The reduced cost of trastuzumab biosimilars has led to increased adoption for HER2-positive breast cancer. This review of trastuzumab biosimilars encompasses this development and real world clinical data in early breast cancer. In addition, we present a retrospective study evaluating the total pathological complete response (tpCR) rates (lack of residual invasive cancer in resected breast tissue and axillary nodes), of MYL-1401O to reference trastuzumab (TRZ) in the neoadjuvant setting for HER2+ early breast cancer (EBC) in Alberta, Canada. Neoadjuvant patients with HER2+ EBC treated with TRZ from November 2018–October 2019 and MYL-1401O from December 2019–September 2020 were identified. Logistic regression was used to control for variables potentially associated with tpCR: trastuzumab product, age, pre-operative T- and N-stage, grade, hormone receptor (HR)-status, HER2-status, chemotherapy regimen, and chemotherapy completion. tpCR was 35.6% in the MYL-1401O group (n = 59) and 40.3% in the TRZ (n = 77) group, p = 0.598. After controlling for clinically relevant variables, there was no significant difference in the odds of achieving tpCR in patients treated with TRZ versus MYL-1401O (OR 1.1, 95% CI 0.5–2.4, p = 0.850). tpCR rates were similar for patients treated with MYL-1401O compared to trastuzumab in our real world study of HER2+ neoadjuvant EBC and comparable to pivotal phase 3 trials.

Tumour thrombus is seen in renal cell and hepatocellular carcinoma, but is rarely reported in colorectal cancer. A woman aged 46 years, with metastatic colonic adenocarcinoma, was found to have a large mass in the inferior vena cava (IVC) extending into the right atrium. Although this lesion was initially thought to be bland thrombus, imaging with contrast-enhanced CT scan and contrast-enhanced ultrasound supported the diagnosis of tumour thrombus. Despite the large size of the lesion, the patient was asymptomatic. Her lack of symptoms, and poor overall prognosis from her cancer led to the decision to avoid aggressive surgical or radiological interventions. Several months later, the patient passed away. At autopsy, there was no evidence of fatal embolisation from the pre-existing thrombus. Diagnosis of tumour thrombus in the IVC is difficult and management can be challenging due to the significant risks associated with treatment options.

The adjuvant treatment landscape for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) early breast cancer (EBC) is rapidly evolving, with a diverse range of therapeutic options—including endocrine therapies, bisphosphonates, ovarian function suppression, olaparib, CDK4/6 inhibitors, and emerging agents such as immunotherapy. While these advances have markedly improved patient outcomes, they also introduce challenges related to implementation, monitoring, and resource allocation. Notably, therapies like CDK4/6 inhibitors require particularly close monitoring, creating logistical and capacity challenges for medical oncologists, whose workloads are already stretched due to rising cancer incidence and treatment complexities. These challenges underscore the need for innovative care delivery solutions to ensure patients with EBC continue to receive optimal care. This paper offers a comprehensive guide—a playbook—of multidisciplinary-team-based care models designed to optimize adjuvant treatment delivery in EBC. Drawing on real-world evidence and successful applications across Canadian centers, we explore models led by nurses, nurse practitioners (NPs), general practitioners in oncology (GPO), and pharmacists. Each model leverages the unique expertise of its team to manage treatment toxicities, facilitate adherence, and enhance patient education, thereby promoting effective and sustainable care delivery. Importantly, these models are not intended to compete with one another, but rather to serve as a flexible recipe book from which breast cancer care teams can draw strategies tailored to their local resources and patient needs. By detailing implementation strategies, benefits, and challenges—in many instances supported by quantitative metrics and economic evaluations—this work aims to inspire care teams nationwide to optimize the adjuvant management of patients with HR+, HER2– EBC.

In the era of rapid development of new, expensive cancer therapies, value frameworks have been developed to quantify clinical benefit (CB). We assessed the evolution of CB since the 2015 introduction of The American Society of Clinical Oncology and The European Society of Medical Oncology value frameworks. Randomized clinical trials (RCTs) assessing systemic therapies for solid malignancies from 2010 to 2020 were evaluated and CB (Δ) in 2010–2014 (pre-value frameworks (PRE)) were compared to 2015–2020 (POST) for overall survival (OS), progression-free survival (PFS), response rate (RR), and quality of life (QoL). In the 485 studies analyzed (12% PRE and 88% POST), the most common primary endpoint was PFS (49%), followed by OS (20%), RR (12%), and QoL (6%), with a significant increase in OS and decrease in RR as primary endpoints in the POST era (p = 0.011). Multivariable analyses revealed significant improvement in ΔOS POST (OR 2.86, 95% CI 0.46 to 5.26, p = 0.02) while controlling for other variables. After the development of value frameworks, median ΔOS improved minimally. The impact of value frameworks has yet to be fully realized in RCTs. Efforts to include endpoints shown to impact value, such as QoL, into clinical trials are warranted.

Breast cancer remains the most common type of cancer among Canadian women, with 28,900 new cases in 2022 alone. Improved detection through screening mammography and advances in multi-modality therapy account for the decline in breast cancer mortality seen in Canada since the 1980s. As 5-year survival rates reach 89%, the number of breast cancer survivors is rising. The concept of cancer survivorship has existed for decades, as has the appreciation that it is a complex domain of cancer care that begins at the time of diagnosis. Even within the group of patients with breast cancer, survivorship experiences and care needs are diverse, reflecting variability in tumour clinicopathologic characteristics, treatment plans, and prognosis. Evidence-based tools and guidelines suggest the assessment and management of cancer survivor’s physical, psychological, social, financial, and employment well-being. There is a need to clinically monitor for breast cancer recurrence and the development of secondary malignancies through screening. Survivorship also warrants attention to health promotion, including weight management, nutrition, physical activity, preventive health, and cessation of alcohol and cigarettes. The provision of survivorship care is the responsibility of all healthcare professionals, which requires close coordination between primary care and specialized cancer centres. In this article, we focus on the physical and psychosocial long-term and late effects faced by survivors of early-stage breast cancer. Many adjuvant therapies for breast cancer are associated with toxicities that negatively impact quality of life (QoL) and adherence. Nonadherence is important to address because it compromises breast cancer outcomes.