Key clinical point: Receptor profiles and the presence of extracranial visceral metastases were significant predictors of prognosis in patients with metastatic breast cancer (BC) who had brain metastases and underwent stereotactic radiosurgery (SRS).

Major finding: The median overall survival (OS) was 14.8 months for the entire cohort. OS outcomes worsened in patients with estrogen receptor-negative (ER−)/human epidermal growth factor receptor 2-negative (HER2−) BC (hazard ratio [HR] 2.00; 95% CI 1.09-3.67) but were better in those with ER+/HER2+ BC (HR 0.43; 95% CI 0.19-0.96). The presence of extracranial visceral metastases (HR 2.90; 95% CI 1.53-5.50) was also associated with poor survival outcomes.

Study details: Findings are from a retrospective analysis of a cohort including 149 patients with metastatic breast cancer and brain metastases underwent received SRS.

Disclosures: This study was supported by Lundbeck Foundation, Copenhagen. The authors declared no conflicts of interest.

Source: Depner JF et al. Treating brain metastases in metastatic breast cancer: Outcomes after stereotactic radiosurgery examined in a retrospective, single-center cohort analysis. Acta Oncol. 2023 (Sep 26). doi: 10.1080/0284186X.2023.2260942

Key clinical point: Receptor profiles and the presence of extracranial visceral metastases were significant predictors of prognosis in patients with metastatic breast cancer (BC) who had brain metastases and underwent stereotactic radiosurgery (SRS).

Major finding: The median overall survival (OS) was 14.8 months for the entire cohort. OS outcomes worsened in patients with estrogen receptor-negative (ER−)/human epidermal growth factor receptor 2-negative (HER2−) BC (hazard ratio [HR] 2.00; 95% CI 1.09-3.67) but were better in those with ER+/HER2+ BC (HR 0.43; 95% CI 0.19-0.96). The presence of extracranial visceral metastases (HR 2.90; 95% CI 1.53-5.50) was also associated with poor survival outcomes.

Study details: Findings are from a retrospective analysis of a cohort including 149 patients with metastatic breast cancer and brain metastases underwent received SRS.

Disclosures: This study was supported by Lundbeck Foundation, Copenhagen. The authors declared no conflicts of interest.

Source: Depner JF et al. Treating brain metastases in metastatic breast cancer: Outcomes after stereotactic radiosurgery examined in a retrospective, single-center cohort analysis. Acta Oncol. 2023 (Sep 26). doi: 10.1080/0284186X.2023.2260942

Key clinical point: Receptor profiles and the presence of extracranial visceral metastases were significant predictors of prognosis in patients with metastatic breast cancer (BC) who had brain metastases and underwent stereotactic radiosurgery (SRS).

Major finding: The median overall survival (OS) was 14.8 months for the entire cohort. OS outcomes worsened in patients with estrogen receptor-negative (ER−)/human epidermal growth factor receptor 2-negative (HER2−) BC (hazard ratio [HR] 2.00; 95% CI 1.09-3.67) but were better in those with ER+/HER2+ BC (HR 0.43; 95% CI 0.19-0.96). The presence of extracranial visceral metastases (HR 2.90; 95% CI 1.53-5.50) was also associated with poor survival outcomes.

Study details: Findings are from a retrospective analysis of a cohort including 149 patients with metastatic breast cancer and brain metastases underwent received SRS.

Disclosures: This study was supported by Lundbeck Foundation, Copenhagen. The authors declared no conflicts of interest.

Source: Depner JF et al. Treating brain metastases in metastatic breast cancer: Outcomes after stereotactic radiosurgery examined in a retrospective, single-center cohort analysis. Acta Oncol. 2023 (Sep 26). doi: 10.1080/0284186X.2023.2260942

Key clinical point: Surgical removal of the primary tumor failed to prolong survival and may not be necessary in patients with de novo metastatic breast cancer (BC).

Major finding: In women with de novo metastatic BC, primary breast tumor surgery vs no surgery improved the local progression-free survival outcomes (hazard ratio [HR] 0.37; 95% CI 0.19-0.74) but not the overall survival (HR 0.93; 95% CI 0.76-1.14).

Study details: Findings are from a meta-analysis of five randomized controlled trials including 1381 patients with de novo metastatic BC, of whom 49.6% underwent primary breast tumor surgery.

Disclosures: This study did not receive any specific funding. Three authors declared having advisory roles, serving as consultants, or receiving speaker fees, consulting fees, or unrelated research grants from various sources.

Source: Villacampa G et al. Impact of primary breast surgery on overall survival of patients with de novo metastatic breast cancer: A systematic review and meta-analysis. Oncologist. 2023 (Sep 12). doi: 10.1093/oncolo/oyad266

Key clinical point: Surgical removal of the primary tumor failed to prolong survival and may not be necessary in patients with de novo metastatic breast cancer (BC).

Major finding: In women with de novo metastatic BC, primary breast tumor surgery vs no surgery improved the local progression-free survival outcomes (hazard ratio [HR] 0.37; 95% CI 0.19-0.74) but not the overall survival (HR 0.93; 95% CI 0.76-1.14).

Study details: Findings are from a meta-analysis of five randomized controlled trials including 1381 patients with de novo metastatic BC, of whom 49.6% underwent primary breast tumor surgery.

