Therapy In Treatment Of Breast Cancer Research Articles

A Smart Nitric Oxide (NO) Generating Immuno‐Trimetallic Nanocatalyst Triggering Chemodynamic Therapy in Breast Cancer Treatment

AbstractChemodynamic therapy (CDT) has great potential in cancer treatment, but its efficacy is limited due to non‐specificity, insufficient hydrogen peroxide (H2O2), and excessive glutathione (GSH) within the tumor microenvironment (TME). Here, an intelligent nanoplatform (Fe3O4@MnO2@NO@Au NPs, abbreviated as CD44FMNA) is reported for the treatment of breast cancer, which is constructed with Fe3O4 nanoparticles (NPs) as the core coated with manganese dioxide (MnO2) nanoshells encapsulating NO donors and gold nanoparticles (Au NPs) within the pores of MnO2, followed by the conjugation of targeting ligand anti‐CD44 mAb. The fabricated CD44FMNA initially remains inactive in normal cells, but after CD44 receptor ‐mediated MDA‐MB‐231 cell‐specific endocytosis, acidic TME can induce the decomposition of the MnO2 shell to release NO donors, thereby dually depleting the existing GSH in cells and enhancing the Fenton‐like reaction in a cascade manner. The generation of hydroxyl radicals (·OH) and the dual depletion of GSH can significantly weaken the GSH‐related antioxidant defense system (ADS) within MDA‐MB‐231 cells, accelerating apoptosis and cell death via the mitochondrial pathway. In addition, in vivo studies demonstrate that CD44FMNA can effectively inhibit tumor growth with good biosafety. Therefore, this nanoplatform may provide an effective therapy for the treatment of breast cancer.

CAR-based immunotherapy for breast cancer: peculiarities, ongoing investigations, and future strategies.

Surgery, chemotherapy, and endocrine therapy have improved the overall survival and postoperative recurrence rates of Luminal A, Luminal B, and HER2-positive breast cancers but treatment modalities for triple-negative breast cancer (TNBC) with poor prognosis remain limited. The effective application of the rapidly developing chimeric antigen receptor (CAR)-T cell therapy in hematological tumors provides new ideas for the treatment of breast cancer. Choosing suitable and specific targets is crucial for applying CAR-T therapy for breast cancer treatment. In this paper, we summarize CAR-T therapy's effective targets and potential targets in different subtypes based on the existing research progress, especially for TNBC. CAR-based immunotherapy has resulted in advancements in the treatment of breast cancer. CAR-macrophages, CAR-NK cells, and CAR-mesenchymal stem cells (MSCs) may be more effective and safer for treating solid tumors, such as breast cancer. However, the tumor microenvironment (TME) of breast tumors and the side effects of CAR-T therapy pose challenges to CAR-based immunotherapy. CAR-T cells and CAR-NK cells-derived exosomes are advantageous in tumor therapy. Exosomes carrying CAR for breast cancer immunotherapy are of immense research value and may provide a treatment modality with good treatment effects. In this review, we provide an overview of the development and challenges of CAR-based immunotherapy in treating different subtypes of breast cancer and discuss the progress of CAR-expressing exosomes for breast cancer treatment. We elaborate on the development of CAR-T cells in TNBC therapy and the prospects of using CAR-macrophages, CAR-NK cells, and CAR-MSCs for treating breast cancer.

Tumor targeted nanohybrid for dual stimuli responsive and NIR amplified photothermal/photo-induced thermodynamic/chemodynamic combination therapy

The combination of photodynamic (PDT) and chemodynamic therapy (CDT) for cancer treatment has gathered a lot of attention in recent years. However, its efficacy is severely limited by elevated levels of hypoxia and glutathione (GSH) in the tumor microenvironment (TME). Multifunctional nanoparticles that can help remodel the TME while facilitating PDT/CDT combination therapy are the need of the hour. To this effect, we have developed O2 self-supplying, free radical generating nanohybrids that exhibit near infra-red (NIR) triggered photothermal (PTT)/photo-induced thermodynamic (P-TDT) and CDT for efficient breast cancer treatment. The surface of nanohybrids has been further modified by biointerfacing with cancer cell membrane. The biomimetic nanohybrids have been comprehensively characterized and found to exhibit high 2,2′-azobis-[2-(2-imidazolin-2-yl)propane] dihydrochloride (AIPH) loading, GSH depletion, oxygen self-supply with TME responsive AIPH release. Biological activity assays demonstrate efficient cellular uptake with homotypic targeting, excellent hemo- and cytocompatibility as well as high intracellular reactive oxygen species generation with synergistic cytotoxicity against tumor cells. The multifunctional nanohybrid proposed in the present study provides an attractive strategy for achieving NIR responsive, tumor targeted PTT/P-TDT/CDT combination therapy for breast cancer treatment.

