Traditional Treatment Options Research Articles

Children and adolescent with suboptimal control of type 1 diabetes improve during the first 2 years on automated insulin delivery system.

This study investigates the influence of the automated insulin delivery system (AID) on glycaemic control in children and adolescents with type 1 diabetes (T1D) who do not reach optimal glycaemic control with traditional treatment options. All the patients aged 7 to 16 years with T1D who initiated the AID system between 24 October 2020 and 5 January 2022 in the Helsinki University Hospital and had haemoglobin A1C (HbA1c) levels above 53 mmol/mol/7.0% (N = 79) were included. Time in tight range (TITR), time in range (TIR), HbA1c, mean sensor glucose (SG) value, time below range (TBR) and SG coefficient of variance (CV) were measured at 0, 3, 12 and 24 months. The changes in the outcome measures between the time points were included in the analyses, and statistically significant level was p-value <0.01. After the initiation of AID, glycaemic control improved, and the effect lasted throughout the study period. Between 0 and 3 months, TITR and TIR increased (mean 11.7% [10.6], mean 18.1% [standard deviation [SD] 13.7], p < 0.001), whereas HbA1c and mean SG values decreased significantly (-8.3 mmol/mol [8.7]/-2.9% [2.9], p < 0.001, -1.8 mmol/L [1.7], p < 0.001). These effects were sustainable and were still visible at 12 and 24 months. Glycaemic control in patients not reaching treatment goals improved significantly after the initiation of the AID system, and the favourable effect lasted throughout the follow-up. AID treatment could be an option for also those paediatric patients with T1D who do not have good skills in diabetes management.

Psychedelics as novel therapeutic agents for chronic pain: mechanisms and future perspectives

Chronic neuropathic pain is a significant public health issue affecting an estimated 1.5 billion individuals worldwide. The mechanisms underlying chronic pain are multifaceted and not fully understood. Chronic pain amplifies specific neural pathways through peripheral and central sensitization triggered by repeated exposure to noxious stimuli, ultimately resulting in physical and emotional pain. Traditional treatment options targeting these mechanisms, such as opioid and non-opioid analgesics, are associated with adverse effects, addiction, and suboptimal pain relief. Using psychedelics to treat chronic pain is an area of growing interest. While psychedelic substances, such as psilocybin, lysergic acid diethylamide, mescaline, and 3,4-methylenedioxymethamphetamine are primarily associated with recreational use or spiritual practices, emerging evidence suggests their potential therapeutic benefits for various mental health disorders, including chronic pain. Psychedelics alter pain perception by directly activating serotonin receptors, exerting anti-inflammatory effects, enhancing descending inhibition, opening a window of neuroplasticity, and facilitating synaptic remodeling. This review mainly elucidates the ongoing research regarding the psychedelic mechanisms of action, pharmacology, clinical applications, and therapeutic potential in treating neuropathic pain.

Waste-to-energy technologies: Integrating anaerobic digestion, microbial electrolysis cells, hydrodynamic cavitation, and electrocoagulation

This study explores a novel integration of electro-physicochemical technologies to generate energy and treat water from combined food waste (FW) and blackwater (FW-BW), with BW containing waste activated sludge with simulated flush water. The FW-BW substrate was gravity-separated and pretreated with hydrodynamic cavitation (HDC). Solids from gravity separation were used for energy generation via anaerobic digestion (AD) alone or integrated with microbial electrolysis cells (AD-MEC). HDC pretreatment had 51.6% more CH4 production in 5 days (266 mL CH4/g VS) and 63% more in 30 days compared to AD without HDC. The CH4 production after 5 days of digestion with HDC pretreatment (266 mL CH4/g VS) was similar to the amount produced without HDC over 30 days (263 mL CH4/g VS). Using MEC increased CH4 production by 12.7% compared to AD-only. The liquids from gravity separation were treated with electrocoagulation (EC) at 15 V (90 min), which removed 96.2% of the chemical oxygen demand (COD) and 100% of the total suspended solids. The pilot scale design indicates that the AD-MEC and EC units would generate 1.4 times more energy than energy consumed through applying these novel technologies. These findings demonstration the applications of four technologies (HDC, AD, MEC, and EC) in an energy-efficient waste management approach, producing bioenergy and cleaner water for low-tier use, especially in areas lacking traditional waste treatment options.

