Wanqing Iris Zhi

Circulating tumor DNA (ctDNA) has emerged as a transformative biomarker in breast cancer, enabling sensitive assessment of tumor burden, molecular residual disease, and treatment resistance. Data presented at the 2025 San Antonio Breast Cancer Symposium (SABCS) demonstrate that ctDNA has moved beyond prognostication to guide treatment in advanced hormone receptor positive disease, most notably in the phase III SERENA-6 trial, where ctDNA-detected ESR1 mutations prospectively triggered endocrine therapy switch and significantly improved clinical outcomes. In early-stage breast cancer, converging evidence across subtypes shows that ctDNA-defined minimal residual disease (MRD) robustly identifies patients at high risk of recurrence. Collectively, these findings position ctDNA as a potential biomarker for dynamic treatment adaptation, supporting the next phase of precision oncology focused on MRD-guided escalation, de-escalation, and therapeutic interception across the breast cancer continuum.

Alice Feng, Mingxiao Yang, Weidong Lu, Wanqing Iris Zhi, Ting Bao. Journal of Acupuncture Research 2025;42:286-94. https://doi.org/10.13045/jar.25.0002

Chemotherapy-induced peripheral neuropathy (CIPN) can lead to chemotherapy dose reduction, delay, and discontinuation, and has limited effective prevention strategies. Our study aimed to identify patient characteristics associated with CIPN severity during weekly paclitaxel chemotherapy in people with early-stage breast cancer. We retrospectively collected baseline data including participants’ age, gender, race, body mass index (BMI), hemoglobin (regular and A1C), thyroid stimulating hormone, Vitamins (B6, B12, and D), anxiety, and depression up to 4 months prior to their first paclitaxel treatment. We also collected CIPN severity by Common Terminology Criteria for Adverse Events (CTCAE) after chemotherapy, chemotherapy relative dose density (RDI), disease recurrence, and mortality rate at the time of the analysis. Logistic regression was used for statistical analysis. We extracted 105 participants’ baseline characteristics from electronic medical records. Baseline BMI was associated with CIPN severity (Odds Ratio [OR] 1.08; 95% CI, 1.01-1.16, P = .024). No significant correlations were observed in other covariates. At median follow-up (61 months), there were 12 (9.5%) breast cancer recurrences and six (5.7%) breast cancer-related deaths. Higher chemotherapy RDI was associated with improved disease-free survival (DFS, OR 1.025; 95% CI, 1.00-1.05; P = .028). Baseline BMI may be a risk factor for CIPN and suboptimal chemotherapy delivery due to CIPN may negatively impact disease-free survival in patients with breast cancer. Further study is warranted to identify mitigating lifestyle factors to reduce incidences of CIPN during breast cancer treatment.

BACKGROUND: Metastatic anaplastic thyroid cancer (ATC) has a dismal prognosis. This pilot study aims to evaluate tremelimumab plus durvalumab with stereotactic body radiotherapy (SBRT) to improve overall survival (OS). METHODS: Eligible patients received up to 4 doses tremelimumab (75mg) given q4 weeks and up to 1 year of durvalumab (1500 mg) given q4 weeks. SBRT at 9Gy x 3 fractions was given within the first 2 weeks of treatment. Paired biopsies (pre-treatment and between 3 and 10 weeks after the first dose of the drug) were done in medically qualified patients. Major inclusion criteria: Metastatic ATC; ECOG PS 0-2; no prior immunotherapy; last anti-cancer treatment > 7 days prior to starting study. The primary endpoint was 1-year OS with the combination of durvalumab, tremelimumab and SBRT in metastatic ATC patients with target OS at 1 year of > 2 out of 12 patients. RESULTS: 13 subjects signed consent but 12 subjects ultimately participated in this trial. One patient who consented to the protocol was admitted to urgent care prior to starting protocol treatment and was deemed no longer eligible for protocol due to decreased performance status, continued drop in hemoglobin, and requirement of steroids. 50% were male with a median age of 71 (range: 49 to 82); ECOG = 1. Prior radiation to neck in 75% of the subjects. 75% of the subjects had prior chemotherapy. 9 subjects underwent analysis with next-generation sequencing or had tissue available for PD-L1 staining. Microsatellite instability (MSI)-high corresponding to mismatch repair defect was noted in 2 subjects. There were 0 confirmed responses and only 1 subject with stable disease treated with >/=4 cycles. The median time that the subjects were on treatment was 11 weeks (1-28 weeks). Microsatellite instability (MSI) status did not affect treatment response. MSI-high patients were on treatment before progression for 8-14 weeks. The median OS was 14.5 weeks with only one person alive beyond 1 year. The presence of a BRAF or p53 mutation did not appear to have affect any outcome. CONCLUSION: Tremelimumab and durvalumab with SBRT did not improve OS for ATC. Future studies looking at other novel immunotherapy combinations in ATC +/- radiation should be evaluated.