Disclosures: This study did not receive any specific funding. Three authors declared having advisory roles, serving as consultants, or receiving speaker fees, consulting fees, or unrelated research grants from various sources.

Source: Villacampa G et al. Impact of primary breast surgery on overall survival of patients with de novo metastatic breast cancer: A systematic review and meta-analysis. Oncologist. 2023 (Sep 12). doi: 10.1093/oncolo/oyad266

Key clinical point: Surgical removal of the primary tumor failed to prolong survival and may not be necessary in patients with de novo metastatic breast cancer (BC).

Major finding: In women with de novo metastatic BC, primary breast tumor surgery vs no surgery improved the local progression-free survival outcomes (hazard ratio [HR] 0.37; 95% CI 0.19-0.74) but not the overall survival (HR 0.93; 95% CI 0.76-1.14).

Study details: Findings are from a meta-analysis of five randomized controlled trials including 1381 patients with de novo metastatic BC, of whom 49.6% underwent primary breast tumor surgery.

Disclosures: This study did not receive any specific funding. Three authors declared having advisory roles, serving as consultants, or receiving speaker fees, consulting fees, or unrelated research grants from various sources.

Source: Villacampa G et al. Impact of primary breast surgery on overall survival of patients with de novo metastatic breast cancer: A systematic review and meta-analysis. Oncologist. 2023 (Sep 12). doi: 10.1093/oncolo/oyad266

Key clinical point: Patritumab deruxtecan (HER3-DXd) showed meaningful clinical efficacy and a manageable safety profile across breast cancer (BC) subtypes in heavily pretreated patients with human epidermal growth factor receptor 3 (HER3)-expressing metastatic BC.

Major finding: The objective response rate was 30.1% (95% CI 21.8%-39.4%) in hormone receptor-positive/HER2-negative BC, 22.6% (95% CI 12.3%-36.2%) in triple-negative BC, and 42.9% (95% CI 17.1%-71.1%) in HER2-positive BC. Although 71.4% of patients reported grade ≥3 treatment-emergent adverse events (TEAE), the overall rate of treatment discontinuation due to TEAE was low (9.9%).

Study details: Findings are from a phase I/II trial including 182 heavily pretreated patients with HER3-expressing advanced BC who received HER3-DXd.

Disclosures: This trial was sponsored by Daiichi Sankyo Co., Ltd. Nine authors declared being employees of or holding stocks and other ownership interests in Daiichi Sankyo. The other authors declared ties with various sources, including Daiichi Sankyo.

Source: Krop IE et al. Patritumab deruxtecan (HER3-DXd), a human epidermal growth factor receptor 3-directed antibody-drug conjugate, in patients with previously treated human epidermal growth factor receptor 3-expressing metastatic breast cancer: A multicenter, phase I/II trial. J Clin Oncol. 2023 (Oct 6). doi: 10.1200/JCO.23.00882

Key clinical point: Patritumab deruxtecan (HER3-DXd) showed meaningful clinical efficacy and a manageable safety profile across breast cancer (BC) subtypes in heavily pretreated patients with human epidermal growth factor receptor 3 (HER3)-expressing metastatic BC.

Major finding: The objective response rate was 30.1% (95% CI 21.8%-39.4%) in hormone receptor-positive/HER2-negative BC, 22.6% (95% CI 12.3%-36.2%) in triple-negative BC, and 42.9% (95% CI 17.1%-71.1%) in HER2-positive BC. Although 71.4% of patients reported grade ≥3 treatment-emergent adverse events (TEAE), the overall rate of treatment discontinuation due to TEAE was low (9.9%).

Study details: Findings are from a phase I/II trial including 182 heavily pretreated patients with HER3-expressing advanced BC who received HER3-DXd.

Disclosures: This trial was sponsored by Daiichi Sankyo Co., Ltd. Nine authors declared being employees of or holding stocks and other ownership interests in Daiichi Sankyo. The other authors declared ties with various sources, including Daiichi Sankyo.

Source: Krop IE et al. Patritumab deruxtecan (HER3-DXd), a human epidermal growth factor receptor 3-directed antibody-drug conjugate, in patients with previously treated human epidermal growth factor receptor 3-expressing metastatic breast cancer: A multicenter, phase I/II trial. J Clin Oncol. 2023 (Oct 6). doi: 10.1200/JCO.23.00882

Key clinical point: Patritumab deruxtecan (HER3-DXd) showed meaningful clinical efficacy and a manageable safety profile across breast cancer (BC) subtypes in heavily pretreated patients with human epidermal growth factor receptor 3 (HER3)-expressing metastatic BC.

Major finding: The objective response rate was 30.1% (95% CI 21.8%-39.4%) in hormone receptor-positive/HER2-negative BC, 22.6% (95% CI 12.3%-36.2%) in triple-negative BC, and 42.9% (95% CI 17.1%-71.1%) in HER2-positive BC. Although 71.4% of patients reported grade ≥3 treatment-emergent adverse events (TEAE), the overall rate of treatment discontinuation due to TEAE was low (9.9%).

Study details: Findings are from a phase I/II trial including 182 heavily pretreated patients with HER3-expressing advanced BC who received HER3-DXd.