An Overview of Prosthetic Implant Attachments in EdentulousPatients

Edentulism is an unresolved health care issue of sustained significance and prevalence in the aged population. Adaptation to wearing complete dentures is a complex process and must be considered from both somatic and psychological standpoints. The difficulties of wearing dentures have been attributed to deficiencies of the denture-bearing tissues, reduced salivary flow,vulnerable tissue and severe ridge resorption. The prosthetic management of the edentulous patient has always been a major challenge. Complete maxillary and mandibular dentures have been the traditional treatment option. However, most of the patients report problems adapting to the mandibular denture due to lack of comfort, retention and stability. It is well known that implantretained/supported overdentures provide improved retention, support, stability, function, and comfort for patients

Efficacy of β-Blockers in Decreasing Mortality in Sepsis and Septic Shock Patients: A Systematic Review.

Sepsis is a life-threatening condition leading to various organ dysfunction due to an underlying infection. Despite providing appropriate treatment, it is still one of the most common causes of death among patients who are admitted to the intensive care unit (ICU). So, multiple studies have been conducted to identify the potential benefits of various drugs in decreasing mortality in sepsis apart from its traditional treatment options. This study aims to identify whether β-blockers play a role in decreasing mortality in sepsis and septic shock patients because of their potential benefits on several organ systems. Medical databases such as Google Scholar, Summon, PubMed Medical Subject Headings (MeSH), PubMed, Science Direct, Cochrane Library, and Multidisciplinary Digital Publishing Institute (MDPI) were systematically searched for relevant publications. The identified articles were assessed based on the inclusion and exclusion criteria, and 11 research articles were finalized, for which quality appraisal was done using appropriate appraisal tools. β-blockers significantly lowered the in-hospital mortality in sepsis and septic shock patients, and they were also associated with better patient outcomes. As there are limited studies, further research needs to be done to explore the role of β-blockers in decreasing mortality in critically ill populations such as sepsis and septic shock patients.

Emerging A-D-A fused-ring photosensitizers for tumor phototheranostics.

As we all know, cancer is still a disease that we are struggling against. Although the traditional treatment options are still the mainstream in clinical practice, emerging phototheranostics technologies based on photoacoustic or fluorescence imaging-guided phototherapy also provide a new exploration direction for non-invasive, low-risk and highly efficient cancer treatment. Photosensitizers are the core materials to accomplish this mission. Recently, more attention has been paid to the emerging A-D-A fused-ring photosensitizers. A-D-A fused-ring photosensitizers display strong and wide absorption spectra, high photostability and easy molecular modification. Since this type of photosensitizer was first used for tumor therapy in 2019, its application boundaries are constantly expanding. Therefore, in this feature article, from the perspective of molecular design, we focused on the development of these molecules for application in phototheranostics over the past five years. The effects of tiny structural changes on their photophysical properties are discussed in detail, which provides a way for structural optimization of the subsequent A-D-A photosensitizers.

Assessment Accuracy of 2D vs. 3D Imaging for Custom-Made Acetabular Implants in Revision Hip Arthroplasty.