The Survival Benefit of Pegylated Liposomal Doxorubicin-Based Neoadjuvant Chemotherapy in the Management of Breast Cancer.

Purpose: This study aims to evaluate the short-term outcomes and prognosis and the cardiac safety of pegylated liposomal doxorubicin (PLD)-based neoadjuvant chemotherapy (NAC) compared with epirubicin-based therapy in breast cancer treatment. Methods: In total, 304 patients diagnosed with stages II and III breast cancer were enrolled that included 97 cases treated with PLD and 207 controls treated with epirubicin in NAC. The effectiveness of the antibreast cancer treatment was evaluated using overall survival (OS) and disease-free survival (DFS) metrics, whereas cardiac toxicity was measured through the left ventricular ejection fraction (LVEF) and electrocardiogram (ECG) assessments. Results: The 5-year DFS and OS rates in the PLD group were 84.5% and 88.7% (with 15 recurrences and 11 deaths), respectively, whereas in the control group, these rates were 72.9% and 79.2% (with 56 recurrences and 43 deaths). Regarding cardiac toxicity, there was no significant difference in ECG abnormalities or LVEF decline between the two groups. Conclusions: The study suggests that PLD-based NAC may provide substantial benefits in terms of DFS and OS, along with a safe cardiac toxicity profile, in patients with stage II-III breast cancer.

Docosahexaenoic Acid (DHA) Down-regulates Cellular, and Exosomal Overexpressed Mammalian Target of Rapamycin (mTOR) in Breast Cancer Cells Under Hypoxic Condition

Background: The omega-3 long-chain polyunsaturated fatty acid, docosahexaenoic acid (DHA), shows anti-proliferative effects in cancer cell lines and animal models. The mammalian target of rapamycin (mTOR) is one of the regulators for the proliferation and survival of cancer cells. This study focused on the effect of DHA on cellular and exosomal expression of mTOR and related tumor-suppressor microRNAs (miRs) in triple-positive (BT-474) and triple-negative (MDA-MB-231) breast cancer (BC) cell lines. Methods: BT-474 and MDA-MB-231 cells were treated with 100 μM DHA under hypoxic and normoxic conditions for 24 hours. The exosomes were isolated by ultracentrifuge and determined by electron microscopy and CD9, CD63, and CD81 immunoblotting. cDNAs from cellular and exosomal total RNA were used for evaluation of the expression of mTOR and related tumor-suppressor miRs, miR-101 and miR-214, by quantitative real-time PCR. Results: We demonstrated that DHA significantly decreased cellular and exosomal expression of mTOR in both normoxic and hypoxic conditions for both cell lines. Consistently, DHA caused significantly increased expression of miR-214 in all treated groups. However, altered expression of miR-101 showed different patterns in cells and exosomes. Conclusion: According to the beneficial effect of DHA in decreasing the expression of a master regulator for the proliferation of cancer cells, mTOR, in part by increased expression of miR-214, it could be used as a supplementary therapy in BC treatment. Also, miRNA replacement therapy would be useful by suppressing the expression of mTOR in BC treatment.

Nanoscale strides: exploring innovative therapies for breast cancer treatment.