Disclosures: This trial was sponsored by Daiichi Sankyo Co., Ltd. Nine authors declared being employees of or holding stocks and other ownership interests in Daiichi Sankyo. The other authors declared ties with various sources, including Daiichi Sankyo.

Source: Krop IE et al. Patritumab deruxtecan (HER3-DXd), a human epidermal growth factor receptor 3-directed antibody-drug conjugate, in patients with previously treated human epidermal growth factor receptor 3-expressing metastatic breast cancer: A multicenter, phase I/II trial. J Clin Oncol. 2023 (Oct 6). doi: 10.1200/JCO.23.00882

Key clinical point: Neoadjuvant chemotherapy (NAC) may increase the odds of a pathological complete response (pCR) in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC) and BRCA1 mutation vs in those with sporadic BC.

Major finding: The rate of achieving a pCR was significantly higher in BRCA1/2 and BRCA1 mutation carriers vs non-carriers (16% and 38%, respectively, vs 7.8%; P < .001), with BRCA1 mutation carrier vs non-carrier status being associated with higher odds of achieving a pCR (odds ratio 6.31; P = .002).

Study details: Findings are from a retrospective study including 522 patients with HR+/HER2− BC who received NAC, of whom 21 and 38 patients had BRCA1 and BRCA2 mutations, respectively.

Disclosures: This study was partly supported by a  US National Institutes of Health/National Cancer Institute Cancer Center Support grant. The authors declared no conflicts of interest.

Source: Myers SP et al. Mutational status is associated with a higher rate of pathologic complete response after neoadjuvant chemotherapy in hormone receptor-positive breast cancer. Ann Surg Oncol. 2023 (Oct 5). doi: 10.1245/s10434-023-14319-0

Key clinical point: Neoadjuvant chemotherapy (NAC) may increase the odds of a pathological complete response (pCR) in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC) and BRCA1 mutation vs in those with sporadic BC.

Major finding: The rate of achieving a pCR was significantly higher in BRCA1/2 and BRCA1 mutation carriers vs non-carriers (16% and 38%, respectively, vs 7.8%; P < .001), with BRCA1 mutation carrier vs non-carrier status being associated with higher odds of achieving a pCR (odds ratio 6.31; P = .002).

Study details: Findings are from a retrospective study including 522 patients with HR+/HER2− BC who received NAC, of whom 21 and 38 patients had BRCA1 and BRCA2 mutations, respectively.

Disclosures: This study was partly supported by a  US National Institutes of Health/National Cancer Institute Cancer Center Support grant. The authors declared no conflicts of interest.

Source: Myers SP et al. Mutational status is associated with a higher rate of pathologic complete response after neoadjuvant chemotherapy in hormone receptor-positive breast cancer. Ann Surg Oncol. 2023 (Oct 5). doi: 10.1245/s10434-023-14319-0

Key clinical point: Neoadjuvant chemotherapy (NAC) may increase the odds of a pathological complete response (pCR) in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC) and BRCA1 mutation vs in those with sporadic BC.

Major finding: The rate of achieving a pCR was significantly higher in BRCA1/2 and BRCA1 mutation carriers vs non-carriers (16% and 38%, respectively, vs 7.8%; P < .001), with BRCA1 mutation carrier vs non-carrier status being associated with higher odds of achieving a pCR (odds ratio 6.31; P = .002).

Study details: Findings are from a retrospective study including 522 patients with HR+/HER2− BC who received NAC, of whom 21 and 38 patients had BRCA1 and BRCA2 mutations, respectively.

Disclosures: This study was partly supported by a  US National Institutes of Health/National Cancer Institute Cancer Center Support grant. The authors declared no conflicts of interest.

Source: Myers SP et al. Mutational status is associated with a higher rate of pathologic complete response after neoadjuvant chemotherapy in hormone receptor-positive breast cancer. Ann Surg Oncol. 2023 (Oct 5). doi: 10.1245/s10434-023-14319-0

Key clinical point: A majority of patients with metastatic breast cancer (BC) who received alpelisib developed hyperglycemia of any grade, with alpelisib-associated hyperglycemia being more prevalent in standard clinical practice than in clinical trials.

Major finding: Overall, 61.5% of patients developed any-grade hyperglycemia, with the rate being considerably higher in patients who received alpelisib as part of standard care vs clinical trial (80.3% vs 34.0%). Baseline body mass index ≥ 25 kg/m² (P = .036) and A1c levels in the prediabetes and diabetes range (P < .001) were significantly associated with the development of any-grade hyperglycemia.

Study details: Findings are from a retrospective cohort study including 247 patients with metastatic BC who received alpelisib either as standard care (n = 147) or in a clinical trial setting (n = 100).

Disclosures: This work was supported partly by the US National Institutes of Health/National Cancer Institute. Some authors declared receiving honoraria, research funding, or consultant fees from some sources.

Source: Shen S et al. Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer. Cancer. 2023 (Sep 25). doi: 10.1002/cncr.34928

Key clinical point: A majority of patients with metastatic breast cancer (BC) who received alpelisib developed hyperglycemia of any grade, with alpelisib-associated hyperglycemia being more prevalent in standard clinical practice than in clinical trials.

Major finding: Overall, 61.5% of patients developed any-grade hyperglycemia, with the rate being considerably higher in patients who received alpelisib as part of standard care vs clinical trial (80.3% vs 34.0%). Baseline body mass index ≥ 25 kg/m² (P = .036) and A1c levels in the prediabetes and diabetes range (P < .001) were significantly associated with the development of any-grade hyperglycemia.

