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Background The Dallas Metastatic Cancer Study is a clinical database established to examine local trends associated with the diagnosis and treatment of de novo metastatic breast cancer and identify factors for further evaluation. Clinical characteristics of patients with de novo metastatic breast cancer are often underreported in the literature. Methods We report data from 2010 to 2021 for patients with de novo metastatic breast cancer along with the impact of clinical variables such as age, BMI, race and ethnicity, insurance status, hypertension, diabetes, and site of metastasis with survival analysis with respect to subtype. Results Black race (HR 2.07, 95% CI 1.56–2.74), public insurance (HR 1.64, 95% CI 1.23–2.18), no insurance (HR 1.69, 95% CI 1.24–2.31), hypertension (HR 1.50, 95% CI 1.18–1.91), diabetes (HR 1.69, 95% CI 1.24–2.31), and visceral metastases including brain (HR 1.68, 95% CI 1.20–2.36), liver (HR 1.80, 95% CI 1.40–2.30), and lung (HR 1.50, 95% CI 1.17–1.92) were associated with increased mortality and remained significant when controlled for subtype. In the multivariate analysis, diabetes (HR 1.74, 95% CI 1.22–2.49) and presence of liver metastases (HR 1.97, 95% CI 1.43–2.49) remained independently associated with decreased overall survival regardless of subtype and other variables. Patients diagnosed at 40 and younger were less likely to have hypertension and diabetes, more likely to be Hispanic, and showed distinct subtype distributions compared to those diagnosed at older ages. Conclusions Future work will focus on these associations at the patient level to identify targets for intervention. Plain language summary The Dallas Metastatic Cancer Study aims to better understand metastatic breast cancer by examining local trends in diagnosis and treatment. The study analyzed data from 2010 to 2021 and specifically focused on patients with a metastatic breast cancer diagnosis at first presentation. The study evaluated how factors such as age, BMI, race, insurance status, and co-existing medical conditions like hypertension and diabetes affected survival. The results show that Black patients, those with public or no insurance, those with specific metastases (i.e., liver, brain, lung) had worse survival outcomes. These outcomes underscore the areas where targeted interventions could improve patient outcomes. Chang, Cao et al. examine local trends associated with the diagnosis and treatment of de novo metastatic breast cancer. Findings show that black race, hypertension, diabetes, as well as the presence of visceral metastases are associated with a worse prognosis.

Involving patient advocates as partners in cancer research improves research and provides favorable experiences for both the researcher and the advocate. Previous work demonstrates challenges to establishing relationships between researchers and advocates, including uncertainty about why the relationships are necessary, how to establish them, what to say, and how they should be structured. To overcome these challenges, we established the Metastatic Breast Cancer Research Conference (MBCRC) Advocate Researcher Program (MARP) at the MBCRC in 2023. We outline the approach to the program to serve as a model for others interested in performing similar activities and report findings from surveys to establish evidence about the value of these relationships. The program connected 21 pairs of researchers and advocates, and participants responded to surveys about their experience, largely describing positive outcomes. Our hope is that a program like this could be used at any cancer conference in the future as we continue to encourage advocates and researchers to work together.

The COVID-19 pandemic substantially impacted the delivery of oncology care, particularly for individuals with metastatic cancers. The objective of this study was to qualitatively evaluate the impacts of COVID-19 on metastatic breast cancer (MBC) care among patients. This study consisted of 36 semi-structured qualitative interviews conducted virtually with people living with MBC, who were members of a patient support organization called Project Life. Project Life is an MBC patient-led, web-based wellness community. Responses were analyzed using Phronetic Iterative Analysis. Interviews were conducted from March 14, 2022, to May 31, 2022. Analysis from 36 individual in-depth qualitative interviews revealed the following themes during COVID-19: (1) variable preferences for telehealth (2) disruptions to care, (3) virtualization of social care. Wide variations existed in preferences surrounding telehealth, centered around ideas of convenience. Disruptions to care included delays to diagnostic care, isolation from caregivers, and interruptions associated with COVID-19 infection. These results call for adaptability in oncology care given wide-ranging preferences on telehealth and the shifting of available support services.

Including patient advocates in basic cancer research ensures that breast cancer research is intentional, supports effective communication with broader audiences, and directly connects researchers with those who they are striving to help. Despite this utility, many cancer research scientists do not work with patient advocates. To understand barriers to engagement and build a framework for enhanced interactions in the future, we hosted a workshop with patient advocates and researchers who do engage, then discussed findings at an international metastatic breast cancer conference to solicit additional feedback and suggestions. Findings demonstrate that researchers are uncertain about how to initiate and maintain relationships with advocates. We offer actionable steps to support researchers working with patient advocates to improve cancer research and accomplish our collective goal of improving lives of those who have been diagnosed with breast cancer. We hope that this initiative will facilitate such collaborative efforts.

Purpose While significant progress in metastatic breast cancer (MBC) treatment has prolonged survival and improved prognosis, there remain substantial gaps in providing patient-centered supportive care. The specific care delivery needs for metastatic cancer differ from that of early-stage cancer due to the incurable nature and lifelong duration of the condition. The objective of this study was to assess how patients living with MBC would re-imagine cancer care delivery. Methods This qualitative study was conducted in partnership with patient-led organizations Guiding Researchers and Advocates to Scientific Partnerships ( GRASP ) and Project Life , a nonprofit, online wellness community founded by patients with MBC for patients living with MBC. Virtual semi-structured interviews ( n  = 36) were conducted with Project Life members purposively sampled from the groups’ overall membership. The interview guide contained items surrounding patients’ lived experiences of MBC, greatest unmet needs related to care, and perspectives on virtual wellness community involvement. Interviews were coded using two-stage deductive and inductive analysis. Results Three major themes for re-imagining cancer care delivery were identified, including holistic care, information needs, and conceptual shifts. Within these several subthemes emerged with patients re-imagining referrals to non-oncological services, caregiver support, acceptance of integrative medicine, streamlined clinical trial enrollment, curated quality patient resources, MBC-specific terminology and approaches, long-term life and goal-of-care planning, and patient-centered voice throughout. Conclusion People living with metastatic cancers have specific supportive care needs. These findings highlight patient-driven areas for re-imagination that are most salient for individuals with MBC.

