Breast Cancer

Fulvestrant, a selective estrogen receptor degrader, is approved for first- and second-line treatment of postmenopausal women with hormone receptor-positive advanced breast cancer (ABC). Meta-analysis of randomized controlled trials (RCTs) evaluating fulvestrant 500 mg in postmenopausal hormone receptor-positive ABC, to evaluate differences in clinical benefit rate (CBR; proportion of patients experiencing best overall response of complete response, partial response, or stable disease for ≥ 24 weeks) between fulvestrant 500 mg and comparator endocrine therapies. Odds ratios (OR) and 95% confidence intervals (CI) for CBR were calculated; fixed effects (FE) models were constructed (first- and second-line data, alone and combined). Six RCTs were included. Four studies evaluated fulvestrant 500 mg vs. fulvestrant 250 mg; two evaluated fulvestrant 500 mg vs. anastrozole 1 mg. In total, 1054 and 534 patients were included (first- and second-line treatment, respectively). Analysis of OR and 95% CI of CBR by therapy line favored fulvestrant 500 mg vs. comparator therapy. Assessing all results combined in the FE model indicated significant improvement in CBR with fulvestrant 500 mg vs. comparator treatments (OR 1.33; 95% CI 1.13–1.57; p = 0.001). Restricting the FE model to therapy line demonstrated significant improvement in CBR vs. comparator treatments (OR 1.33; 95% CI 1.02–1.73; p = 0.035) for first-line, and a trend to improvement vs. comparator treatments (OR 1.27; 95% CI 0.90–1.79; p = 0.174) for second-line. In postmenopausal patients with hormone receptor-positive ABC, fulvestrant 500 mg first-line was associated with significantly greater CBR (more patients benefiting from treatment) vs. comparator endocrine therapy.

Liquid biopsy using circulating tumor DNA (ctDNA) has been reported to be less invasive and effective for comprehensive genetic analysis of heterogeneous solid tumors, including decision-making for therapeutic strategies, predicting recurrence, and detecting genetic factors related to treatment resistance in various types of cancers. Breast cancer, colorectal cancer, and lung cancer are among the most prevalent malignancies worldwide, and clinical studies of liquid biopsy for these cancers are ongoing. Liquid biopsy has been used as a companion diagnostic tool in clinical settings, and research findings have accumulated, especially in cases of colorectal cancer after curative resection and non-small cell lung cancer (NSCLC) after curative chemoradiotherapy, in which ctDNA detection helps predict eligibility for adjuvant chemotherapy. Liquid biopsy using ctDNA shows promise across a wide range of cancer types, including breast cancer, and its clinical applications are expected to expand further through ongoing research. In this article, studies on liquid biopsy in breast cancer, colorectal cancer, and NSCLC are compared focusing on ctDNA.

A case of breast cancer that metastasized to the cervix 10 years and 8 months after mastectomy is reported. The patient had undergone pancreaticoduodenectomy due to solitary metastasis to the head of the pancreas 4 years previously. The cervical metastasis was associated with abnormal genital bleeding. After pancreaticoduodenectomy the serum levels of CEA, CA15-3 and NCC-ST-439, which are markers of breast cancer, were within normal limits, but the serum level of CA15-3 had increased month by month. The patient had abnormal genital bleeding and presented to the department of gynecology at our hospital. The tumor was in the cervix, bled easily and 2.5 × 2.0 cm in size on ultrasonography. It was thought to be carcinoma of the cervix, but biopsy revealed the tumor to be an adenocarcinoma pathologically and CA15-3 was immunohistochemically demonstrated in the resected specimen, similar to lobular carcinoma of the breast. Abdominal CT scan revealed involvement of the ovaries and uterus, prompting hysterectomy with bilateral oophorectomy. After discharge, she received chemoendocrine therapy. However, she subsequently died due to peritoneal carcinomatosis.

We reported that IL-6 and IL-8 levels at the beginning of treatment are predictive indicators of response to therapy and prognosis of patients with recurrent breast cancer. The aim of this study was to investigate the trend of IL-6 and IL-8 levels in heavily pretreated patients with recurrent breast cancer. Cytokine level trends in 12 patients heavily pretreated with anthracyclines were studied. Patients were divided into two groups according to the objective response. There were 5 partial response (PR)/no change (NC), and 7 progressive disease (PD) patients. Blood was taken every four weeks. IL-6 was measured by chemiluminescent enzyme immunoassay. IL-8 was measured by ELISA. The pretreatment level of IL-6 in the PR/NC group (11.0±2.1 pg/ml) was significantly lower than that (15.3±2.7 pg/ml) in the PD group. However, there was no difference in IL-8 level between the PR/NC group (12.5±5.5 pg/ml) and the PD group (11.5±1.1 pg/ml). IL-6 levels in the PR/NC group were maintained within normal levels or decreased to within normal levels after treatment, while levels of IL-6 in the PD group gradually increased until the time of patient death. A decrease in IL-8 level after treatment was observed in only one patient in the PR/NC group. Mild increase of IL-8 levels was observed in the PD group. Continuous elevation of IL-6 levels indicates poor prognosis in heavily pretreated patients with recurrent breast cancer. Combination therapy including agents that reduce IL-6 levels will be a new strategy for aggressively treating recurrent breast cancer.

This rapid communication highlights the correlations between digital pathology—whole slide imaging (WSI) and radiomics—magnetic resonance imaging (MRI) features in triple-negative breast cancer (TNBC) patients. The research collected 12 patients who had both core needle biopsy and MRI performed to evaluate pathologic complete response (pCR). The results showed that higher collagenous values in pathology data were correlated with more homogeneity, whereas higher tumor expression values in pathology data correlated with less homogeneity in the appearance of tumors on MRI by size zone non-uniformity normalized (SZNN). Higher myxoid values in pathology data are correlated with less similarity of gray-level non-uniformity (GLN) in tumor regions on MRIs, while higher immune values in WSIs correlated with the more joint distribution of smaller-size zones by small area low gray-level emphasis (SALGE) in the tumor regions on MRIs. Pathologic complete response (pCR) was associated with collagen, tumor, and myxoid expression in WSI and GLN and SZNN in radiomic features. The correlations of WSI and radiomic features may further our understanding of the TNBC tumoral microenvironment (TME) and could be used in the future to better tailor the use of neoadjuvant chemotherapy (NAC). This communication will focus on the post-NAC MRI features correlated with pCR and their association with WSI features from core needle biopsies.

This paper describes a very rare case of stromal sarcoma of the breast coexisting with simultaneous noninvasive ductal carcinoma in the same breast. A 75-year-old female was seen at our hospital for a lump in the right breast. On physical examination, a 10 X 8 cm well-defined and movable hard mass with a smooth surface was palpated in the upper outer quadrant of the breast. Aspiration cytology suggested a non-epithelial tumor with marked dysplasia (class 3b). Drill biopsy revealed probable stromal sarcoma. Simple mastectomy and axillary lymphonode sampling was performed. Histologically, the tumor was stromal sarcoma in the upper outer quadrant of the breast. In addition, noninvasive ductal carcinoma was simultaneously detected in the upper inner quadrant of the breast as an independent lesion. No positive axillary nodes were found. To date, as far as we could investigate, there was no preceding case report of both stromal sarcoma and carcinoma in a single patient at the same time.

The Japanese NPO Central Committee on Quality Control of Mammographic Screening has initiated international exchange activities regarding quality control of mammographic screening with the concerned organizations in East Asian countries with the objective of contributing to reducing breast cancer mortality in the region. This paper describes the status of the international exchanges that are being carried out in various East Asian countries in relation to mammography and also discusses future aspects.