Breast cancer (BC) is a predominant malignancy in women that constitutes approximately 30% of all cancer cases and has a mortality rate of 14% in recent years. The prevailing therapies include surgery, chemotherapy, and radiotherapy, each with its own limitations and challenges. Despite oral or intravenous administration, there are numerous barriers to accessing anti-BC agents before they reach the tumor site, including physical, physiological, and biophysical barriers. The complexity of BC pathogenesis, attributed to a combination of endogenous, chronic, intrinsic, extrinsic and genetic factors, further complicates its management. Due to the limitations of existing cancer treatment approaches, there is a need to explore novel, efficacious solutions. Nanodrug delivery has emerged as a promising avenue in cancer chemotherapy, aiming to enhance drug bioavailability while mitigating adverse effects. In contrast to conventional chemotherapy, cancer nanotechnology leverages improved permeability to achieve comprehensive disruption of cancer cells. This approach also presented superior pharmacokinetic profiles. The application of nanotechnology in cancer therapeutics includes nanotechnological tools, but a comprehensive review cannot cover all facets. Thus, this review concentrates specifically on BC treatment. The focus lies in the successful implementation of systematic nanotherapeutic strategies, demonstrating their superiority over conventional methods in delivering anti-BC agents. Nanotechnology-driven drug delivery holds immense potential in treating BC. By surmounting multiple barriers and capitalizing on improved permeability, nanodrug delivery has demonstrated enhanced efficacy and reduced adverse effects compared to conventional therapies. This review highlights the significance of systematic nanotherapy approaches, emphasizing the evolving landscape of BC management.

SERM Therapy for patients of breast cancer and otherwise.

Madam, In Pakistan, the most frequently diagnosed cancer among females is breast cancer, where every year at least 90,000 women suffer from the disease [1]. This incidence is 2.5 times higher than that of Pakistan’s neighbouring countries and the highest in Asia[1]. The current treatments for breast cancer in the country are all invasive forms of therapy and include radiation therapy, chemotherapy, lymph node removal, and mastectomy. This letter aims to draw attention to a newer form of treatment for breast cancer known as selective estrogen receptor modulators (SERMs). Selective estrogen receptor modulators (SERMs) are synthetic molecules that provide a non-invasive therapy for breast cancer patients. Recent studies have proposed that the specificity of SERM’s mechanism of action and antiviral properties yield fruitful outcomes in treating covid-positive breast cancer patients [2], giving SERMs a significant advantage over former treatments such as radiation therapy or chemotherapy which reduce the body’s ability to fight infections. SERMs block the effects of estrogen on breast tissue, preventing cancer cells from dividing. They also act as an adjuvant in breast cancer therapy [3], suppressing secondary tumor formation. A recent study published in the Journal of Clinical Oncology showed significant benefits from two years of tamoxifen therapy in estrogen receptor- positive premenopausal patients of breast cancer [4].  On various other tissues, they act as estrogen, allowing for their use alongside other treatments for postmenopausal women to prevent bone loss and osteoporosis [3]. Despite SERM ‘s wide range of benefits in patients with breast cancer, it is not a fully recognized form of treatment for this population in Pakistan. Such hormonal therapy is only offered by a handful of high-end private-sector hospitals. This is attributed to a lack of research in this area due to various socio-economic factors. A limited choice of treatment for women with breast cancer in Pakistan results from fear of stigmatization and feminine sensitivity [5]. Attention should be brought to alternative therapies for breast cancer treatment to improve prognosis and help patients make the best possible shared decision-making choices.

Challenges of Breast Cancer Treatment through Microbial Therapeutic Delivery

Breast cancer remains a significant global health concern, necessitating innovative approaches for its treatment. Using bacteria as vehicles for therapeutic delivery has emerged as a promising strategy. As a group of prokaryotic microorganisms, bacteria have great potential for use in cancer therapy. Thus, strategies for treating breast cancer need to be continuously refined to achieve a better patient outcome. This manuscript explores the potential of bacterial-based therapies for breast cancer treatment, elucidating the mechanisms underlying their application, safety considerations, and recent advancements. Nevertheless, notable challenges in bacterial-based cancer treatments include potential cytotoxicity, incomplete cancer cell lysis, and the risk of genomic mutations. With an emphasis on engineering bacteria to target and deliver therapeutic agents specifically to tumor sites, this manuscript provides insights into the future of personalized, precise, and effective breast cancer treatment.

Optimisation of dispersive liquid-liquid microextraction for plasma sample preparation in bioanalysis of CDK4/6 inhibitors in therapeutic combinations for breast cancer treatment