Study details: Findings are from a retrospective cohort study including 247 patients with metastatic BC who received alpelisib either as standard care (n = 147) or in a clinical trial setting (n = 100).

Disclosures: This work was supported partly by the US National Institutes of Health/National Cancer Institute. Some authors declared receiving honoraria, research funding, or consultant fees from some sources.

Source: Shen S et al. Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer. Cancer. 2023 (Sep 25). doi: 10.1002/cncr.34928

Key clinical point: A majority of patients with metastatic breast cancer (BC) who received alpelisib developed hyperglycemia of any grade, with alpelisib-associated hyperglycemia being more prevalent in standard clinical practice than in clinical trials.

Major finding: Overall, 61.5% of patients developed any-grade hyperglycemia, with the rate being considerably higher in patients who received alpelisib as part of standard care vs clinical trial (80.3% vs 34.0%). Baseline body mass index ≥ 25 kg/m² (P = .036) and A1c levels in the prediabetes and diabetes range (P < .001) were significantly associated with the development of any-grade hyperglycemia.

Study details: Findings are from a retrospective cohort study including 247 patients with metastatic BC who received alpelisib either as standard care (n = 147) or in a clinical trial setting (n = 100).

Disclosures: This work was supported partly by the US National Institutes of Health/National Cancer Institute. Some authors declared receiving honoraria, research funding, or consultant fees from some sources.

Source: Shen S et al. Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer. Cancer. 2023 (Sep 25). doi: 10.1002/cncr.34928

Key clinical point: Chemotherapy-free front-line treatment with dalpiciclib plus pyrotinib demonstrated promising efficacy and manageable safety in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: At a median follow-up of 25.9 months, 28 (70%) patients had a confirmed objective response, with 2 and 26 patients achieving complete and partial responses, respectively. Grades 3 and 4 treatment-related adverse events were reported by 82.9% and 12.2% of patients respectively, and of these, decreased white blood cells, decreased neutrophil count, diarrhea, and anemia were the most common.

Study details: Findings are from a single arm phase 2 study including 41 patients with HER2+ advanced BC who received front-line treatment with dalpiciclib+pyrotinib.

Disclosures: This study was funded by the XINRUI Project of Cancer Supportive Care and Treatment Research, China. H Li declared serving as an employee of Jiangsu Hengrui Pharmaceuticals Co., Ltd. (Shanghai, China) during the study period.

Source: Yan M et al. Dalpiciclib and pyrotinib in women with HER2-positive advanced breast cancer: A single-arm phase II trial. Nat Commun. 2023;14:6272 (Oct 7). doi: 10.1038/s41467-023-41955-7

Key clinical point: Chemotherapy-free front-line treatment with dalpiciclib plus pyrotinib demonstrated promising efficacy and manageable safety in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: At a median follow-up of 25.9 months, 28 (70%) patients had a confirmed objective response, with 2 and 26 patients achieving complete and partial responses, respectively. Grades 3 and 4 treatment-related adverse events were reported by 82.9% and 12.2% of patients respectively, and of these, decreased white blood cells, decreased neutrophil count, diarrhea, and anemia were the most common.

Study details: Findings are from a single arm phase 2 study including 41 patients with HER2+ advanced BC who received front-line treatment with dalpiciclib+pyrotinib.

Disclosures: This study was funded by the XINRUI Project of Cancer Supportive Care and Treatment Research, China. H Li declared serving as an employee of Jiangsu Hengrui Pharmaceuticals Co., Ltd. (Shanghai, China) during the study period.

Source: Yan M et al. Dalpiciclib and pyrotinib in women with HER2-positive advanced breast cancer: A single-arm phase II trial. Nat Commun. 2023;14:6272 (Oct 7). doi: 10.1038/s41467-023-41955-7

Key clinical point: Chemotherapy-free front-line treatment with dalpiciclib plus pyrotinib demonstrated promising efficacy and manageable safety in patients with human epidermal growth factor receptor 2-positive (HER2+) advanced breast cancer (BC).

Major finding: At a median follow-up of 25.9 months, 28 (70%) patients had a confirmed objective response, with 2 and 26 patients achieving complete and partial responses, respectively. Grades 3 and 4 treatment-related adverse events were reported by 82.9% and 12.2% of patients respectively, and of these, decreased white blood cells, decreased neutrophil count, diarrhea, and anemia were the most common.

Study details: Findings are from a single arm phase 2 study including 41 patients with HER2+ advanced BC who received front-line treatment with dalpiciclib+pyrotinib.

Disclosures: This study was funded by the XINRUI Project of Cancer Supportive Care and Treatment Research, China. H Li declared serving as an employee of Jiangsu Hengrui Pharmaceuticals Co., Ltd. (Shanghai, China) during the study period.

Source: Yan M et al. Dalpiciclib and pyrotinib in women with HER2-positive advanced breast cancer: A single-arm phase II trial. Nat Commun. 2023;14:6272 (Oct 7). doi: 10.1038/s41467-023-41955-7

Key clinical point: In patients with breast cancer (BC), hypofractionated proton postmastectomy radiotherapy (PMRT), which is administered in larger doses and fewer sessions, showed similar rates of complications as conventional fractionated proton PMRT.