Revision total hip arthroplasty (rTHA) presents significant challenges, particularly in patients with severe acetabular bone defects. Traditional treatment options often fall short, leading to the emergence of custom-made 3D-printed acetabular implants. Accurate assessment of implant positioning is crucial for ensuring optimal postoperative outcomes and for providing feedback to the surgical team. This single-center, retrospective cohort study evaluates the accuracy of standard 2D radiographs versus 3D CT scans in assessing the positioning of these implants, aiming to determine if 2D imaging could serve as a viable alternative for the postoperative evaluation. We analyzed the implant positions of seven rTHA patients with severe acetabular defects (Paprosky ≥ Type IIIA) using an alignment technique that integrates postoperative 2D radiographs with preoperative CT plans. Two independent investigators, one inexperienced and one experienced, measured the positioning accuracy with both imaging modalities. Measurements included translational shifts from the preoperatively templated implant position in the craniocaudal (CC), lateromedial (LM), and ventrodorsal (VD) directions, as well as rotational differences in anteversion (AV) and inclination (INCL). The study demonstrated that 2D radiographs, when aligned with preoperative CT data, could accurately assess implant positions with precision nearly comparable to that of 3D CT scans. Observed deviations were 1.4 mm and 2.7 mm in CC and LM directions, respectively, and 3.6° in AV and 0.7° in INCL using 2D imaging, all within clinically acceptable ranges. For 3D CT assessments, mean interobserver variability was up to 0.9 mm for translational shifts and 1.4° for rotation, while for 2D alignment, observer differences were 1.4 mm and 3.2° for translation and rotation, respectively. Comparative analysis of mean results from both investigators, across all dimensions (CC, LM, AV, and INCL) for 2D and 3D matching, showed no significant differences. In conclusion, conventional anteroposterior 2D radiographs of the pelvis can sufficiently determine the positioning of custom-made acetabular implants in rTHA. This suggests that 2D radiography is a viable alternative to 3D CT scans, potentially enhancing the implementation and quality control of advanced implant technologies.

Comparison of vonoprazan bismuth-containing triple therapy with quadruple therapy in Helicobacter pylori-infected treatment-naive patients: a prospective multicenter randomized controlled trial.

Helicobacter pylori infection is linked to various gastrointestinal conditions, such as chronic active gastritis, peptic ulcers, and gastric cancer. Traditional treatment options encounter difficulties due to antibiotic resistance and adverse effects. Therefore, the aim of this study was to explore the effectiveness of a new treatment plan that combines vonoprazan (VPZ), amoxicillin, and bismuth for the eradication of H. pylori. A total of 600 patients infected with H. pylori were recruited for this multicenter randomized controlled trial. Patients treated for H. pylori elimination were randomly assigned at a 1:1 ratio to receive 14days of vonoprazan-based triple therapy (vonoprazan + amoxicillin + bismuth, group A) or standard quadruple therapy (esomeprazole + clarithromycin + amoxicillin + bismuth, group B). Compliance and adverse effects were tracked through daily medication and side effect records. All patients underwent a 13C/14C-urea breath test 4weeks after treatment completion. Intention-to-treat (ITT) and per-protocol (PP) analyses revealed no substantial differences in H. pylori eradication rates between groups A and B (ITT: 83.7% vs 83.2%; PP: 90.9% vs 89.7%). However, significant differences were observed in the assessment of side effects (13.7% vs 28.6%, P<0.001). Specifically, group A had significantly fewer "bitter mouths" than group B did (3.7% vs 16.2%, P<0.001). Triple therapy comprising vonoprazan (20mg), amoxicillin (750mg), and bismuth potassium citrate (220mg) achieved a PP eradication rate ≥90%, paralleling standard quadruple therapy, and had fewer adverse events and lower costs (¥306.8 vs ¥645.8) for treatment-naive patients.