Cyclin D dependent kinase 4 and 6 (CDK 4/6) inhibitors are novel anticancer drugs used in therapeutic combinations with endocrine therapy for breast cancer treatment. Their determination in patient plasma is of high interest as a prerequisite for possible therapeutic drug monitoring. Dispersive liquid-liquid microextraction (DLLME) shows great potential in bioanalytical sample preparation. Its simplicity and speed, along with the suitability for using small amounts of sample and hazardous solvents are some of its main advantages. However, its application on plasma samples is scarce and requires further development. The aim of this work was to explore the applicability of DLLME in the simultaneous extraction of six drugs of interest from human plasma, with an emphasis placed on achieving high extraction recoveries with low sample and solvent consumption. To tackle the low availability and amount of the plasma sample, as well as the complexity of the biological matrix, three novel DLLME modes are proposed: organic sample DLLME (OrS-DLLME), aqueous sample DLLME (AqS-DLLME), and a modified air-assisted DLLME (AA-DLLME). The extractant and disperser type and volume, volume ratios of all the components in the ternary system, effect of pH and salting out were optimised for all three proposed modes of DLLME. Optimised representative DLLME-HPLC-DAD-FLD method was validated and shown to be linear (R > 0.994), precise (RSD ≤13.8%, interday), accurate (bias −13.1–13.1%, interday) and robust (relative effect −3.34–6.08%). Simultaneous extraction of all six drugs with high recoveries (81.65–95.58%) was achieved. Sample volumes used were as low as 50–100 μL, with necessary organic solvent volumes in μL ranges. Greenness scores obtained using the AGREE software were between 0.63 and 0.66, demonstrating compliance with green analytical chemistry principles. Finally, the validated method was successfully applied on breast cancer patient plasma samples.

Abstract ED13-2: Radiation therapy and cardiovascular disease in breast cancer

Abstract This presentation will review the topic of radiation-induced cardiac dysfunction in patients with breast cancer. Specific areas of discussion include the a review of the cardiac-sparing techniques available for radiation therapy in breast cancer treatment; guidelines for the prevention, diagnosis, and treatment of cardiac dysfunction after radiation exposure in patients with breast cancer; and new areas of research in the field of radiation-induced cardiac disease in breast cancer. Emerging knowledge of how concurrent systemic therapies may interact with radiation to affect heart function will also be discussed. In addition, future directions in the field of radiation-induced heart dysfunction will be reviewed. Citation Format: Carmen Bergom. Radiation therapy and cardiovascular disease in breast cancer [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 ED13-2.

Preclinical In Vitro Investigation of MDM2 Inhibition in Combination with Antiangiogenic Therapy for Breast Cancer Treatment

Background: Combining antiangiogenic drugs with other chemotherapeutic drugs has been found to produce superior therapeutic outcomes and prevent drug resistance in a variety of cancers. Methods: Experimental assays such as the MTT assay, flow cytometry, western blotting, and qPCR have been used to evaluate the efficacy of combination therapy. Results: When compared to controls and monotherapies, the combination treatment of axitinib and idasanutlin demonstrated a substantial decrease in cell viability at lower doses, a significant decrease in migration, and a shift toward early and late apoptosis. This study examined major apoptotic, metastatic, and angiogenic factors, including MDM2, p21, BCL-2, BCL-XL, and MMP9, which have showed differential expressions at the protein and mRNA levels after combination. Axitinib and idasanutlin decreased tumorigenesis and migration in vitro in the MCF-7 cell line when compared to other chemotherapeutic medications. The suggested mechanisms of the antitumorigenic effect of the combination therapy may depend on its capacity to promote the production of apoptotic markers and reduce antiapoptotic markers. Conclusions: Treatments with axitinib and idasanutlin demonstrated effective therapeutic targeting of the primary angiogenic growth factor and, consequently, the pro-metastatic arbitrators. This will not only eliminate cancer cells but also stop other malignant processes and ultimately reduce the metastatic cascade.

A Review of Different Types of Liposomes and Their Advancements as a Form of Gene Therapy Treatment for Breast Cancer.

Breast cancer incidence and mortality rates have increased exponentially during the last decade, particularly among female patients. Current therapies, including surgery and chemotherapy, have significant negative physical and mental impacts on patients. As a safer alternative, gene therapy utilising a therapeutic gene with the potential to treat various ailments is being considered. Delivery of the gene generally utilises viral vectors. However, immunological reactions and even mortality have been recorded as side effects. As a result, non-viral vectors, such as liposomes, a system composed of lipid bilayers formed into nanoparticles, are being studied. Liposomes have demonstrated tremendous potential due to their limitless ability to combine many functions into a system with desirable characteristics and functionality. This article discusses cationic, anionic, and neutral liposomes with their stability, cytotoxicity, transfection ability, cellular uptake, and limitation as a gene carrier suitable for gene therapy specifically for cancer. Due to the more practical approach of employing electrostatic contact with the negatively charged nucleic acid and the cell membrane for absorption purposes, cationic liposomes appear to be more suited for formulation for gene delivery and therapy for breast cancer treatment. As the other alternatives have numerous complicated additional modifications, attachments need to be made to achieve a functional gene therapy system for breast cancer treatment, which were also discussed in this review. This review aimed to increase understanding and build a viable breast cancer gene therapy treatment strategy.