Major finding: At a median follow-up of 39.3 months, both conventional fractionated and hypofractionated proton PMRT had similar complication rates (15% vs 20%; absolute difference 4.9%; one-sided 95% CI 18.5; P = .27), with all complications occurring in patients with immediate expander or implant-based reconstruction.

Study details: Findings are from the phase 2 MC1631 trial including 82 patients with BC who underwent mastectomy with or without immediate breast reconstruction and were randomly assigned to receive either conventional fractionated (50 Gy in 25 fractions of 2 Gy) or hypofractionated (40.05 Gy in 15 fractions of 2.67 Gy) proton PMRT.

Disclosures: This study was partly supported by Mayo Clinic and other sources. The lead author declared serving as co-chair of the Breast Cancer Subcommittee of the Particle Therapy Cooperative Group.

Source: Mutter RW et al. Conventional versus hypofractionated postmastectomy proton radiotherapy in the USA (MC1631): A randomised phase 2 trial. Lancet Oncol. 2023 24(10):1083-1093 (Sep 8). doi: 10.1016/S1470-2045(23)00388-1

Key clinical point: In patients with breast cancer (BC), hypofractionated proton postmastectomy radiotherapy (PMRT), which is administered in larger doses and fewer sessions, showed similar rates of complications as conventional fractionated proton PMRT.

Major finding: At a median follow-up of 39.3 months, both conventional fractionated and hypofractionated proton PMRT had similar complication rates (15% vs 20%; absolute difference 4.9%; one-sided 95% CI 18.5; P = .27), with all complications occurring in patients with immediate expander or implant-based reconstruction.

Study details: Findings are from the phase 2 MC1631 trial including 82 patients with BC who underwent mastectomy with or without immediate breast reconstruction and were randomly assigned to receive either conventional fractionated (50 Gy in 25 fractions of 2 Gy) or hypofractionated (40.05 Gy in 15 fractions of 2.67 Gy) proton PMRT.

Disclosures: This study was partly supported by Mayo Clinic and other sources. The lead author declared serving as co-chair of the Breast Cancer Subcommittee of the Particle Therapy Cooperative Group.

Source: Mutter RW et al. Conventional versus hypofractionated postmastectomy proton radiotherapy in the USA (MC1631): A randomised phase 2 trial. Lancet Oncol. 2023 24(10):1083-1093 (Sep 8). doi: 10.1016/S1470-2045(23)00388-1

Key clinical point: In patients with breast cancer (BC), hypofractionated proton postmastectomy radiotherapy (PMRT), which is administered in larger doses and fewer sessions, showed similar rates of complications as conventional fractionated proton PMRT.

Major finding: At a median follow-up of 39.3 months, both conventional fractionated and hypofractionated proton PMRT had similar complication rates (15% vs 20%; absolute difference 4.9%; one-sided 95% CI 18.5; P = .27), with all complications occurring in patients with immediate expander or implant-based reconstruction.

Study details: Findings are from the phase 2 MC1631 trial including 82 patients with BC who underwent mastectomy with or without immediate breast reconstruction and were randomly assigned to receive either conventional fractionated (50 Gy in 25 fractions of 2 Gy) or hypofractionated (40.05 Gy in 15 fractions of 2.67 Gy) proton PMRT.

Disclosures: This study was partly supported by Mayo Clinic and other sources. The lead author declared serving as co-chair of the Breast Cancer Subcommittee of the Particle Therapy Cooperative Group.

Source: Mutter RW et al. Conventional versus hypofractionated postmastectomy proton radiotherapy in the USA (MC1631): A randomised phase 2 trial. Lancet Oncol. 2023 24(10):1083-1093 (Sep 8). doi: 10.1016/S1470-2045(23)00388-1

HONOLULU – Patients with acute respiratory distress syndrome (ARDS) and coexisting pulmonary hypertension (PH) are significantly more likely to have longer and more costly hospital stays and to die in-hospital than patients with ARDS without PH, results of a retrospective study suggest.

Among more than 156,000 hospitalized patients with ARDS, 16.8% of whom also had a diagnosis of PH, the presence of PH was associated with about a 50% higher risk for in-hospital mortality and a 37% higher risk for longer hospital stays. In addition, the presence of PH was associated with nearly $20,000 of higher hospital expenditures, reported Kaushik Kumar, MBBS, at the annual meeting of the American College of Chest Physicians (CHEST).

“Clinicians should be vigilant in identifying and managing pulmonary hypertension in ARDS patients,” Dr. Kumar, a resident in internal medicine at Medstar Health, Baltimore, said in an oral abstract presentation.

He added that PH has the potential to serve as an indicator of disease severity for patients with ARDS.
 

National database

PH is a frequent complication of ARDS, likely related to a combination of pulmonary vasoconstriction, thromboembolism, and interstitial edema, he said.

To test their hypothesis that the presence of PH in patients with ARDS is associated with worse outcomes, Dr. Kumar and colleagues drew on the National Inpatient Sample database for information on adults aged 18 years and older who had been diagnosed with ARDS with or without PH.

They identified a total of 156,687 patients of whom 26,324 (16.8%) also had been diagnosed with PH. Among the cohort with PH, there were higher proportions of older patients, women, and patients with multiple comorbidities.

