Evaluating the Role of Artificial Intelligence in Enhancing Multidisciplinary Team Decisions for Breast Cancer Management - European Journal of Breast Health

Background: The prognostic significance of low-level human epidermal growth factor receptor 2 (HER2) expression in hormone receptor-positive/HER2-negative (HR+/HER2−) metastatic breast cancer remains unclear, particularly in patients treated with cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). This study aimed to evaluate the impact of HER2-low status on treatment response and survival outcomes in this setting. Methods: This multicenter retrospective cohort study included patients with HR+/HER2− metastatic breast cancer who received first-line endocrine therapy combined with palbociclib or ribociclib between January 2018 and May 2025. HER2-low tumors were defined as immunohistochemistry (IHC) 1+ or 2+ with negative in situ hybridization, while HER2-zero tumors were classified as IHC 0. Treatment response, progression-free survival (PFS), and overall survival (OS) were compared between groups using Kaplan–Meier analysis and Cox regression models. Results: A total of 309 patients were analyzed, including 122 (39.5%) with HER2-low disease and 187 (60.5%) with HER2-zero disease. Baseline clinicopathological characteristics were well balanced between groups. The overall response rate was 75.4% in the HER2-low group and 72.7% in the HER2-zero group (p > 0.05). Median PFS was 23.9 months for HER2-low patients and 25.2 months for HER2-zero patients (log-rank p = 0.785). Median OS was 49.5 and 53.1 months, respectively, with no statistically significant difference (log-rank p = 0.649). HER2 status was not an independent predictor of PFS or OS in multivariable analyses. Conclusions: In patients with HR+/HER2− metastatic breast cancer treated with first-line endocrine therapy plus CDK4/6 inhibitors, HER2-low expression was not associated with differences in treatment response or survival outcomes. These findings suggest that HER2-low status does not have prognostic or predictive relevance in this endocrine-sensitive population.

Background and Objectives: This study aimed to identify clinicopathological factors associated with axillary pathological complete response (ApCR) in patients with HER2-positive breast cancer presenting with clinically node-positive disease (cN+) confirmed by biopsy who received neoadjuvant therapy (NAT), and to assess the prognostic significance of ApCR on survival outcomes. Materials and Methods: A total of 221 patients with clinically node-positive (cN+) HER2-positive invasive breast cancer, with nodal involvement confirmed by fine-needle aspiration or core needle biopsy, who received neoadjuvant therapy (NAT) and subsequently underwent surgery at three centers between January 2015 and January 2025 were retrospectively reviewed. The association between clinicopathological factors and axillary pathological complete response (ApCR) was analyzed using logistic regression. Survival analyses were performed using the Kaplan–Meier method. Results: The median follow-up duration was 34.3 months. Axillary pathological complete response (ApCR) was achieved in 67.9% of patients. The ApCR rate was higher in stage II disease compared with stage III (76.9% vs. 62.9%). Patients with HER2 3+ tumors demonstrated a higher ApCR rate (70.8%) than those with HER2 2+/FISH+ tumors (46.2%). In multivariable logistic regression, HER2 3+ status (OR = 2.745; 95% CI: 1.138–6.619; p = 0.025) and lower clinical stage (OR = 2.251; 95% CI: 1.182–4.287; p = 0.014) were independently associated with a higher likelihood of achieving ApCR. In survival analyses, the 3-year event-free survival rate was 92% (95% CI: 86–98%) in the ApCR group, compared with 75% (95% CI: 63–87%) in the non-ApCR group. Kaplan–Meier analysis demonstrated that ApCR was a significant prognostic factor for EFS (p = 0.001). Median overall survival (OS) was not reached in either group due to the limited number of death events. Conclusions: ApCR was frequent in node-positive HER2-positive breast cancer after neoadjuvant therapy. HER2 3+ status and lower clinical stage independently predicted ApCR, which in turn was associated with improved event-free survival. These findings underscore the prognostic relevance of ApCR in this setting.

OBJECTIVE: Extrapulmonary neuroendocrine carcinoma (EP-NEC) is a rare tumor type, and a standard therapy for EP-NEC has not yet been established. The purpose of this research was to explore the overall survival (OS) and therapeutic effects of platinum-etoposide combination therapy in EP-NEC. METHODS: This retrospective study was conducted based on the medical records from January 2010 to March 2020. Eligible patients had been pathologically diagnosed with EP-NEC. RESULTS: Forty-seven patients were included in the study. About 72.3% (n=34) of the patients were diagnosed with metastatic disease at the first diagnosis. The most common primary tumor site was the stomach. The median progression-free survival (PFS) of the patient group, who received the combination of platinum/etoposide, was 5.83 months (95% CI 4.46-7.20), whereas the median OS of the patients, who were found to have metastatic disease at the first diagnosis, was 13.6 months (95% CI 9.01-18.18). There was no difference in PFS and OS between patients with and without liver metastasis. CONCLUSION: The outcome of advanced EP-NECs with platinum/etoposide chemotherapy remains poor. Obviously, there is a need for new, more effective treatment options.

Background: We assessed the prognostic value of the pan-immune–inflammation value (PIV), systemic immune–inflammation index (SII), lung immune prognostic index (LIPI), and c-reactive protein–albumin–lymphocyte (CALLY) index in advanced non-small cell lung cancer (NSCLC) treated with first-line immune checkpoint inhibitor (ICI)-based therapy. Methods: This multicenter retrospective study included 161 patients who received ICI monotherapy, chemoimmunotherapy, or dual ICI therapy. The objective response rate (ORR), clinical benefit rate (CBR), progression-free survival (PFS), and overall survival (OS) were analyzed using Kaplan–Meier and Cox regression models. Results: A high CALLY index was associated with a significantly higher CBR (82.1% vs. 59.5%; p = 0.015), longer PFS (14.95 vs. 7.13 months; p = 0.002), and longer OS (25.79 vs. 13.24 months; p = 0.003). In the multivariable analyses, a high CALLY index remained independently associated with improved PFS (HR = 0.52, p = 0.006) and OS (HR = 0.53, p = 0.010), whereas a high SII was independently associated with poorer PFS (HR = 1.74, p = 0.021) and OS (HR = 1.90, p = 0.009). PIV and LIPI were not independently associated with survival outcomes. Conclusions: SII and the CALLY index emerged as independent prognostic biomarkers in advanced NSCLC receiving first-line immunotherapy-based treatment. The CALLY index showed the strongest and most consistent association with clinical benefit, PFS, and OS.