Key clinical studies on changing clinical practice of advanced breast cancer in 2022

With the improvement of comprehensive treatment of breast cancer and the continuous development of anti-tumor drugs, the survival time of breast cancer patients, especially advanced breast cancer, has been further extended. In recent years, the treatment of advanced breast cancer has ushered an era of fine classification and precise tiered therapy. In 2022, many breakthroughs have been made in the field of advanced breast cancer research. With changes in the treatment of each subtype, some treatment schemes affecting clinical practice have been incorporated into treatment guidelines. The treatment for hormone-receptor-positive advanced breast cancer focuses on patients who have failed treatment with cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors. Novel anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugates (ADC) in advanced HER2 positive breast cancer are the focus of research. More research evidence is needed for immunotherapy in advanced triple-negative breast cancer (TNBC), and the treatment with ADC targeting Trop-2 has been effective. Treatment with ADC in HER2-low breast cancer are changing clinical practice. In this article, we summarized the research progress of different types of advanced breast cancer in this year, in order to better guide the individualized treatment and improve the prognosis of advanced breast cancer patients

An association of a simultaneous nuclear and cytoplasmic localization of Fra-1 with breast malignancy

BACKGROUND: Overexpression of Fra-1 in fibroblasts causes anchorage-independent cell growth and oncogenic transformation. A high level of Fra-1 expression is found in various tumors and tumorigenic cell lines, suggesting that Fra-1 may be involved in malignant progression. This study aimed to investigate the significance of Fra-1 expression in breast carcinogenesis. METHODS: The expression of Fra-1 was investigated by immunohistochemistry in neoplastic breast diseases ranging from benign fibroadenoma to very aggressive undifferentiated carcinoma. The correlations of Fra-1 expression with other indicators of breast carcinoma prognosis (ER, PR and ErbB2 receptors) were analyzed. RESULTS: All neoplastic breast tissues, either benign or malignant breast tissues, were nuclear immunoreactive for Fra-1-recognizing antibody. The pattern of Fra-1 expression by benign neoplastic cells was predominantly nuclear. However, the nuclear/cytoplasmic concomitant immunoreactivity was observed in all types of breast carcinomas. A clear shift in Fra-1 immunoreactivity, from an exclusively nuclear to a simultaneous nuclear and cytoplasmic localization was noticed in ~90% of breast carcinomas. CONCLUSION: The overall expression, pattern and intensity of Fra-1 proteins were correlated with breast oncogenesis. Overexpression of Fra-1, leading to a persistent high cytoplasmic accumulation, may play a role in the process of breast carcinogenesis

tRNA-Derived Fragments as Novel Predictive Biomarkers for Trastuzumab-Resistant Breast Cancer

Background/Aims: Resistance to trastuzumab remains a common challenge to HER-2 positive breast cancer. Up until now, the underlying mechanism of trastuzumab resistance is still unclear. tRNA-derived small non-coding RNAs, a new class of small non-coding RNA (sncRNAs), have been observed to play an important role in cancer progression. However, the relationship between tRNA-derived fragments and trastuzumab resistance is still unknown. Methods: We detected the levels of tRNA-derived fragments expression in normal breast epithelial cell lines, trastuzumab-sensitive and -resistant breast cancer cell lines using high-throughput sequencing. qRT-PCR was conducted to validate the differentially expressed fragments in serums from trastuzumab-sensitive and -resistant patients. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the power of specific tRNA-derived fragments. Progression-free survival (PFS) was analyzed using Cox-regression. Results: Our sequence results showed that tRNA-derived fragments were differentially expressed in the HBL-100, SKBR3, and JIMT-1 cell lines. tRF-30-JZOYJE22RR33 and tRF-27-ZDXPHO53KSN were found significantly upregulated in trastuzumab-resistant patients compared to sensitive individuals, and the ROC analysis showed that tRF-30-JZOYJE22RR33 and tRF-27-ZDXPHO53KSN were correlated with trastuzumab resistance. In a multivariate analysis, higher levels of tRF-30-JZOYJE22RR33 and tRF-27-ZDXPHO53KSN expression were associated with significantly shorter PFS in patients with metastatic HER-2 positive breast cancer. Conclusion: Our results suggest that tRF-30-JZOYJE22RR33 and tRF-27-ZDXPHO53KSN play important roles in trastuzumab resistance. Patients with high levels of tRF-30-JZOYJE22RR33 and tRF-27-ZDXPHO53KSN expression benefitted less from trastuzumab-based therapy than those that express lower-levels of these molecules. tRF-30-JZOYJE22RR33 and tRF-27-ZDXPHO53KSN may be potential biomarkers and intervention targets in the clinical treatment of trastuzumab-resistant breast cancer

Combination of everolimus with trastuzumab plus paclitaxel as first-line treatment for patients with HER2-positive advanced breast cancer (BOLERO-1) : a phase 3, randomised, double-blind, multicentre trial

