

Immune checkpoint inhibitors have transformed anticancer pharmacotherapy, with nivolumab demonstrating significant immunomodulatory potential when combined with cytotoxic agents. However, real-world pharmacological evidence regarding the safety, tolerability and biomarker-guided response of neoadjuvant nivolumab combined with platinum-based chemotherapy in resectable non-small cell lung cancer (NSCLC) remains limited. This study aimed to evaluate the pharmacological efficacy, safety profile and predictive biomarker associations of this combination regimen in clinical practice. A multicenter retrospective pharmacological outcome study was conducted in 58 patients with stage IB-IIIB resectable NSCLC who received four cycles of neoadjuvant nivolumab in combination with platinum-based chemotherapy. The primary pharmacodynamic endpoint was major pathological response (MPR), serving as a surrogate marker of drug efficacy. Secondary endpoints included pathological complete response (pCR), treatment completion rate, post-treatment surgical resectability and incidence of adverse drug reactions graded according to CTCAE v5.0. Programmed death-ligand 1 (PD-L1) expression and KRAS mutation status were evaluated as predictive biomarkers of drug response. The median patient age was 60 years, with male predominance (70.7%). Adenocarcinoma was the most prevalent histological subtype (60.3%). High PD-L1 expression (≥50%) was observed in 31.5% of patients, while KRAS mutations were detected in 44.8%. Curative surgical resection was achieved in 77.6% of patients following neoadjuvant pharmacotherapy. MPR and pCR rates were 43.1% and 29.3%, respectively, with significantly higher response rates observed in patients exhibiting elevated PD-L1 expression. Grade ≥3 adverse drug reactions occurred in 17.2% of patients, with no treatment-related mortality, indicating an acceptable safety and tolerability profile. Neoadjuvant nivolumab combined with platinum-based chemotherapy demonstrates favorable pharmacological efficacy, manageable toxicity and biomarker-driven therapeutic response in resectable NSCLC under real-world clinical conditions. These findings support the role of personalized immunopharmacotherapy and reinforce the clinical relevance of biomarker-guided drug selection in modern pharmaceutical oncology.

Emerging evidence indicates that tumour innervation promotes cancer progression via a non-canonical TLR7 signalling pathway. However, its impact across breast cancer subtypes, patient populations, associated molecular pathways, and oncogenic drivers remains poorly defined. We analysed TLR7 signature scores in human breast cancer across multiple datasets and evaluated their associations with prognosis, clinical outcomes, TNBC subtypes, metastasis, molecular signatures, oncogenic signalling, and pathological complete response. We demonstrate that the TLR7score signature is significantly elevated in triple-negative breast cancer (TNBC) - the most aggressive breast cancer subtype-compared with ER⁺ disease. Within TNBC, high TLR7 signalling characterises basal- and mesenchymal-like tumours relative to the luminal androgen receptor (LAR) subtype. Across multiple breast cancer cohorts, including TNBC, TLR7score alone does not uniformly predict prognosis, as both high- and low-scoring tumours are associated with reduced survival. Using sequential cut-off analysis in seven independent clinical cohorts, we show that both TLR7score-high (e.g. HR = 4.7, P = 0.01) and TLR7score-low (HR = 3.37, P = 0.038) tumours are associated with unfavourable outcomes relative to intermediate-score tumours. TLR7score-high lesions are enriched for cell proliferation, neuronal, and mast cell-related pathways, as well as RB1 and TP53 loss and elevated E2F, PI3K, MET, and MYC signalling. In contrast, TLR7score-low tumours show increased ER signalling and are enriched for T cell-associated but not neuronal pathways, delineating innervated versus non-innervated TNBC phenotypes. Moreover, TLR7score correlates with pathological complete response (pCR) in a treatment-dependent manner. Collectively, these findings suggest that TNBC progression involves both TLR7-dependent and TLR7-independent mechanisms and that TLR7score may enable patient stratification for distinct therapeutic strategies.

Short-term efficacy and safety of neoadjuvant chemotherapy plus immune checkpoint inhibitors vs chemotherapy alone in locally advanced gastric cancer: a real-world propensity score-matched analysis.