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating adverse effect of neurotoxic chemotherapy that significantly worsens the quality of life of cancer survivors. Materials and Methods Survivors of solid tumors with persistent moderate-to-severe CIPN defined as numbness, tingling, or pain rated ≥4 on an 11-point numeric rating scale (NRS) were randomized in a 1:1:1 ratio to 8 weeks of real acupuncture (RA) versus sham acupuncture (SA) versus usual care (UC). We previously reported the primary endpoint (NRS); here we report the following health-related quality of life endpoints: Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), and Brief Fatigue Inventory (BFI). For each endpoint, the mean changes from baseline and 95% confidence intervals were estimated within each arm and compared between arms using linear mixed models. Results We enrolled 75 survivors of solid tumors with moderate-to-severe CIPN into the study. Compared with baseline, at week 8, FACT/GOG-Ntx, HADS anxiety, and ISI scores significantly improved in RA and SA, but not in UC. Compared with UC, at week 8, FACT/GOG-Ntx scores significantly increased in RA and SA arms indicating improved CIPN-related symptoms and quality of life (p = .001 and p = .01). There was no statistically significant difference between RA and SA. There was no difference in HADS depression or BFI among RA, SA, and UC at weeks 8 and 12. Conclusion Acupuncture may improve CIPN-related symptoms and quality of life in cancer survivors with persistent CIPN. Further large sample size studies are needed to delineate placebo effects. Implications for Practice The authors conducted a randomized sham acupuncture- and usual care-controlled clinical trial to evaluate the impact of acupuncture on health-related quality of life outcomes in patients with solid tumors with chemotherapy-induced peripheral neuropathy (CIPN). Statistically significant improvements in quality of life, anxiety, insomnia, and fatigue were achieved with 8 weeks of real acupuncture when compared with baseline, without statistically significant differences between real and sham acupuncture. These findings suggest that acupuncture may be effective for improving CIPN-related symptoms and quality of life and reducing anxiety and insomnia in cancer survivors with persistent CIPN, with further study needed to delineate placebo effects.

Background: Yoga is a meditative movement therapy focused on mind‐body awareness. The impact of yoga on health‐related quality of life (HRQOL) outcomes in patients with chemotherapy‐induced peripheral neuropathy (CIPN) is unclear.Methods: We conducted a pilot randomized wait‐list controlled trial of 8 weeks of yoga (n = 21) versus wait‐list control (n = 20) for CIPN in 41 breast and gynecological cancer survivors with persistent moderate to severe CIPN. HRQOL endpoints were Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and Insomnia Severity Index (ISI). The Treatment Expectancy Scale (TES) was administered at baseline. We estimated mean changes and 95% confidence intervals (CIs) from baseline to weeks 8 and 12 and compared arms using constrained linear mixed models.Results: At week 8, HADS anxiety scores decreased −1.61 (−2.75, −0.46) in the yoga arm and −0.32 (−1.38, 0.75) points in the wait‐list control arm (p = 0.099). At week 12, HADS anxiety scores decreased −1.42 (−2.57, −0.28) in yoga compared to an increase of 0.46 (−0.60, 1.53) in wait‐list control (p = 0.017). There were no significant differences in HADS depression, BFI, or ISI scores between yoga and wait‐list control. Baseline TES was significantly higher in yoga than in wait‐list control (14.9 vs. 12.7, p = 0.019). TES was not associated with HADS anxiety reduction and HADS anxiety reduction was not associated with CIPN pain reduction.Conclusions: Yoga may reduce anxiety in patients with CIPN. Future studies are needed to confirm these findings.Clinical Trial Registration Number: ClinicalTrials.gov Identifier: NCT03292328.