BACKGROUND : mTOR inhibition has been shown to reverse trastuzumab resistance from hyperactivated the PIK/AKT/mTOR pathway due to PTEN loss, by sensitizing PTEN-deficient tumors towards trastuzumab. The BOLERO-1 study evaluated the efficacy and safety of adding everolimus to trastuzumab and paclitaxel as first-line therapy for HER2+ advanced breast cancer (ABC). METHODS : In this phase III, randomized, double-blind trial, patients were enrolled across 141 sites in 28 countries. Eligible patients were ≥18 years of age, with locally assessed HER2+ advanced breast cancer (ABC), with Eastern Cooperative Oncology Group performance status of 0-1, who had not received prior trastuzumab or chemotherapy for ABC, had measurable disease as per Response Evaluation Criteria in Solid Tumors or bone lesions in the absence of measurable disease, without prior systemic therapy for advanced disease except endocrine therapy. The patients were randomized 2:1 (with an interactive voice and web response system) to receive either daily everolimus (10 mg/day) orally or placebo plus weekly trastuzumab intravenously at 4 mg/kg loading dose on Day-1 with subsequent weekly doses of 2 mg/kg of each 4-week cycle plus paclitaxel intravenously at a dose of 80 mg/m2 on days 1, 8, and 15 of each 4- week cycle. Randomization was stratified according to prior use of trastuzumab and visceral metastasis. Patients and investigators were blinded to the assigned treatments. Identity of experimental treatments was concealed by use of everolimus and placebo that were identical in packaging, labelling, appearance, and administration schedule. The two primary objectives were investigator-assessed progression-free survival (PFS) in the full study population and in the subset of patients with hormone receptor-negative (HR) breast cancer at baseline; the latter was added during the course of the study, prior to unblinding based on new clinical and biological findings from other studies. All efficacy analyses were based on the intention-to-treat population. Enrolment for this trial is closed and results of the final PFS analyses are presented here. Clinicaltrials.gov identifier: NCT00876395. FINDINGS : Between 10-Sep-2009 and 16-Dec-2012, 719 patients were randomized to receive everolimus (n=480) or placebo (n=239). Median follow-up was 41.3 months (IQR: 35.4 – 46.6 months). INTERPRETATION : The primary objective in the full population was not met; median PFS was 15.0 months with everolimus vs 14.5 months with placebo (hazard ratio, 0.89; 95% CI, 0.73-1.08; p=0.1166). In the HR subpopulation (n=311), median PFS with everolimus was 20.3 months vs 13.1 months with placebo (hazard ratio, 0.66; 95% CI, 0.48-0.91; p=0.0049), however, the protocol-specified statistical significance threshold (p=0.0044) was not crossed. The most common adverse events (AEs) with everolimus vs placebo were stomatitis (314 [66.5%] vs 77 [32.4%] patients), diarrhea (267 [56.6%] vs 111 [46.6%] patients), and alopecia (221 [46.8%] vs 125 [52.5%]). The most frequently reported grade 3/4 AEs in the EVE arm vs PBO arm were neutropenia (117 [24.8%] of 472 patients vs 35 [14.7%] of 238 patients), stomatitis (59 [12.5%] of 472 patients vs 3 [1.3%] of 238 patients), anemia (46 [9.7%] of 472 patients vs 6 [2.5%] of 238 patients) and diarrhea (43 [9.1%] of 472 patients vs 10 [4.2%] of 238 patients) On-treatment AE-related deaths were reported in 17 [3.6%] vs 0% of patients respectively.Interpretation: The primary objective of PFS was not met. However, consistent with the preliminary observations from BOLERO-3, everolimus prolonged median PFS by 7.2 months in patients with HR, HER2+ ABC, which warrants further investigation. The safety profile was generally consistent with what was previously reported in BOLERO-3. Proactive monitoring and early management of AEs in patients treated with everolimus and chemotherapy is critical..Novartis Pharmaceuticals Corporation.http://www.journals.elsevier.com/the-lancet-oncology2016-07-31hb201

Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

The 14th St Gallen International Breast Cancer Conference (2015) reviewed new evidence on locoregional and systemic therapies for early breast cancer. This manuscript presents news and progress since the 2013 meeting, provides expert opinion on almost 200 questions posed to Consensus Panel members, and summarizes treatment-oriented classification of subgroups and treatment recommendation

The complete chloroplast genome sequence of Althaea rosea (L.) Cavan. (Malvaceae) and its phylogenetic analysis

Althaea rosea is a medicinal plant traditionally used in anti-inflammation. In this study, we characterized the complete chloroplast (cp) genome sequence of A. rosea to investigate its phylogenetic relationship. The cp genome of A. rosea was 160,189 bp in length with 37.0% overall GC content, including a large single-copy (LSC) region of 88,046 bp and a small single-copy (SSC) region of 21,055 bp, which were separated by a pair of inverted repeats (IRs) of 25,544 bp. The cp genome contained 128 genes, including 83 protein-coding genes, 37 tRNA genes, and 8 rRNA genes. Phylogenetic analysis based on whole cp genome sequences showed that A. rosea is closest to A. officinalis, and Althaea had a close relationship with Gossypium in Malvaceae

The complete chloroplast genome of Polygonatum ordoratum (Mill.) Druce and its phylogenetic analysis

The first complete chloroplast (cp) genome of Polygonatum ordoratum has been reported in this study. The cp genome was 154,468 bp in length, containing a large single copy-region (LSC) of 83,417 bp, a small single copy-region (SSC) of 18,457 bp, and a pair of inverted repeat regions (IRs) of 26,297 bp, with an overall GC content of 37.76%. The cp genome contained 131 genes, including 85 protein-coding genes, 38 transfer RNA genes, and 8 ribosomal RNA genes. Phylogenetic analysis showed that P. odoratum was classified into a monophyletic group within the genus Polygonatum of Asphodelaceae