The in-hospital mortality rate was 36.8% among patients with PH, compared with 24.6% among those without. The mean length of stay was also longer among patients with PH, at 12 days versus 10 days.

In an unadjusted analysis, mean total hospital charges for patients with ARDS and PH were $210,165, versus $160,683 for patients with ARDS who did not have PH.

In an analysis in which the investigators controlled for age, sex, index admission length of stay, insurance status, and comorbidities, in-hospital mortality for patients with PH remained significantly higher, with an odds ratio of 1.52 (P < .001). PH was also significantly associated with longer length of stay (odds ratio, 1.37; P < .001) and higher total hospital costs, with a mean difference of $19,406.

Dr. Kumar said that the findings underscore the importance of a tailored approach to managing patients with ARDS, especially in the presence of PH.

The investigators plan further studies to assess the role of PH-targeted therapies, to examine the role of sepsis and right ventricular failure and to explore the long-term impact of PH among ARDS survivors, including effects with respect to pulmonary function, quality of life, and long-term morbidity.
 

Potential to inform practice

A pulmonologist who was not involved in the study said in an interview that the findings of the trial suggest that PH may have a greater influence on mortality than is currently understood and that further investigations into this association could change practice in the future.

“I think it would be very important for us to understand if that is going to change our outlook on how ARDS is managed. It’s possible that some of the interventions that we give people who don’t have pulmonary hypertension, for example, increasing the airway pressure in order to minimize oxygenation, may have a detrimental effect on the pulmonary vasculature,” said Timothy Morris, MD, medical director of the pulmonary and exercise lab and professor of medicine at the University of California, San Diego.

“I think it’s a little bit premature to say that this should guide management now, but it’s certainly an interesting question that may end up changing practice in the future,” said Dr. Morris, who was moderator of the session in which Dr. Kumar presented the data.

The study was supported by the Agency for Healthcare Research and Quality and Medstar Health Research Institute. Dr. Kumar and Dr. Morris have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

HONOLULU – Patients with acute respiratory distress syndrome (ARDS) and coexisting pulmonary hypertension (PH) are significantly more likely to have longer and more costly hospital stays and to die in-hospital than patients with ARDS without PH, results of a retrospective study suggest.

Among more than 156,000 hospitalized patients with ARDS, 16.8% of whom also had a diagnosis of PH, the presence of PH was associated with about a 50% higher risk for in-hospital mortality and a 37% higher risk for longer hospital stays. In addition, the presence of PH was associated with nearly $20,000 of higher hospital expenditures, reported Kaushik Kumar, MBBS, at the annual meeting of the American College of Chest Physicians (CHEST).

“Clinicians should be vigilant in identifying and managing pulmonary hypertension in ARDS patients,” Dr. Kumar, a resident in internal medicine at Medstar Health, Baltimore, said in an oral abstract presentation.

He added that PH has the potential to serve as an indicator of disease severity for patients with ARDS.
 

National database

PH is a frequent complication of ARDS, likely related to a combination of pulmonary vasoconstriction, thromboembolism, and interstitial edema, he said.

To test their hypothesis that the presence of PH in patients with ARDS is associated with worse outcomes, Dr. Kumar and colleagues drew on the National Inpatient Sample database for information on adults aged 18 years and older who had been diagnosed with ARDS with or without PH.

They identified a total of 156,687 patients of whom 26,324 (16.8%) also had been diagnosed with PH. Among the cohort with PH, there were higher proportions of older patients, women, and patients with multiple comorbidities.

The in-hospital mortality rate was 36.8% among patients with PH, compared with 24.6% among those without. The mean length of stay was also longer among patients with PH, at 12 days versus 10 days.

In an unadjusted analysis, mean total hospital charges for patients with ARDS and PH were $210,165, versus $160,683 for patients with ARDS who did not have PH.

In an analysis in which the investigators controlled for age, sex, index admission length of stay, insurance status, and comorbidities, in-hospital mortality for patients with PH remained significantly higher, with an odds ratio of 1.52 (P < .001). PH was also significantly associated with longer length of stay (odds ratio, 1.37; P < .001) and higher total hospital costs, with a mean difference of $19,406.

Dr. Kumar said that the findings underscore the importance of a tailored approach to managing patients with ARDS, especially in the presence of PH.

The investigators plan further studies to assess the role of PH-targeted therapies, to examine the role of sepsis and right ventricular failure and to explore the long-term impact of PH among ARDS survivors, including effects with respect to pulmonary function, quality of life, and long-term morbidity.
 

Potential to inform practice

A pulmonologist who was not involved in the study said in an interview that the findings of the trial suggest that PH may have a greater influence on mortality than is currently understood and that further investigations into this association could change practice in the future.

“I think it would be very important for us to understand if that is going to change our outlook on how ARDS is managed. It’s possible that some of the interventions that we give people who don’t have pulmonary hypertension, for example, increasing the airway pressure in order to minimize oxygenation, may have a detrimental effect on the pulmonary vasculature,” said Timothy Morris, MD, medical director of the pulmonary and exercise lab and professor of medicine at the University of California, San Diego.

“I think it’s a little bit premature to say that this should guide management now, but it’s certainly an interesting question that may end up changing practice in the future,” said Dr. Morris, who was moderator of the session in which Dr. Kumar presented the data.

