Triple negative breast cancer (TNBC) has been shown to respond to neoadjuvant chemotherapy (NACT). It has been established that achieving pathological complete response (pCR) for certain aggressive subtypes of breast cancer, including HER-2 (over-expressed) and TNBC, provides an important surrogate marker for predicting long-term clinical response and survival outcomes. How to increase the number of patients that achieve pCR remains challenging. Platinum-based NACT seems to be part of the solution and capecitabine, an active drug in metastatic breast cancer, but not a standard one in earlier stages may have found its place in the adjuvant setting. In the near future immunotherapy can play a role in early TNBC
The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences from low-to-middle-income countries, incorporating also the view of a patient advocate. This information will help set the stage for future approaches to optimize the understanding and clinical utilization of TIL analysis in patients with BC.
Cervical cancer (CC) represents 6% of gynecological malignant tumors. The incidence is decreasing in Portugal, especially with the introduction of nationwide screening program in 2008 and Human Papillomavirus vaccination in 2010. Still, special concern should be placed in improving their quality of life (QoL).
Methodology
Retrospective analysis of 109 patients diagnosed with locally advanced cervical cancer in our center between 2010 and 2017. The goal is assessing complications that interfere with the patient's lifestyle such as venous thromboembolism (VTE), ureter hydronephrosis (UHNF), psychological distress (PD) or Palliative care (PC) referral.
Results
109 patients, with median age 56 years old. Mostly admitted through the emergency department (79%), being the most common symptom metrorrhagia (46,8%). 65,1% were Stage IIB. Concurrent chemoradiotherapy was applied to 79,8% (n=87). VTE was highly prevalent, present in 12,8% of patients (n=14) and an association with OS (p=0,014) and tumor staging (p=0,001) was evident. PD including anxiety, depression or uncoping was observed in 25,7% (n=28), especially in younger women (p=0,46; HR 0,96 [95% CI: 0,93–0,99]. Psycho-oncology support was provided to 82% (n=23) of patients. UHNF was present in 21,1% (n=23). Nephrostomy or ureteral stent was performed before the beginning of treatment in 13,8% (n=15). No difference was observed in OS or DFS in this subgroup. PC was presented to 22% (n=24) patients, although 67% of them were only referred to PC in the last month of life.
Conclusion
CC patients have higher incidence of VTE with negative impact in morbimortality and QoL. More studies are necessary to determine the use of prophylactic anticoagulation, especially in patients with concomitant comorbidities. PD may be underdiagnosed and underrepresented in this study. Raised awareness and psycho-oncology support should be provided. PC support should be involved in the patient and families' lives sooner.
Over the last years, the incidence of brain metastases in HER2 breast cancer patients has increased. Surgery and radiotherapy are the current standard local therapies. Nevertheless, it is unclear which and when systemic treatment should be applied in addition to local treatment. This work aims to present an updated review of current systemic treatment options for patients with HER2+ metastatic breast cancer with brain metastases and to present a case study of clinical cases that occurred in a Portuguese population. The methodology of this work included a literature search in PubMed for the impact of HER2-targeting agents, such as pertuzumab, trastuzumab emtansine (T-DM1), lapatinib, neratinib, trastuzumab deruxtecan, and tucatinib in the treatment of patients with HER2+ breast cancer with brain metastases. Then, a cohort of Portuguese patients with HER2+ breast cancer (n=44) was analyzed. In this exploratory study, considering a follow-up of 23.9 months, three patients (6.8%) developed brain metastases despite having shown a complete pathological response. The role of systemic treatment for patients with HER2 breast cancer with brain metastases has rapidly evolved following recent successes in phase II and III clinical trials. The biggest challenge is how to integrate systemic and local treatment in the management of these patients.
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