Purpose: We examined the characteristics of breast cancer patients with oligometastases (OM) treated with stereotactic ablative body radiotherapy (SABR) to identify factors associated with local progression, distant metastasis progression, time to subsequent therapy, progression‐free survival (PFS), and overall survival (OS).Methods: We retrospectively reviewed a single‐institution database of patients treated with radiotherapy between 2008 and 2018 and identified 79 patients who received SABR to OM. Twenty‐seven patients had genetic testing of metastatic tumors using an institutional targeted sequencing platform. Kaplan–Meier analysis, Cox regression, and competing risk models were used to compare clinical and genetic correlates with outcomes.Results: Median follow‐up was 50 months (IQR: 29–66) with 67% of patients alive at the last follow‐up. Of the 65% of patients who progressed, 82% progressed outside of the radiation field, 18% experienced local failure, and 80% had oligoprogression. Median OS was 86 months (IQR: 29–66), and PFS was 33 months (IQR: 10–38). Less than 5 years from diagnosis to SABR and triple‐negative breast cancer (TNBC) were associated with worse OS. Advanced T stage, any prior chemotherapy, and TNBC were associated with worse PFS. Alterations in CEBPB, RB1, TBX3, PTEN, and CDK4 were associated with worse survival outcomes.Conclusion: Long‐term systemic disease control and survival can be achieved with SABR for oligometastatic breast cancer. Hormone receptor‐positive patients with a long disease interval from initial diagnosis and limited systemic progression history may be ideal for SABR to all sites of disease.

High‐dose (HD) cisplatin remains the standard of care with chemoradiation for locally advanced oropharyngeal cancer (OPC). Cooperative group trials mandate bolus‐HD (100 mg/m2 x 1 day, every three weeks) cisplatin administration at the beginning of the week to optimize radiosensitization‐‐a requirement which may be unnecessary. This analysis evaluates the impact of chemotherapy administration day of week (DOW) on outcomes. We also report our institutional experience with an alternate dosing schedule, split‐HD (50 mg/m2 x2 days, every three weeks). We retrospectively reviewed 435 definitive chemoradiation OPC patients from 12/10/2001‐December 23, 2014. Those receiving non‐HD cisplatin regimens or induction chemotherapy were excluded. Data collected included DOW, dosing schedule (bolus‐HD vs split‐HD), smoking, total cumulative dose (TCD), stage, KPS, HPV status, and creatinine (baseline, peak, and post‐treatment baseline). Local failure (LF), regional failure (RF), locoregional failure (LRF), distant metastasis (DM), any failure (AF, either LRF or DM) and overall survival (OS) were calculated from RT start. Median follow up was 8.0 years (1.8 months ‐ 17.0 years). DOW, dosing schedule, and TCD were not associated with any outcomes in univariable or multivariable regression models. There was no statistically significant difference in creatinine or association with TCD in split‐HD vs bolus‐HD. There was no statistically significant association between DOW and outcomes, suggesting cisplatin could be administered any day. Split‐HD had no observed differences in outcomes, renal toxicity, or TCD compared to bolus‐HD cisplatin. Our data suggest there is some flexibility of when and how to give HD cisplatin compared to clinical trial mandates.