Recent advances in treatment of prurigo nodularis

Abstract Prurigo nodularis is a chronic skin condition which has significant negative impacts on the psychosocial function and quality of life of affected patients. It is a heterogeneous disease with complex underlying pathogenic mechanisms, and the clinical efficacy of traditional treatment options is often limited. Recently, great advances have been made in the pathogenesis of prurigo nodularis, which have enabled the development of novel targeted therapies for this disease. Various clinical trials have investigated the therapeutic efficacy of biologics which target the Th2 pathway. Dupilumab, a monoclonal antibody targeting interleukin 4 (IL-4) receptor α, has shown clinical efficacy and obtained United States Food and Drug Administration approval for prurigo nodularis. In addition, nemolizumab (IL-31 receptor A antagonist) and vixarelimab (oncostatin M receptor β antagonist) have shown therapeutic efficacy in clinical trials for prurigo nodularis. Small-molecule inhibitors with clinical promise which are currently under investigation include nalbuphine (opioid receptor modulator), Janus kinase inhibitors, and aprepitant and serlopitant (neurokinin-1 receptor antagonists). The recent development of new biologics and small-molecule inhibitors targeting various immunological and neurological signaling pathways have provided great hope that we are entering a new era of targeted therapies for this challenging clinical condition. In addition, recent advances in RNA sequencing technology may enable the identification of unique signaling pathways and the development of novel treatments for this disease in the future. In this review article, we summarize the current knowledge of the pathogenesis of prurigo nodularis, and discuss recent advances in treatment for this challenging clinical condition.

Scoping review of the role of equine assisted psychotherapy and learning in opioid abuse treatment

Opioid abuse is an epidemic in the United States with the number of deaths associated with this addiction growing each year, and yet, identification of a successful treatment plan is a major limitation to addressing this epidemic. Traditional treatment programs do not always fit for all addicts; however, equine assisted psychotherapy and learning (EAPL) shows promise as an alternative treatment option for those individuals where traditional treatment options have failed. Nevertheless, due to the novelty of this treatment option, literature concerning EAPL is limited. The purpose of this scoping review was to identify articles that address the characteristics and methodologies found in EAPL programs as it relates to opioid abuse treatment. Through the use of this scoping review, literature covering four key topics were gathered: 1) addiction treatment curriculums, 2) EAPL programs, 3) physiological effect of addiction treatment for humans, and 4) physiological effect of EAPL participation on the human and horse. Research associated with physiological effect was the most lacking of the topics covered during this review of literature. Reviewed literature pointed to a variety of populations that participate in addiction treatment programs that range from inpatient to long term recovery. EAPL programs offer an assortment of activity options to combat the challenges presented by the range of populations treated. Vital signs were mentioned in the literature reviewed as the leading way to track physiological changes but were not discussed in relation to addiction-specific treatment. Physiological measures showed change in both horses and humans who participated in equine programming but did not dictate concrete cause and effect instances. The limited literature identified through this scoping review validates the need to further explore the intentional relationship between EAPL and opioid abuse treatment programming.

Endoscopic Management Options for Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is a prevalent condition that affects a significant portion of the Western population. Despite its benign pathophysiology, it has the potential to cause serious complications over time, ranging from conditions that are benign, premalignant, and/or malignant. Traditional treatment options include lifestyle measures, anti-secretory medications (e.g., proton pump inhibitor (PPI)), and surgical options (e.g., Nissen and Toupet fundoplication). However, recent studies have revealed long-term side effects of anti-secretory medications. Moreover, surgical options, though effective, are considered invasive and associated with potential complications. In the current age of ongoing research in minimally invasive options, endoscopic treatment of GERD has become popular. As a result, procedures such as radiofrequency treatment and transoralincisionlessfundoplication (TIF) have gained FDA approval and are currently being covered by most insurance. In this review article, we will discuss pre-procedural workup, appropriate patient selection, advantages, disadvantages, procedure techniques, and follow-up of patients who undergo various endoscopic treatments for GERD.In addition, we will review the short and long-term success of these techniques in improving quality of life, use of PPI, and improvement in symptoms considering published data in high-quality peer-reviewed journals.

Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis.