The Aryl Hydrocarbon Receptor Ligand 6-Formylindolo(3,2-b)carbazole Promotes Estrogen Receptor Alpha and c-Fos Protein Degradation and Inhibits MCF-7 Cell Proliferation and Migration

Introduction: Worldwide, breast cancer is the most common cancer in women and is the main cause of death among all neoplasia in this group. Luminal A breast cancer represents approximately 70% of all breast cancers and is treated with hormone therapies targeting estrogen receptor alpha (ERα). Unfortunately, patients develop drug resistance leading to recurrence of neoplasia due to estrogen-independent ERα reactivation. Therefore, it is crucial to identify new molecular targets downstream ERα signaling pathway that allows the implementation of better treatments to improve the outcome of breast cancer patients. Overexpression of c-Fos, an ERα gene target, has been associated with increased cell motility, malignancy, metastasis, and invasion while its neutralization results in decreased breast cancer tumorigenesis. The aryl hydrocarbon receptor (AHR) ligands halogenated and polycyclic aromatic hydrocarbons, highly toxic compounds, down regulate c-Fos and ERα levels. The present study aimed to evaluate whether 6-formylindolo(3,2-b)carbazole (FICZ), a no toxic AHR agonist, modifies c-Fos levels in MCF-7 mammary carcinoma cells as well as to determine its effects on cell proliferation and migration. In addition, the possible mechanism through which FICZ mediates c-Fos levels in MCF-7 cells was investigated. Methods: Initially, the effect of FICZ on c-Fos mRNA and protein levels in MCF-7 cells, untreated or treated with estradiol, was evaluated by qPCR and Western blot. 2,3,7,8-Tetrachloro-dibenzo-p-dioxin, an AHR prototype agonist, was used as a positive control. Next, we examined the effect of FICZ on MCF-7 cell proliferation and migration by cell counting, MTT, 3H-thymidine incorporation, and scratch-wound assays. Finally, the involvement of proteasome 26S on ERα and c-Fos protein degradation was investigated by the use of MG132 and Western blot. Results: The data show that FICZ treatment downregulates c-Fos mRNA and protein levels, most likely by promoting ERα proteasome degradation, blocking MCF-7 cell proliferation and migration. The results also demonstrate that liganded ERα was required for FICZ-mediated ERα degradation. Conclusions: Activation of AHR results in a decreased MCF-7 cell proliferation and migration by ERα and c-Fos down regulation. Targeting AHR might be a promising therapy for breast cancer treatment, particularly when estrogen-independent ERα reactivation presents.

T-type Ca2+ channels and their relationship with pre-neoplastic and neoplastic lesions in the human breast.

The expression of T-type voltage-dependent Ca2+ channels (Cav3) has been previously observed in breast cancer, but their expression and subcellular localization were not evaluated in pre-neoplastic lesions. Therefore, this work aimed to evaluate protein expression and subcellular localization of T-type channel isoforms in human breast tissue samples. Protein expressions of CaV3.1, CaV3.2, and CaV3.3 were evaluated by immunohistochemistry in breast without alteration, in proliferative non-neoplastic lesions, and in neoplastic ductal epithelial lesions of the human breast. CaV3.1, CaV3.2, and CaV3.3 nuclear expressions were decreased in advanced stages of neoplastic transformation, whereas CaV3.1 and CaV3.2 cytoplasmic expression increased. Also, the decrease in nuclear expression was correlated with an increase in cytoplasmic expression for CaV3.1 isoform. The change in CaV3 protein expression and subcellular localization are consistent with the neoplastic transformation stages of mammary epithelial cells, evident in early neoplastic lesions, such as ductal carcinomas in situ. These results suggest a possible involvement of CaV3 in the carcinogenic processes and could be considered as a potential pharmacological target in new therapies for breast cancer treatment.

Photodynamic therapy in breast cancer treatment.