The study was supported by the Agency for Healthcare Research and Quality and Medstar Health Research Institute. Dr. Kumar and Dr. Morris have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

HONOLULU – Patients with acute respiratory distress syndrome (ARDS) and coexisting pulmonary hypertension (PH) are significantly more likely to have longer and more costly hospital stays and to die in-hospital than patients with ARDS without PH, results of a retrospective study suggest.

Among more than 156,000 hospitalized patients with ARDS, 16.8% of whom also had a diagnosis of PH, the presence of PH was associated with about a 50% higher risk for in-hospital mortality and a 37% higher risk for longer hospital stays. In addition, the presence of PH was associated with nearly $20,000 of higher hospital expenditures, reported Kaushik Kumar, MBBS, at the annual meeting of the American College of Chest Physicians (CHEST).

“Clinicians should be vigilant in identifying and managing pulmonary hypertension in ARDS patients,” Dr. Kumar, a resident in internal medicine at Medstar Health, Baltimore, said in an oral abstract presentation.

He added that PH has the potential to serve as an indicator of disease severity for patients with ARDS.
 

National database

PH is a frequent complication of ARDS, likely related to a combination of pulmonary vasoconstriction, thromboembolism, and interstitial edema, he said.

To test their hypothesis that the presence of PH in patients with ARDS is associated with worse outcomes, Dr. Kumar and colleagues drew on the National Inpatient Sample database for information on adults aged 18 years and older who had been diagnosed with ARDS with or without PH.

They identified a total of 156,687 patients of whom 26,324 (16.8%) also had been diagnosed with PH. Among the cohort with PH, there were higher proportions of older patients, women, and patients with multiple comorbidities.

The in-hospital mortality rate was 36.8% among patients with PH, compared with 24.6% among those without. The mean length of stay was also longer among patients with PH, at 12 days versus 10 days.

In an unadjusted analysis, mean total hospital charges for patients with ARDS and PH were $210,165, versus $160,683 for patients with ARDS who did not have PH.

In an analysis in which the investigators controlled for age, sex, index admission length of stay, insurance status, and comorbidities, in-hospital mortality for patients with PH remained significantly higher, with an odds ratio of 1.52 (P < .001). PH was also significantly associated with longer length of stay (odds ratio, 1.37; P < .001) and higher total hospital costs, with a mean difference of $19,406.

Dr. Kumar said that the findings underscore the importance of a tailored approach to managing patients with ARDS, especially in the presence of PH.

The investigators plan further studies to assess the role of PH-targeted therapies, to examine the role of sepsis and right ventricular failure and to explore the long-term impact of PH among ARDS survivors, including effects with respect to pulmonary function, quality of life, and long-term morbidity.
 

Potential to inform practice

A pulmonologist who was not involved in the study said in an interview that the findings of the trial suggest that PH may have a greater influence on mortality than is currently understood and that further investigations into this association could change practice in the future.

“I think it would be very important for us to understand if that is going to change our outlook on how ARDS is managed. It’s possible that some of the interventions that we give people who don’t have pulmonary hypertension, for example, increasing the airway pressure in order to minimize oxygenation, may have a detrimental effect on the pulmonary vasculature,” said Timothy Morris, MD, medical director of the pulmonary and exercise lab and professor of medicine at the University of California, San Diego.

“I think it’s a little bit premature to say that this should guide management now, but it’s certainly an interesting question that may end up changing practice in the future,” said Dr. Morris, who was moderator of the session in which Dr. Kumar presented the data.

The study was supported by the Agency for Healthcare Research and Quality and Medstar Health Research Institute. Dr. Kumar and Dr. Morris have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Postmastectomy breast reconstruction (PMbR) showed breast cancer-specific survival (BCSS) outcomes comparable with those of conventional mastectomy and may be recommended in patients with stage T0-3N2-3M0 non-triple-negative breast cancer (BC).

Major finding: Compared with conventional mastectomy, PMbR did not have any significant detrimental effect on BCSS outcomes (hazard ratio [HR] 0.85; P = .197); however, histopathological grade levels III-IV (HR 3.28; P = .010), T4 stage (HR 3.08; P = .013), and triple-negative BC (HR 4.84; P < .001) were associated with worsened BCSS outcomes in the PMbR group.

Study details: This retrospective study retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database and included 2545 women with N2-3M0 stage BC who underwent either PMbR (n = 761) or conventional mastectomy (n = 1784).

Disclosures: This study was supported by the Clinical Research Program of the first affiliated Hospital of Xi'an Jiaotong University, China, and other sources. The authors declared no conflicts of interest.

Source: Zhao Y, Yan L, et al. Efficacy of breast reconstruction for N2-3M0 stage female breast cancer on breast cancer-specific survival: A population-based propensity score analysis. Cancer Med. 2023 (Oct 5). doi: 10.1002/cam4.6579

Key clinical point: Postmastectomy breast reconstruction (PMbR) showed breast cancer-specific survival (BCSS) outcomes comparable with those of conventional mastectomy and may be recommended in patients with stage T0-3N2-3M0 non-triple-negative breast cancer (BC).