The aim of this work is to update the practical guidelines for adjuvant radiotherapy of the regional lymphatics in breast cancer, originally issued in 2014 by the Breast Cancer Expert Panel of the German Society of Radiation Oncology. Acomprehensive literature review concerning regional nodal irradiation (RNI) was performed using the search terms "breast cancer," "radiotherapy," and "regional node irradiation." Furthermore, data from recently published meta-analyses and international breast cancer society guidelines-providing new insights since 2014-served as the basis for defining evidence-based recommendations. This paper delineates the indications and dose-fractionation strategies for radiotherapy targeting the regional lymphatic pathways following breast cancer surgery. The guideline was updated to reflect current evidence regarding radiotherapy of the lymphatic drainage system. The recommendations are categorized according to two primary objectives for RNI: (1)improving oncological outcomes; (2)enabling de-escalation of axillary surgery. The update distinguishes between clinical scenarios with and without neoadjuvant chemotherapy (NACT). Specifically, it addresses the increasingly relevant topic of treatment de-escalation following pathologic complete response (pCR) after NACT in initially node-positive patients. The updated guidelines address current developments and ongoing challenges in RNI. They provide clinically oriented recommendations for establishing indications in both the primary (upfront) surgery setting and following neoadjuvant therapy.

The CHRONO trial: Protocol for a randomized controlled trial of early time-restricted eating in patients with breast or rectal cancer.

Definitive, stereotactic ablative radiotherapy and endocrine therapy without surgery for select low-risk breast cancers: A prospective, phase II trial.

Breast cancer treatment is rapidly evolving toward precision-based de-escalation strategies for oncological safety and minimizing treatment-related morbidity. In early stage disease, minimally invasive approaches, such as non-surgical ablation techniques, including cryoablation and radiofrequency ablation, potentially constitute alternatives to conventional surgery for carefully selected low-risk tumors. Active surveillance trials challenge the necessity of immediate surgery for low-risk ductal carcinoma in situ, reflecting a paradigm shift toward risk-adapted management. In the neoadjuvant setting, achieving radiologic and pathologic complete responses, particularly in HER2-positive and triple-negative subtypes, is being investigated to determine the feasibility of omitting breast surgery under strict imaging and biopsy-guided protocols. Circulating tumor DNA-based minimal residual disease assays offer a promising tool for refining risk stratification and potentially guiding the extent of surgery and adjuvant therapy. These strategies represent a transformative movement toward biologically tailored, response-adapted, less invasive treatments for early breast cancer to optimize quality of life without compromising long-term outcomes.

Phase II randomized trial of 41.4Gy vs. 50.4Gy in neoadjuvant chemoradiotherapy for resectable esophageal cancer.

A Radiogenomic Model using MRI and Gene Signature to Predict Complete Response in Breast Cancer.

Pathological response to herceptin-containing neoadjuvant therapy in HER2 IHC2+/ISH+ and IHC3+ early-stage invasive ductal carcinoma.

Lipiodol-Based Balloon-Occluded Transcatheter Arterial Chemoembolization Can Be a Curative Treatment Option for Hepatocellular Carcinoma.

Past, present, and future perspectives in estrogen-receptor-low breast cancer.

Chemoradiotherapy has proven effective in enabling conversion surgery (CS). However, the priority of immunochemotherapy compared with chemoradiotherapy as induction therapy for initially unresectable cT4 esophageal squamous cell carcinoma (ESCC) remains unclear. We aimed to compare the survival outcomes of CS following induction immunochemotherapy (iICT) versus induction chemoradiotherapy (iCRT) in these patients. This multi-institutional retrospective cohort study included initially unresectable cT4 ESCC patients who underwent CS after iICT or iCRT between 2019 and 2022. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and the log-rank-test. Univariable and multivariable analyses for prognostic factors were performed. In total, 118 patients were included: 43 in the iICT group and 75 in the iCRT group. There were no significant differences between the two groups in terms of pathological complete response rates (P = 0.637) or R0 resection rates (P = 0.885). The iICT group had a lower rate of postoperative overall recurrence (P = 0.005) and distant metastasis (P = 0.015) than the iCRT group. The OS (1-year: 90.4% vs. 76.0%; 3-year: 77.3% vs. 54.9%, P = 0.027) and DFS (1-year: 85.4% vs. 58.7%; 3-year: 73.1% vs. 39.0%, P = 0.001) rates were significantly higher in the iICT group than in the iCRT group. Multivariable Cox analysis demonstrated that the iICT regimen was independently associated with improved OS and DFS. iICT combined with CS was a safe and manageable treatment option and was associated with improved OS and DFS in patients with initially unresectable cT4 ESCC.