Breast cancer is a serious public problem in modern society. Photodynamic therapy (PDT) is increasingly used in modern medicine. Currently, PDT is an innovative method of treating breast cancer. Irreversible damage to neoplastic tissues is associated with the use of physicochemical processes. Generating cytotoxic reactive oxygen species [singlet oxygen (1O2)] is leading to tumor cell death. At the same time, valuable information can be extracted from breast cancer cells. Photogenerated 1O2 is the major factor responsible for cell necrosis during PDT. 1O2 can react rapidly intracellularly with all organic substances. The use of photodynamic therapy on tissues in vitro creates conditions for testing various types of solutions and implementing them in in vivo treatment. This article is a review of recent advances in PDT for treatment of breast cancer. PDT is a novel cancer diagnostic and cancer treatment therapy. Therefore, an understanding of the possibility to generate a toxic form of 1O2 is necessary. The knowledge gained from the basics of PDT in vitro can be useful in biomedical applications in vivo. The current literature mentions PDT in the treatment of cancers located very deep within the human body. Therefore, the development of agents used to deliver 1O2 to the deep cancerous tissue is a new challenge which can have an efficient impact on this discipline. This review covers the literature between 2000-2022.

The Combination Therapy in Breast Cancer Treatment

Breast cancer (BC) is the cancer that most commonly diagnosed worldwide, which result in the cause of cancer-related deaths. The majority of BC diagnoses were HR+ and HER2- (71%) and HER2+BC accounts for 10-20% of all breast tumors. There is no magic drug for the treatment of breast cancer at present. Endocrine therapy is the preferable treatment for HR+/HER2- metastatic breast cancer. However, long-term use may produce certain drug resistance. Tucatinib, as a HER2 inhibitor, can be combined with chemotherapy to treat HER2+BC.Combination therapy can offers patients the opportunity to derive the maximum benefit from treatment, at the same time, it can minimize or eliminate relapse, drug resistance and toxic effects and thus the BC patients can have a good quality of life. This paper discussed the combination therapy of endocrine therapy or tucatinib with other drugs and compared their advantages and disadvantages in breast cancer therapy, providing better choice for clinical treatment of BC.

Treatment of chest wall osteoradionecrosis with a contralateral breast Y-V flap: a case report

Chest wall osteoradionecrosis, one of the most serious complications of radiation therapy for breast cancer treatment, is usually treated by wide debridement followed by coverage with a well-vascularized flap. However, the extent of radiation-induced injury and limits in performing wide resection of the injured bones often present challenges in treatment. Herein, we present our experience treating chest wall osteoradionecrosis with a contralateral breast Y-V flap in an 81-year-old woman. She was diagnosed with chest wall osteoradionecrosis and had grade 3 ptotic breasts. Redundant contralateral breast tissue was used for reconstruction to cover the wound. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast, while preserving the perforators of the left lateral thoracic artery. The flap was spread using the Y-V advancement fashion to cover the wound. The patient was discharged 2 weeks after surgery. At 19 months postoperation, there were no complications or recurrence. The patient was satisfied with the short recovery time and surgical results. The contralateral breast Y-V flap allows simple and quick reconstruction, potentially expanding the available treatment options and therefore increasing flexibility in choosing a treatment plan for patients.

Nanoparticles-based Chemo-Phototherapy Synergistic Effects for Breast Cancer Treatment: A Systematic Review

Despite the promising outcomes, conventional therapies for breast cancer treatment suffer from apparent limitations, including systemic toxicity, adverse reactions, and tumor recurrence. In light of that, therapy that combines chemo-phototherapy with nanoparticles is of immense value as it provides an alternative that hope exerts better outcomes. This review systematically assesses publications between 2010 and 2022, focusing on the application of nanoparticles in chemo-phototherapy for breast cancer. A detailed search was conducted in Scopus, PubMed, and WoS, and relevant studies within the 11 years were selected. Final 18 out of 40 initial papers were selected, including studies on in vivo analysis. Detailed information on chemo-phototherapy effects, drug cargo design, the toxicity of nanomaterials, and immunomodulatory effects were extracted and discussed. This review demonstrates the promising anticancer activity of combined synergistic effects for breast cancer management.