Major finding: Compared with conventional mastectomy, PMbR did not have any significant detrimental effect on BCSS outcomes (hazard ratio [HR] 0.85; P = .197); however, histopathological grade levels III-IV (HR 3.28; P = .010), T4 stage (HR 3.08; P = .013), and triple-negative BC (HR 4.84; P < .001) were associated with worsened BCSS outcomes in the PMbR group.

Study details: This retrospective study retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database and included 2545 women with N2-3M0 stage BC who underwent either PMbR (n = 761) or conventional mastectomy (n = 1784).

Disclosures: This study was supported by the Clinical Research Program of the first affiliated Hospital of Xi'an Jiaotong University, China, and other sources. The authors declared no conflicts of interest.

Source: Zhao Y, Yan L, et al. Efficacy of breast reconstruction for N2-3M0 stage female breast cancer on breast cancer-specific survival: A population-based propensity score analysis. Cancer Med. 2023 (Oct 5). doi: 10.1002/cam4.6579

Key clinical point: Postmastectomy breast reconstruction (PMbR) showed breast cancer-specific survival (BCSS) outcomes comparable with those of conventional mastectomy and may be recommended in patients with stage T0-3N2-3M0 non-triple-negative breast cancer (BC).

Major finding: Compared with conventional mastectomy, PMbR did not have any significant detrimental effect on BCSS outcomes (hazard ratio [HR] 0.85; P = .197); however, histopathological grade levels III-IV (HR 3.28; P = .010), T4 stage (HR 3.08; P = .013), and triple-negative BC (HR 4.84; P < .001) were associated with worsened BCSS outcomes in the PMbR group.

Study details: This retrospective study retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database and included 2545 women with N2-3M0 stage BC who underwent either PMbR (n = 761) or conventional mastectomy (n = 1784).

Disclosures: This study was supported by the Clinical Research Program of the first affiliated Hospital of Xi'an Jiaotong University, China, and other sources. The authors declared no conflicts of interest.

Source: Zhao Y, Yan L, et al. Efficacy of breast reconstruction for N2-3M0 stage female breast cancer on breast cancer-specific survival: A population-based propensity score analysis. Cancer Med. 2023 (Oct 5). doi: 10.1002/cam4.6579

Key clinical point: Human epidermal growth factor receptor 2 (HER2)-low vs HER2-0 expression was associated with improved breast cancer-specific survival (BCSS) outcomes in patients with early-stage triple-negative breast cancer (TNBC), particularly in the high-risk subgroups.

Major finding: Patients with HER2-low vs HER2-0 BC had significantly better BCSS rates in the overall population (96.6% vs 93.7%; log-rank P = .027) and in high-risk subpopulations comprising patients without a pathological complete response despite neoadjuvant chemotherapy (log-rank P = .047) or those with stage-III BC (log-rank P = .010).

Study details: Findings are from a study including 1445 female patients with early-stage TNBC, of whom 51.7% and 48.3% showed HER2-0 and HER2-low status, respectively.

Disclosures: This study was sponsored by the Health Commission of Henan Province, China. The authors declared no conflicts of interest.

Source: Ma Y et al. HER2-low status was associated with better breast cancer-specific survival in early-stage triple-negative breast cancer. Oncologist. 2023 (Sep 28). doi: 10.1093/oncolo/oyad275

Key clinical point: Human epidermal growth factor receptor 2 (HER2)-low vs HER2-0 expression was associated with improved breast cancer-specific survival (BCSS) outcomes in patients with early-stage triple-negative breast cancer (TNBC), particularly in the high-risk subgroups.

Major finding: Patients with HER2-low vs HER2-0 BC had significantly better BCSS rates in the overall population (96.6% vs 93.7%; log-rank P = .027) and in high-risk subpopulations comprising patients without a pathological complete response despite neoadjuvant chemotherapy (log-rank P = .047) or those with stage-III BC (log-rank P = .010).

Study details: Findings are from a study including 1445 female patients with early-stage TNBC, of whom 51.7% and 48.3% showed HER2-0 and HER2-low status, respectively.

Disclosures: This study was sponsored by the Health Commission of Henan Province, China. The authors declared no conflicts of interest.

Source: Ma Y et al. HER2-low status was associated with better breast cancer-specific survival in early-stage triple-negative breast cancer. Oncologist. 2023 (Sep 28). doi: 10.1093/oncolo/oyad275

Key clinical point: Human epidermal growth factor receptor 2 (HER2)-low vs HER2-0 expression was associated with improved breast cancer-specific survival (BCSS) outcomes in patients with early-stage triple-negative breast cancer (TNBC), particularly in the high-risk subgroups.

Major finding: Patients with HER2-low vs HER2-0 BC had significantly better BCSS rates in the overall population (96.6% vs 93.7%; log-rank P = .027) and in high-risk subpopulations comprising patients without a pathological complete response despite neoadjuvant chemotherapy (log-rank P = .047) or those with stage-III BC (log-rank P = .010).

Study details: Findings are from a study including 1445 female patients with early-stage TNBC, of whom 51.7% and 48.3% showed HER2-0 and HER2-low status, respectively.

Disclosures: This study was sponsored by the Health Commission of Henan Province, China. The authors declared no conflicts of interest.

Source: Ma Y et al. HER2-low status was associated with better breast cancer-specific survival in early-stage triple-negative breast cancer. Oncologist. 2023 (Sep 28). doi: 10.1093/oncolo/oyad275