Thierry Petit

18F–FDG PET–CT has emerged as a powerful imaging tool for initial staging and prognosis evaluation of patients with Breast Cancer (BC). However

Neoadjuvant therapy has become the standard of care in early-stage triple-negative breast cancer (TNBC), providing both prognostic information and a platform for treatment individualization. The achievement of a pathological complete response (pCR) is strongly associated with excellent long-term outcomes, whereas the presence of residual disease (RD) indicates a markedly increased risk of recurrence. This dual prognostic value has established post-neoadjuvant treatment as a critical arena for risk-adapted strategies. In patients achieving pCR, de-escalation of adjuvant therapy is under active investigation, with several randomized trials assessing whether surveillance may safely replace prolonged immunotherapy. Conversely, the management of patients with RD has become increasingly complex, as clinicians must navigate between established options such as capecitabine, olaparib, and pembrolizumab, while antibody-drug conjugates are likely to emerge as future therapeutic options in this high-risk setting. In parallel, locoregional approaches are evolving, with trials evaluating axillary de-escalation and even the omission of surgery in highly selected cases. Looking forward, the integration of biomarkers such as circulating tumor DNA and tumor-infiltrating lymphocytes may help refine these strategies, paving the way toward truly personalized post-neoadjuvant care in TNBC.

Background: Breast cancer (BC) survivors receiving adjuvant treatments often report clinically relevant cancer-related cognitive complaints (CRCC), which have a significant impact on quality of life. We aimed to develop a comprehensive model of prediction of CRCC, including clinical and serum inflammatory protein data. Methods: We included 9575 stage I-III BC patients from the CANTO cohort (NCT01993498). Data were collected at diagnosis, 2 (year-2), and 4 (year-4) years post-diagnosis. Outcome of interest was CRCC (cognitive dimension of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 questionnaire, score < 75/100) at year-2 and year-4. Serum inflammatory markers (IL-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IFNg, IL-1, IL1Ra, TNF-a, and CRP) were available in a subset of patients with hormone-receptor-positive BC. Multivariable logistic regression models assessed associations of baseline clinical and inflammatory variables with CRCC. Results: Rates of CRCC were 31% (diagnosis), 39% (year-2), and 37% (year-4). Baseline validated predictors of CRCC reported at year-2 were chemotherapy, pretreatment CRCC, pain, and fatigue; predictors of CRCC reported at year-4 were pretreatment CRCC, pain, and anxiety. Other clinically relevant factors associated with CRCC at both time points during model development were pretreatment insomnia, receipt of endocrine therapy, and younger age/premenopausal status. No significant associations were observed between inflammatory markers and CRCC. Conclusions: Approximately 1 in 3 BC survivors in this cohort reported CRCC at diagnosis, with this rate being stable until year-4 after diagnosis. Pretreatment symptom burden and chemotherapy were validated as risk factors for long-term CRCC. No associations between inflammatory markers and self-reported CRCC emerged from this study.

Supplementary Data 1 from Metabolomic Prediction of Breast Cancer Treatment–Induced Neurologic and Metabolic Toxicities

Supplementary Data and methods