Natalia Krawczyk

Purpose: Bone marrow carcinomatosis (BMC) is a rare but clinically relevant manifestation of metastatic breast cancer (mBC), characterized by diffuse marrow infiltration and hematologic dysfunction. Evidence on epidemiology, clinical presentation, prognosis, and optimal treatment is limited. We performed a bicentric retrospective real-world analysis of patients diagnosed with BMC, representing the largest reported European cohort to date. Methods: We retrospectively analyzed 37 patients diagnosed with BMC at two German university breast cancer centers between 2010 and 2023. Clinical characteristics, hematologic abnormalities, metastatic patterns, treatments, and overall survival (OS) were evaluated. Incidence estimates were calculated based on institutional breast cancer and mBC populations. A systematic literature review contextualized the findings. Results: The estimated incidence of BMC was 2.6% among patients with mBC and 0.5% among all breast cancer cases. Most patients had HR-positive/HER2-negative disease (89%). Hematologic abnormalities were frequent, including anemia (84%), thrombocytopenia (76%), and pancytopenia (57%). Median OS after BMC diagnosis was 12 months (95% CI 6.0–38.0). Patients with bone-only metastases did not reach median OS, whereas those with additional metastatic sites had a median OS of 9 months (95% CI 5.0–12.0). Patients receiving endocrine therapy plus CDK4/6 inhibition showed numerically longer OS (34 months, 95% CI 5.0–NA) compared with chemotherapy alone (12 months, 95% CI 5.0–38.0). Conclusions: BMC remains a rare but challenging complication of mBC. Endocrine-based targeted therapy may improve outcomes in selected HR-positive/HER2-negative patients. Larger multicenter studies are needed to optimize diagnosis and treatment strategies.

Preferred working time models and equal opportunities in gynecology and obstetrics: a sub-analysis of the trinational FARBEN survey focusing on German participants from Western and Eastern federal states - Journal of the Turkish-German Gynecological Association

Introduction: The trinational survey project conducted by the young forums of the German, Austrian, and Swiss societies for gynecology and obstetrics aims to evaluate the preferences of prospective and practicing gynecologists regarding various working time models, training systems, career pathways, and the reconciliation of professional and family life. Materials and methods: Between October 2023 and May 2024, 1364 participants completed the FARBEN survey. The questionnaire comprised 62 items addressing aspects such as general workplace conditions, working time models, training priorities, team structures, and professional aspirations. Participation was voluntary and anonymous. The present analysis constitutes a national sub-analysis focusing on the preferences of German respondents, stratified by their current workplace setting (university hospitals, non-university hospitals, or outpatient care facilities). Results: Among the 1008 German respondents, 26.3% were employed in university hospitals, 55.4% in non-university hospitals, and 10.8% in outpatient care. Respondents working in university hospitals were significantly more likely to pursue an academic career (68.0% held a doctoral degree, and 7.5% held a habilitation—the highest academic qualification in German-speaking countries—or a professorship; 38.5% aspired to a habilitation, compared to 6.6% in non-university hospitals). Female respondents employed in university hospitals tended to have children at a later stage and returned to work earlier following parental leave. Institutional childcare was reported to be more accessible and flexible at university hospitals (20.4%) compared to non-university hospitals (9.6%) and outpatient care (8.4%). Furthermore, 34.1% of university hospital respondents indicated that their department head was female, in contrast to 19.2% in non-university hospitals ( p < 0.001). Conclusions: Work–life balance and the compatibility of family life with a medical career are essential for most gynecologists in training, irrespective of their workplace setting. Respondents employed in academic institutions were more inclined to pursue scientific careers and reported greater flexibility and better childcare support. In light of the growing shortage of medical professionals, employment policies should prioritize these aspects. Initiatives such as the guideline “Safe Surgery During Pregnancy” can support the alignment of clinical training with family planning and help prevent career disadvantages related to parenthood.

Medical advancements in breast cancer are truly remarkable. Especially in recent years, numerous new therapeutics have been approved and surgical strategies have been de-escalated for specific patient groups. In the therapeutic setting, CDK4/6 inhibitors as oral maintenance therapy in early breast cancer and immune checkpoint inhibitors (Pembrolizumab) for triple-negative breast cancer (BC) are noteworthy. In the surgical field, prospective randomized controlled trials have currently explored the possibility to deescalate axillary surgery by omitting sentinel lymph node excision (INSEMA, SOUND). As a result, there have been significant improvements in prognosis and a reduction in surgical morbidity for patients. Many exciting trials are underway, and it remains to be seen whether antibody–drug conjugates beyond trastuzumab emtansine, will find their way into the treatment lines for early-stage BC. Furthermore, the integration of artificial intelligence in both diagnostics and treatment recommendation evaluation is a promising area with great potential.

Background/Objectives: This single-center analysis evaluated the number of potential candidates for endocrine-based oral maintenance therapy in a real-world setting, focusing on three therapeutic agents, namely, olaparib, abemaciclib, and ribociclib, for patients with hormone receptor-positive HER2-negative early breast cancer. Methods: All breast cancer cases from the past 10 years (n = 3230) that underwent treatment at the certified Breast Cancer Center of the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Lübeck Campus, were analyzed. Results: Of a total of 2038 patients with HR+ HER2− eBC, 685 patients (33.6%) qualified for one or more of the three agents—olaparib, abemaciclib, and ribociclib. Of these 685 patients, 523 patients (76.4%) had node-positive and 162 (23.6%) node-negative disease. Moreover, 368 patients (18.1% of a total of 2038 patients with HR+ HER2− eBC) were eligible exclusively for ribociclib, including all node-negative patients. A total of 141 patients (6.9%) met the criteria for all three agents. In contrast, 1353 patients (66.4%) had no indication for combined endocrine therapy. Conclusions: To our knowledge, this is the largest analysis addressing all three therapeutic strategies for combined endocrine therapy. The broad indication criteria of the NATALEE study may increase clinic workloads due to more frequent physician/patient interactions. It also remains unclear how therapy recommendations will influence actual treatment, as increased visits and potential side effects could affect patient compliance and adherence.

Background/Objectives: This single-center analysis evaluated the number of potential candidates for endocrine based oral maintenance therapy in a real-world setting, focusing on three therapeutic agents: olaparib, abemaciclib and ribociclib for patients with hormone receptor positive HER2-negative early breast cancer. Methods: All breast cancer cases from the past 10 years (n= 3,230) that underwent treatment at the certified Breast Cancer Center of the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Lübeck Campus, were analyzed. Results: A total of 685 patients (33.6%) qualified for one or more of the three agents—olaparib, abemaciclib, and ribociclib. Of these, 523 patients (76.4%) had node-positive disease. All of these patients met the criteria for ribociclib based on the NATALEE trial and 368 (18.1%) were eligible exclusively for ribociclib, including all node-negative patients. 141 patients (6.9%) met the criteria for all three agents. In contrast, 1,353 patients (66.4%) had no indication for combined endocrine therapy. Conclusions: To our knowledge, this is the largest analysis addressing all three therapeutic strategies for combined endocrine therapy. The broad indication criteria of the NATALEE study may increase clinic workloads due to more frequent physician-patient interactions. It also remains unclear how therapy recommendations will influence actual treatment, as increased visits and potential side effects could affect patient compliance and adherence.