Osteoarthritis (OA) is a chronic degenerative disease significantly impacting both patient quality of life and socioeconomics. Traditional treatment options, including pharmacological and surgical interventions, are often limited. Advancements in our understanding of the pathological mechanisms behind OA indicate the involvement of pathological angiogenesis. Transarterial microembolization (TAME), a minimally invasive radiological procedure, may present an innovative therapeutic approach. This review aims to consolidate current knowledge and experiences regarding TAME as a therapeutic modality for alleviating chronic joint pain associated with OA. It explores the role of TAME, focusing on its indications, patient selection, clinical outcomes, and future perspectives. Potential complications and associated risks are systematically addressed, alongside proposed strategies for risk mitigation and effective management.The presented patient cases originate from our institution, supplemented by a thorough review of relevant literature retrieved from PubMed.TAME represents a promising therapeutic approach, providing relief from the burden of joint diseases and substantially enhancing patient quality of life. Clinical outcomes emphasize the efficacy and safety of TAME in mitigating pain and improving functional capabilities in patients with chronic joint pain associated with OA. With mounting evidence of its therapeutic benefits and applicability to numerous joint-related pathologies, TAME offers a valuable addition to the arsenal of treatments for these conditions. · TAME is an innovative therapy for treating chronic joint pain related to OA.. · TAME is a technically challenging minimally invasive intervention requiring a high level of expertise.. · Understanding the challenges and complications of TAME can reduce risk and enhance procedural outcomes.. · Wilms LM, Jannusch K, Weiss D et al. Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis. Fortschr Röntgenstr 2024; DOI 10.1055/a-2288-5743.

Strategies for Treating Traumatic Neuromas with Tissue-Engineered Materials.

Neuroma, a pathological response to peripheral nerve injury, refers to the abnormal growth of nerve tissue characterized by disorganized axonal proliferation. Commonly occurring after nerve injuries, surgeries, or amputations, this condition leads to the formation of painful nodular structures. Traditional treatment options include surgical excision and pharmacological management, aiming to alleviate symptoms. However, these approaches often offer temporary relief without addressing the underlying regenerative challenges, necessitating the exploration of advanced strategies such as tissue-engineered materials for more comprehensive and effective solutions. In this study, we discussed the etiology, molecular mechanisms, and histological morphology of traumatic neuromas after peripheral nerve injury. Subsequently, we summarized and analyzed current nonsurgical and surgical treatment options, along with their advantages and disadvantages. Additionally, we emphasized recent advancements in treating traumatic neuromas with tissue-engineered material strategies. By integrating biomaterials, growth factors, cell-based approaches, and electrical stimulation, tissue engineering offers a comprehensive solution surpassing mere symptomatic relief, striving for the structural and functional restoration of damaged nerves. In conclusion, the utilization of tissue-engineered materials has the potential to significantly reduce the risk of neuroma recurrence after surgical treatment.

New and Traditional Treatment Options for Idiopathic Scoliosis in Children and Adolescents

Scoliosis is a medical condition common in children and adolescents, which causes an abnormal curvature of the spine in a “C” or “S” shape. Three main forms of scoliosis exist: neuromuscular, congenital, and idiopathic with idiopathic being most common. Traditional treatments include observation, rigid bracing (a corrective orthosis), casting, surgery, and physiotherapeutic scoliosis-specific exercises. Surgical corrections include spinal fusion or placement of traditional or growing rods. Treatment options for scoliosis have recently expanded, to include newer flexible bracing and surgical procedures such as tethering and posterior dynamic deformity correction. Providers should be screening for scoliosis, and all providers can benefit from knowing the latest options available to help their patients receive the best care before reaching skeletal maturity.

