Faculty Bibliography

BACKGROUND:Neoadjuvant chemotherapy has been used to downstage locally advanced ER+/HER2- breast cancer with low response rates. The optimal neoadjuvant regimen for this population is unknown. PATIENTS AND METHODS/METHODS:Between 2017 and 2022, 192 patients (ages 28-78) with stage II/III ER+/Her2- breast cancer at our institution were evaluated. Patients were divided into 4 groups based on the neoadjuvant chemotherapy regimen used (AC-T, TC, TAC, or other). The responses were categorized as complete (ypT0/is ypN0), partial, no response, or progressive disease. RESULTS:The choice of neoadjuvant chemotherapy was not predictive of pCR (P = .3864), even among those with more advanced nodal disease. No significant difference was noted in OS or IDFS at 24 or 48 months between the AC-T and TC groups. In the AC-T group (n = 130), 9 patients had a CR (6.98%), while no patients in TC group had a CR. Those who were premenopausal were more likely to achieve pCR compared to those postmenopausal. Race significantly impacted IDFS. CONCLUSIONS:In this single center study, we found no differences in IDFS or OS when comparing neoadjuvant TC to AC-T. The AC-T regimen group had a higher pCR rate of 6.98% compared to 0% in TC regimen group. Further exploration is needed to understand why non-white populations have inferior IDFS.

BACKGROUND:Metastatic hormone receptor positive (HR+)/human epidermal growth factor receptor-2 negative (Her2-) breast cancer remains a significant cause of cancer-related mortality. First-line treatment with endocrine therapy (ET) with a cyclin-dependent kinases 4 and 6 inhibitor (CDK4/6i) has largely become the standard systemic therapy. Following progression, no prospective randomized data exist to help guide second-line treatment. MATERIALS AND METHODS:This study used a nationwide electronic health record (EHR)-derived de-identified database, specifically analyzing 1210 patients with HR+/Her2- metastatic breast cancer (MBC) who were treated in the first-line setting with a CDK4/6i from the years 2015-2020. The aim of this study was to assess what therapies were given after first-line progression on CDK4/6i and to observe treatment patterns over time. Determination of second-line treatment efficacy, specifically assessing real-world progression-free survival (rwPFS) and overall survival (OS) was performed. RESULTS:A total of 839 patients received a documented second-line therapy after progression on first-line CDK4/6i treatment. Chemotherapy was chosen for 29.7% of patients, and the use of chemotherapy decreased over time. Three hundred two (36.0%) of patients continued a CDK4/6i. Data were adjusted for age, race, Eastern Cooperative Oncology Group (ECOG) performance status, stage at breast cancer diagnosis, and insurance payer type. Continuation of the CDK4/6i was associated with improved rwPFS (HR 0.48, 95% CI 0.43-0.53, P < .0001) and OS (HR 0.30, 95% CI 0.26-0.35, P < .0001) compared to chemotherapy. A majority of these patients continued the same CDK4/6i in the second-line setting, as was given in the first-line setting. CONCLUSION:While prospective data are needed, analysis of real-world data suggests a survival benefit for continuation of a CDK4/6i beyond frontline progression for patients with HR+/Her2- MBC.

The term "CD30+ T-cell lymphoproliferative disorders" describes a group of diverse diseases of the skin, subcutaneous tissues and mucosa that range from lesions requiring clinical observation to those necessitating systemic cytotoxic chemotherapy. Careful consideration of both clinical and histopathologic presentation is needed for appropriate diagnosis and treatment. This review will present the current classification of these disorders and potential treatment paradigms. Primary cutaneous CD30+ T-cell lymphoproliferative disorders, breast-implant associated anaplastic large-cell lymphoma and mucosal entities will be discussed.

Hormone-receptor-positive breast cancer is the most common subtype of breast cancer among patients with both early-stage and metastatic disease. Recent advances in the understanding of its pathophysiology have led to the discovery and utilization of targeted inhibitors to cyclin-dependent kinases 4 and 6 (CDK4/6). There are currently three available CDK4/6 inhibitors available for use in USA: palbociclib, ribociclib, and abemaciclib. Their oral administration and tolerable toxicities make this class of agents appealing to both patients and health care providers. Abemaciclib, the most recently approved CDK4/6 inhibitor, has unique pharmacologic properties and potential toxicities. This review highlights the current understanding of abemaciclib and discusses its current and future roles in the treatment of breast cancer.

Acute Myeloid Leukemia (AML) is an aggressive bone marrow malignancy that is fatal if left untreated. Previous classification was strictly based on morphology, which gave little information in terms of prognosis or guide to treatment. Recent research has provided vital information into the chromosomal and molecular pathogenesis of leukemia development. The discovery of these abnormalities via proteomics and genomics have provided two key insights. First, these novel discoveries provide prognostic significance into the predictive result of chemotherapy. Second, these chromosomal and protein abnormalities have provided potential drug targets for new treatment modalities. This article will elaborate on many of these new molecular findings and discuss their implications on the treatment of AML.