Purpose Although metastatic breast cancer (MBC) is treatable, it is not curable and most patients remain on treatment indefinitely. While oncologists commonly prescribe the recommended starting dose (RSD) from the FDA-approved label, patient tolerance may differ from that seen in clinical trials. We report on a survey of medical oncologists’ perspectives about treatment-related toxicity and willingness to discuss flexible dosing with patients. Methods We disseminated a confidential survey via social media/email in Spring 2021. Eligible respondents needed to be US-based medical oncologists with experience treating patients with MBC. Results Of 131 responses, 119 were eligible. Physicians estimated that 47% of their patients reported distressing treatment-related side effects; of these, 15% visited the Emergency Room/hospital and 37% missed treatment. 74% ( n  = 87) of doctors reported improvement of patient symptoms after dose reduction. 87% ( n  = 104) indicated that they had ever, if appropriate, initiated treatment at lower doses. Most (85%, n  = 101) respondents did not believe that the RSD is always more effective than a lower dose and 97% ( n  = 115) were willing to discuss individualized dosing with patients. Conclusion Treatment-related side effects are prevalent among patients with MBC, resulting in missed treatments and acute care visits. To help patients tolerate treatment, oncologists may decrease initial and/or subsequent doses. The majority of oncologists reject the premise that a higher dose is always superior and are willing to discuss individualized dosing with patients. Given potential improvements regarding quality of life and clinical care, dose modifications should be part of routine shared decision-making between patients and oncologists.

In advanced HER2-positive breast cancer, the standard taxane-trastuzumab-pertuzumab (THP) regimen faces competition from new therapies, emphasizing the need for biomarkers to guide treatment. This study evaluates the HER2DX ERBB2 mRNA score as a prognostic predictor, aiming to tailor treatment strategies. We retrospectively analyzed 94 patients treated with the THP regimen between 2010 and 2024. The HER2DX ERBB2 mRNA score was categorized as low ( n  = 14), medium ( n  = 20), or high ( n  = 60), and its correlation with progression-free survival (PFS) and overall survival (OS) was assessed using Cox regression models. The median follow-up was 31.5 months. Patients with ERBB2 -high scores had significantly better median PFS (33.9 vs. 10.6 months, hazard ratio [HR] = 0.40, 95% CI: 0.24–0.69, p  < 0.001) and OS (not reached vs. 30.8 months, HR = 0.26, 95% CI: 0.13–0.49, p  < 0.001) compared to ERBB2 -low patients. Based on these findings, further validation of this biomarker in tumor samples from the CLEOPATRA phase III trial is ongoing, which could help optimize treatment strategies in this population.

We present an integrated single-cell RNA-seq resource of the breast tumor microenvironment consisting of 236,363 cells from 119 biopsy samples across 8 publicly available datasets. In this computational study, we first leverage this novel resource to define cancer epithelial cell heterogeneity based on two clinically relevant markers and define six new and distinct subsets of natural killer cells. We then illustrate how cancer epithelial cell heterogeneity impacts immune cell interactions. We develop T cell InteractPrint, which considers how cancer epithelial cell heterogeneity shifts the predicted strength of T cell interactions. We use InteractPrint to predict response to immune checkpoint inhibition (ICI) in two clinical trials testing immunotherapy in patients with breast cancer. T cell InteractPrint was predictive in both trials (AUC=0.81 and 0.84), versus PD-L1 expression (AUC=0.54 and 0.72). This result provides an alternative predictive biomarker to PD-L1 to select patients who should receive ICI. Competing Interest Statement The authors have declared no competing interest. Footnotes * Fixed typo in Figure 4A

In the previous issue of the District Overview, the authors used economic mobility data from a study by economists Raj Chetty, Nathaniel Hendren, Patrick Kline and Emmanuel Saez (CHKS hereafter) to compare economic mobility in the US versus the Eighth District. They focused on an indicator of economic mobility that measures a family's probability of moving from the bottom 20% of the income distribution to the top 20% in one generation. In this issue, they introduce some factors that may be part of an explanation for the differences in income mobility across locations. Then, they look at potential explanations for the low economic mobility in Memphis. As before, they shape their analysis based on the results of the CHKS study, released earlier this year. CHKS analyzed a set of 37 variables that can potentially help explain geographic differences in economic mobility.

The Eighth District is composed of 339 counties in all or parts of seven states: Arkansas, Illinois, Indiana, Kentucky, Mississippi, Missouri and Tennessee. These counties are covered by 81 commuting zones. Averaging the mobility indicator across these counties, the authors calculate that the probability of moving from the bottom 20% of the income distribution to the top 20% of the income distribution in one generation was 6.4% in the Eighth District. The probability of moving up for those growing up in the Eighth District was also 1.7 percentage points lower than the national average (8.1%). In summary, the probability of moving up for people born in the Eighth District taken as a whole is only somewhat lower than the national average. However, the District contains pockets where the probability of moving up is extremely low, and it contains no areas with remarkably high income mobility.