Thrombolysis treatment and multi- disciplinary management of central retinal artery occlusion in comparison with traditional ophthalmological treatment options

<p>The management of central retinal artery occlusion (CRAO) has long been conservative therapy with limited efficacy carried out in ophthalmology departments together with etiolo&shy;gi&shy;cal investigations lacking a standardised protocol. However, CRAO is analogous to ischemic central nervous system stroke and is associated with increased stroke risk, thus, systemic thrombolysis treatment and multidisciplinary management can be beneficial. Since May 2022, at Semmelweis University CRAO patients diagnosed within 4.5 hours are given intravenous thrombolysis therapy and undergo etiologic workup based on current stroke protocols. Here we report our experience with the multidisciplinary, protocol-based management of CRAO in comparison with former non-protocol based ophthalmological conservative treatment.</p>. <p>We reviewed CRAO patients&rsquo; data treated conservatively and with paracentesis within 6 hours at the Department of Ophthalmology between 2013 and 2022 including changes in visual acuity, neurolo&shy;gical and cardiovascular findings compared to those in the thrombolysis project.&nbsp;</p>. <p>Of the 78 patients receiving non-protocol care, visual improvement was seen in 37% with natural course, 47% with conservative treatment and 47% with paracentesis. Four patients had significant carotid stenosis (2 underwent endarterectomy), 1 carotid dissection, 6 cardioembolism and 1 giant cell arteritis. Of the 4 patients within 4,5 hours, 3 gave their consent to the clinical trial and were treated with thrombolysis and underwent a full etiological assessment.&nbsp;<br>2 pa&shy;tients had improved visual acuity, 2 pa&shy;tients had significant carotid stenosis and underwent endarterectomy, 1 patient was started on anticoagulation for newly diagnosed atrial fibrillation.</p>. <p>CRAO patients presenting within 4,5 hours are rare and more patients are needed in our study to establish the efficacy of thrombolysis. However uniform protocollized evaluation helps identifying embolic sources thus, avoiding further and potentially more serious thromboembolic events.</p>.

Exploring the Functional Roles of lncRNA-HOTAIR in Glioma: Unraveling its Impact on Tumor Progression

Abstract: Gliomas, a heterogeneous class of brain cancers, pose significant challenges as they are considered incurable. They represent the most recurrent primary intracranial cancer and exhibit distinct clinical and biological characteristics. Traditional treatment options for glioma include radiotherapy, chemotherapy, and surgery; however, the emergence of molecular-targeted therapy has provided a new avenue for improved therapeutic responses. One intriguing oncogene type of long noncoding RNAs (lncRNAs) in glioma is the HOX Transcript Antisense RNA, commonly referred to as HOTAIR. HOTAIR is characterized by its overexpression in various cancers and is situated in the intergenic region between HOXC12 and HOXC11 of the HOXC cluster on chromosome 12. Its upregulation in glioma has been found to be associated with tumor grade and plays a significant role in disease progression. HOTAIR exerts vital functions in glioma, including promoting angiogenesis, modulating glutamine catabolism, and influencing sensitivity to temozolomide (TMZ), a commonly used chemotherapy drug. Knockdown of HOTAIR has been shown to suppress cell invasion, migration, and proliferation, while inducing apoptosis, ultimately leading to tumor repression. HOTAIR achieves its biological effects, by targeting specific microRNAs (miRNAs). In this review study, we have summarized several signaling pathways that are intricately linked to HOTAIR in the context of glioma. Understanding the mechanisms and interactions involving HOTAIR and these signaling pathways may provide valuable insights for the development of targeted therapies and improved management strategies for glioma. This review provides a summary of the potential roles of HOTAIR in glioma, encompassing its effects in commercial cell lines, patient-derived cell lines, animal studies, and clinical trials.

Deciphering cellular and molecular mechanism of MUC13 mucin involved in cancer cell plasticity and drug resistance.

There has been a surge of interest in recent years in understanding the intricate mechanisms underlying cancer progression and treatment resistance. One molecule that has recently emerged in these mechanisms is MUC13 mucin, a transmembrane glycoprotein. Researchers have begun to unravel the molecular complexity of MUC13 and its impact on cancer biology. Studies have shown that MUC13 overexpression can disrupt normal cellular polarity, leading to the acquisition of malignant traits. Furthermore, MUC13 has been associated with increased cancer plasticity, allowing cells to undergo epithelial-mesenchymal transition (EMT) and metastasize. Notably, MUC13 has also been implicated in the development of chemoresistance, rendering cancer cells less responsive to traditional treatment options. Understanding the precise role of MUC13 in cellular plasticity, and chemoresistance could pave the way for the development of targeted therapies to combat cancer progression and enhance treatment efficacy.