Solubility Enhancement and Characterization of Tamoxifen Citrate Using Co-crystallization

Tamoxifen citrate (TC) is one of the anti-estrogen agents which has low solubility in the water. As TC is still used as the main therapy in breast cancer treatment, modifications are still being made to increase the solubility of TC for a successful treatment. In this research, co-crystallization of TC was performed using Nicotinamide (NIC), Isonicotinamide (ISO), Saccharin (SAC), Aspartame (ASP), and Benzoic Acid (BNZ) as a coformer with the molar ratio of 1:1, 1:2, and 2:1. Co-crystal was prepared by solvent drop grinding (SDG) and solvent evaporation (SE) methods using methanol. The results of the solubility test showed that TC-NIC and TC-ISO co-crystals with a 1:2 molar ratio made using the SDG and SE methods gave the best results. Meanwhile, the best dissolution test results were shown by TC-ISO co-crystals with a ratio of 1:2. Based on the characterization of physical stability, the SDG method resulted in more stable TC co-crystals than the SE method. Therefore, in this case, the SDG method could be more advantageous to be used for development in the field of co-crystallization.

Abstract P4-11-16: Feasibility and patient satisfaction with a smartphone application to improve medication adherence among patients with breast cancer

Abstract Introduction: Low medication adherence is associated with worse outcomes among patients with breast cancer (BC). Retrospective studies have shown decreased survival in patients with BC who are non-adherent to endocrine therapy, but less is known about newer oral cancer therapies and the impact on adherence to medications for chronic non-cancer conditions. New strategies to improve global medication adherence are needed. We assessed the feasibility and patient satisfaction of the Medisafe smartphone application in the initial phase of a trial to increase global medication adherence. Methods: Patients treated with oral anti-neoplastic therapy for treatment of BC were eligible. Enrolled patients received individualized instruction on Medisafe app installation and use. The Medisafe app sends patients push notification reminders at the times specified for each of their standing oral medications. Patients self-report whether each medication dose was taken or missed directly in the app. Patients were followed for 12 weeks. The primary endpoint was feasibility, defined as completion of the 12-week study intervention. uMARS (end-user Mobile Application Rating Scale) questionnaires were used to assess patient satisfaction with the Medisafe app at week 12. The objective feedback component of the uMARS contains 16 questions and includes 4 objective quality subscales: engagement, functionality, aesthetics, and information quality. Each question is answered on a 1-5 scale (5 indicates highest satisfaction), and mean responses were used to calculate an overall satisfaction score and a satisfaction score for each subsection. Results: Between July 2020 and July 2021, 58 patients were enrolled. The mean participant age was 58 years (range 31 - 87). As of June 30,2020 20 patients reached the 12-week endpoint. Of these patients, 18 (90%) completed the 12-week intervention. Of the 17 patients who completed the uMARS questionnaire, the mean overall uMARS score of the Medisafe app was 3.8 (SD 0.6). Table 1 displays the results for the uMARS subscales, which include a mean functionality score of 4.0 (SD 0.7) and mean information quality score of 4.1 (SD 0.7). Notably, 70.6% of participants reported that the app was easy to use and clearly designed, and 76.5% reported that the app’s content was appropriately designed for its specific target audience. Of the 13 patients who reported viewing educational information within the app, 84.6% reported that the information seemed credible. Almost half of patients (43.8%) reported that the app increased their awareness of the importance of addressing health behavior. Conclusions: Our early findings suggest that the use of a smartphone application to improve medication adherence among patients with cancer is feasible, with a high rate of participant completion. Furthermore, high patient-reported satisfaction with the Medisafe app suggests acceptability to promote long-term behavior change. Table 1: Patient Reported Satisfaction with the Medisafe App Evaluated Assessed by the Objective Feedback Component of the uMARS (end-user Mobile Application Rating Scale) Questionnaire at Week 12 (n=17) uMARS Objective ScoreMean± SDOverall3.8± 0.6  Engagement3.2± 0.8  Functionality4.0± 0.7  Performance4.2± 0.8  Ease of use4.1± 1.0  Aesthetics4.0± 0.6  Information Quality4.1± 0.7  Quality of info3.8± 0.8  Visual info4.3± 0.9  Credibility4.5± 0.8 Citation Format: Melissa K Accordino, Sophie Ulene, Erin Honan, Meghna S Trivedi, Katherine D Crew, Erik Harden, Cynthia Law, Dawn L Hershman. Feasibility and patient satisfaction with a smartphone application to improve medication adherence among patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-16.