Abstract Background: Breast cancer (BC) is the commonest diagnosed cancer in Singaporean women. Increasingly, non-metastatic BC are treated aggressively with neoadjuvant therapy (NAT). Early identification and addressing supportive care needs of NAT treated patients is important for effective cancer care whilst maintaining optimal physical, psychological and social function. This project aims to explore the longitudinal trends of quality of life (QOL) of BC patients enrolled in a NAT program. Methods: This was a prospective cohort study of females aged 21 diagnosed with non-metastatic BC, referred to the NAT program at the SingHealth network of acute hospitals. The Functional Assessment of Cancer Therapy-Breast (FACT-B) was used as a health related QOL measure prior to NAT, within 2 months post definitive breast surgery and at 1-year post diagnosis. In older adults (OA) ≥65 years, the Attitude scale, Now vs Later as well as Health Outcome tool were also performed at baseline. Here we report pre-NAT baseline FACT-B and questionnaire results of OA patients recruited into the NAT program between Jun 2020 and Jun 2021. Results: Pre-NAT median FACT-B scores was 117 (IQR 102-126) for the entire cohort (n=119) and 116 (IQR 104-126) for OA (n=22). OA had significantly lower median Social Wellbeing score at baseline compared to patients < 65 years (p=0.01), while Physical, Emotional, and Functional Wellbeing were not significantly different. More than 50% of OA favoured QOL over quantity of life on the Attitude Scale. 68% of patients would rather have QOL now than 1 year later with half expecting their QOL to reduce by 50% in this time period. When the time scale was extended to 5 years, 64% would rather have QOL 5-years from now instead of QOL now with close to 80% expecting their QOL to be lower in 5 years than presently. Of the 4 outcomes, maintaining independence scored the highest, followed by keeping alive, then reducing/eliminating pain and other symptoms. Conclusion: Our study suggests that OA with BC report similar QOL to younger patients at baseline prior to NAT. Majority of OA patients favoured QOL over quantity of life, and viewed the ability to maintain independence as more important than survival prolongation representing their unique attitude towards cancer treatment and outcomes. Citation Format: Jun Ma, Zewen Zhang, Jasmine Yun Ting Tan, Whee Sze Ong, Sulastri Kamis, Benita Kiat Tee Tan, Veronique Kiak Mien Tan, Ravindran Kanesvaran, Tira Jing Ying Tan. Quality of Life and Perspectives of Older Adults with Early & Locally Advanced Breast Cancers Undergoing Pre-operative Therapy [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 P6-05-21.
Abstract Background: Non-metastatic breast cancers (BC) are increasing treated with neoadjuvant therapy (NAT). Complete pathological response (pCR) is associated with improved survival. Early identification of care needs during NAT is crucial. We report our institution’s experience with NAT. Methods: A prospectively recruited cohort diagnosed with BC, referred to NAT program at SingHealth acute hospitals between June 2020 and June 2021. Demographics, clinical data, pCR (absence of invasive carcinoma in breast and axilla), and Functional Assessment of Cancer Therapy Breast (FACT-B) as quality of life (QOL) measure were collected. Definition of young BC (YBC) were ≤40 years, older adults (OA) ≥65 years. Results: Among 119 eligible patients, 7 (6%) were clinically stage 1, 71 (60%) stage 2, and 41 (35%) stage 3. Twenty-eight (24%) were triple negative (TNBC; defined as HER2- hormonal receptor 0-10% [HR-]), 26 (22%) HER2+ HR-, 45 (38%) HER2+ HR+, 20 (17%) HER2- HR+. Among 71 HER2+ BC, two-thirds received anthracycline (A) based chemotherapy, a quarter A-sparing and remaining 9% taxane only. Majority (89%) received dual HER2 blockade. Among TNBC, 28 (71%) received additional platinum and 2 (7%) immunotherapy. Majority (77%; n=92) completed NAT. Toxicity was main reason for incompletion. Three patients did not undergo surgery: 1 defaulted, 1 demised and the last patient’s surgery was not due at analysis. Of the 116 who underwent surgery, 23 (20%) had breast conservation and 93 (80%) mastectomy. Forty-nine (42%) achieved pCR - 12 (43%) TNBC, 17 (65%) HER2+ HR-, 20 (44%) HER2+ HR+ and 0 in HER2- HR+ (p < 0.001). The pCR rates were also lower by increasing age (Multivariable OR 0.93; 95% CI, 0.90-0.97). Baseline median FACT-B scores was 117 (IQR 102-126) for the cohort: 108 for YBC, 116 for OA and 120 for the rest (p=0.200). At baseline, median score was 28, 24, 18, 22 and 27 in physical, social, emotional, functional wellbeing and BC subscale, respectively, and YBC and OA patients had lower social wellbeing scores than the remaining cohort (22 vs 24, p=0.011). Conclusion: Highest pCR were observed with HER2+ followed by TNBC. Pre-operatively, FACT-B scores were comparable by demographics, staging and tumor subtypes. However, care must be paid to social wellbeing for women in age extremes undergoing NAT. Citation Format: Zewen Zhang, Jun Ma, Jasmine Yun Ting Tan, Whee Sze Ong, Sulastri Kamis, Grace Yang, Benita Kiat Tee Tan, Veronique Kiak Mien Tan, Tira J. Tan. Neoadjuvant therapy in Asian breast cancer patients with early & locally advanced breast cancers – A contemporary experience from a large tertiary hospital in Singapore [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 P4-07-49.
Nanoscience is a new emerging, meaningful, and useful research branch. The important part of nanoscience to me, as well as to many other chemists, is that nanoscience and nanotechnology can help us understand and resolve issues, especially in interfacial area, which could not be settled using traditional chemical/physical theories. For example, the secret of the self-cleaning lotus leaf in nature is revealed by chemists using advanced microscope SEM, which is designed for observing micro/nanostructures. Nanoscaled structure-enhancement effect is found to be critical for obtaining superhydrophobicity. It’s very interesting and it is what I’m concerned with and my research is actually in the interdisciplinary area of chemistry, biology, and nanoscience.
The immune system plays a complex role in the recognition/prevention, early eradication as well as progression of cancer. Recently, we have witnessed great momentum in the field of immuno-oncology. Checkpoint inhibitors and chimeric antigen receptor T cell therapy have now entered the clinic, with impressive and durable clinical responses seen across a broad array of tumor types. There are several lines of evidence supporting the development of an immune targeted approach in breast cancer. Emerging data of early clinical trials evaluating monotherapy checkpoint inhibition have shown modest activity in breast cancer, in particular high grade and aggressive subtypes such as triple negative, human epidermal growth factor receptor 2 (HER2)-positive and luminal B breast cancers. A considerable amount of effort is currently underway in exploring the use of combinatory strategies where therapies with distinct and potentially complementary mechanisms of actions may further enhance the immune response broadening out the group of breast cancer patients who would benefit from this strategy of cancer treatment. In this review, we discuss approaches to targeting the immune system in breast cancer adopted through understanding why the host immune system has failed in natural tumor suppression as well as the processes evolved by the tumor to circumvent an active immune system.
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