Redefining the battle against colorectal cancer: a comprehensive review of emerging immunotherapies and their clinical efficacy.

Colorectal cancer (CRC) is the third most common cancer globally and presents a significant challenge owing to its high mortality rate and the limitations of traditional treatment options such as surgery, radiotherapy, and chemotherapy. While these treatments are foundational, they are often poorly effective owing to tumor resistance. Immunotherapy is a groundbreaking alternative that has recently emerged and offers new hope for success by exploiting the body's own immune system. This article aims to provide an extensive review of clinical trials evaluating the efficacy of various immunotherapies, including CRC vaccines, chimeric antigen receptor T-cell therapies, and immune checkpoint inhibitors. We also discuss combining CRC vaccines with monoclonal antibodies, delve into preclinical studies of novel cancer vaccines, and assess the impact of these treatment methods on patient outcomes. This review seeks to provide a deeper understanding of the current state of CRC treatment by evaluating innovative treatments and their potential to redefine the prognosis of patients with CRC.

An osteopathic approach for a patient with sequela after treatment for a cheek squamous cell carcinoma

Abstract Surgical and radiation treatment for head and neck cancer are associated with both chronic and acute pain. While traditional treatment options, commonly antiepileptics and opioids, can be effective, many patients may still experience significant and debilitating pain. This case report describes a 61-year-old woman with a past medical history of spindle type squamous cell carcinoma in the left cheek that metastasized to the left parotid and submandibular glands. She was treated with surgical excision followed by radiation. She presented to the Osteopathic Manipulative Medicine clinic with the complaint of severe left sided facial pain, and limited range of motion that resolved with osteopathic manipulation.

Clinical Outcomes of Patients with HER2 Positive Metastatic Breast Cancer to the Brain, with First-Line Trastuzumab, Pertuzumab and Chemotherapy, in a Real-World Setting.

In this observational study, we analyzed the treatment patterns and clinical outcomes of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC) who developed brain metastases during their disease in a 2.7 million-member public health-provider in Israel. Newly diagnosed patients with mBC who initiated first-line treatment between January 2013 and June 2021 were identified. Time on treatment (ToT) and overall survival (OS) were assessed at a minimum of 6 months follow-up (cutoff: December 2021). We identified a total of 61 patients: 98.4% females, median age 50 years (IQR = 44-63), 85% invasive ductal tumors, 44% hormone receptor positive, 51% performance status 0-1. The median duration of follow-up was 6.2 years. All patients initiated a combination treatment of trastuzumab, pertuzumab, and chemotherapy (TPC), and 72% moved to second-line treatment during the study follow-up period (82% ado-trastuzumab emtansine). The median ToT for first-line and second-line treatments were 16.9 months (95% CI = 13.9-27.7) and 7.9 months (95% CI = 5.6-10.9), respectively. The median overall survival (OS) was 45.5 months (95% CI = 35.4-71.2) from the initiation of first-line treatment. When considering the timing of brain metastases, the median OS was 36.3 months (95% CI = 10.0-NR) for those diagnosed upfront (n = 15, 25%), 59.1 months (95% CI = 32.5-NR) for those diagnosed while on TPC (n = 25, 41%), and 40.8 months (95% CI = 35.4-NR) for those diagnosed at a later stage (n = 21, 34%). The median OS from brain metastases diagnosis was 25.1 months (95% CI = 17.0-34.6). Patients with upfront brain involvement at the time of mBC diagnosis had shorter survival compared to those who started TPC without brain metastases. Nonetheless, the overall results from this study compare favorably with previous studies and contribute to understanding the value of traditional treatment options, which will serve as a baseline for future treatment strategies in the real-world setting.