Recent advancements of neoadjuvant strategies in locally advanced rectal cancer.

Incorporating Individual Early Response in the Dose-Effect Relationship of Complete Pathological Response Following Neoadjuvant Radiochemotherapy for Rectal Cancer.

Purpose To develop a deep learning-based deformable registration method for dynamic contrast-enhanced (DCE) breast MRI that preserves tumor regions while maintaining global anatomic alignment during neoadjuvant chemotherapy (NAC) response assessment. Materials and Methods This retrospective study included internal and external cohorts of patients with breast cancer who were undergoing NAC. The internal cohort comprised patients who underwent DCE MRI from 2017 to 2020, and the external cohort was derived from the I-SPY2 trial. A conditional pyramid registration network integrating unsupervised keypoint detection with a volume-preserving mechanism was developed. Registration performance was evaluated using the Dice similarity coefficient (DSC), average landmark error, and tumor volume difference. A local-global biomarker derived from registered images was evaluated for predicting pathologic complete response (pCR) using the area under the receiver operating characteristic curve (AUC) and accuracy. Paired t tests were used for statistical comparisons. Results In 314 patients (all female; age, 50.6 years ± 12.0 [SD]) with 1630 scans in the internal cohort, the proposed method achieved a DSC of 0.95 ± 0.02, an average landmark error of 5.35 mm ± 3.46, and a tumor volume difference of 11.0% ± 10.7. In 100 patients (all female; age, 48.5 years ± 12.3) with 372 scans in the external cohort, the method achieved a DSC of 0.91 ± 0.09 and a tumor volume difference of 15.5% ± 13.8. Improvements in landmark distance and tumor preservation were statistically significant (P < .05) compared with most methods. For pCR prediction, incorporation of the proposed biomarker achieved an AUC of 0.81 ± 0.04 and an accuracy of 72.1% ± 5.0. Conclusion The proposed framework improved anatomic alignment while preserving tumor volume in longitudinal DCE breast MRI during NAC response assessment and enabled a registration-based biomarker for predicting treatment response. Keywords: MR Imaging, Image Postprocessing, Breast, Neural Networks, Radiomics, Prognosis, DCE Breast MRI, Deep Learning, Deformable Registration, Neoadjuvant Chemotherapy, Unsupervised Keypoint Detection Supplemental material is available for this article. © RSNA, 2026 See also the commentary by Zhang in this issue.

Prognostic factors and the role of GnRHa in premenopausal HR+/HER2+ breast cancer achieving pathologic complete response after neoadjuvant chemotherapy.

The outcomes of salvage surgery for previously irradiated recurrent head and neck squamous cell carcinoma (HNSCC) remain suboptimal. This phase II trial evaluated the effects of preoperative tislelizumab (an anti-programmed cell death protein 1 monoclonal immunoglobulin G4 antibody) plus chemotherapy followed by salvage surgery and adjuvant tislelizumab in this setting. Eligible patients (n = 34) with resectable recurrent HNSCC after radiotherapy received preoperative tislelizumab (200 mg), albumin-bound paclitaxel (260 mg/m2), and cisplatin (60-75 mg/m2) every 3 weeks for 2 cycles, followed by salvage surgery and 6 cycles of adjuvant tislelizumab. The primary endpoint was major pathologic response (MPR). Secondary endpoints included pathologic complete response (pCR), the objective response rate (ORR), 2-year event-free survival (EFS), 2-year overall survival (OS), and safety. The ORR was 35.3% (12/34). Of 26 surgical patients, R0 resection was achieved in 19 (73.1%). The MPR rate was 19.2% (5/26), with a pCR rate of 15.4% (4/26). At a median follow-up of 32 months, 2-year EFS was 39.6% and 2-year OS was 54.8%. All MPR patients remained disease free. Grade 1 to 2 adverse events were common; one grade 3 hyperglycemia occurred. High baseline B-cell receptor (BCR) repertoire diversity and clonal abundance (top 1%/10%) correlated with poor prognosis, with top 1% clonality showing strong prognostic power (AUC = 0.910; P = 0.006). Preoperative chemoimmunotherapy followed by surgery and adjuvant immunotherapy was feasible with encouraging survival in previously irradiated recurrent HNSCC. Baseline BCR repertoire characteristics may serve as a noninvasive prognostic biomarker.