COVID-19 infection and impact on cancer recurrence: comprehensive results from over 32,000 patients with breast cancer. In this study, researchers assessed the relationship between COVID-19 infection after breast cancer diagnosis and cancer recurrence. In total, 32,871 patients diagnosed with localized breast cancer from January 1, 2011, to December 31, 2024, were included for analysis. Median age at diagnosis was 63 years. Estrogen receptor–positive (ER+) disease was reported in 18,297 patients, and ER-negative (ER–) disease in 3,563 patients; 11,011 patients had unknown ER status. Median follow-up was 47 months. A total of 2,449 patients had a reported COVID-19 infection after breast cancer diagnosis. The frequency of any recurrence was 15.35% in the post-diagnosis COVID-19 group vs 9.69% in the no post-diagnosis COVID-19 group. Additionally, patients with COVID-19 had a higher rate of distant recurrence compared to patients without post-diagnosis COVID-19 (11.15% vs 7.65%). Overall, COVID-19 infection was significantly associated with an increased risk of any recurrence, with a hazard ratio [HR] of 1.21 (95% confidence interval [CI]: 1.08–1.34; P<0.001). In subtype analyses, researchers found that COVID-19 infection was significantly associated with increased risk of any recurrence in ER+ disease (HR: 1.42; P<0.001), but no such association was observed in ER– disease (HR: 1.18; P=0.169). Furthermore, the post-diagnosis COVID-19 group had a significantly lower 5-year invasive disease-free survival (iDFS) rate compared to the no COVID-19 group (85.7% vs 88.6%; P<0.001). Findings from bulk ribonucleic acid sequencing showed downregulated HLA and p53 in post-diagnosis COVID-19, indicating that infection promotes an immunosuppressive, protumorigenic environment.
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Survival differences after diagnosis of breast cancer as second primary cancer vs as first primary cancer. Researchers evaluated the data from the Kaiser Permanente Southern California cancer registry from 2000 to 2022 to determine survival differences among female patients with invasive breast cancer as a first (FPC) vs second primary cancer (SPC). The FPC cohort included 42,972 patients, and the SPC cohort included 6,363 patients. Mean age at diagnosis was younger in the FPC cohort (59.8 years) compared to the SPC cohort (66.0 years). In the FPC and SPC cohorts, 65% and 71% of patients, respectively, were diagnosed with localized disease. At mean 7-year follow-up, the overall and breast cancer–specific mortality rates were greater in the SPC cohort (26% and 13%, respectively) compared to the FPC cohort (17% and 9%, respectively). In multivariable models adjusted for age at diagnosis, disease stage, disease subtype, race/ethnicity, year of diagnosis, comorbidities, body mass index, and smoking, overall mortality was increased in the SPC cohort vs the FPC cohort (adjusted HR [aHR]: 1.35), as was breast cancer–specific survival (aHR: 1.27). These findings were similar when stratifying patients based on age at diagnosis (<50 years and ≥50 years), stage, and subtype; however, breast cancer–specific mortality was not increased in triple-negative breast cancer (TNBC; aHR: 1.04).
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Breast cancer risk according to molecular subtype among people living with HIV in the United States. Researchers analyzed data from 2010 to 2019 to assess trends in breast cancer risk among women living with human immunodeficiency virus (HIV). A total of 286 cases of in situ breast cancer and 1,120 cases of invasive breast cancer were identified among women living with HIV. In the invasive breast cancer group, 676 cases were ER+ and 379 were ER–, and among the latter, 261 (68.9%) were triple-negative and 76 (20.1%) were human epidermal growth factor 2 (HER2)–enriched. There were no significant average annual percentage changes in breast cancer incidence across subtypes in this patient population. Women living with HIV had a 33% decreased risk of invasive breast cancer compared to the general population (standardized incidence ratio [SIR]: 0.67; 95% CI: 0.63–0.71); there was a significant 43% reduction in incidence of ER+ breast cancer in women living with HIV vs the general population (SIR: 0.57; 95% CI: 0.53–0.61), while there was a 7% decrease in the incidence of ER– breast cancer (SIR: 0.93; 95% CI: 0.84–1.03). Furthermore, women living with HIV experienced slightly lower incidence of HER2-enriched breast cancer (15%; SIR: 0.85, 95% CI: 0.67–1.06) and TNBC (4%; SIR: 0.96, 95% CI: 0.84–1.08). The risk of in situ breast cancer was 38% lower in patients with HIV compared to the general population (SIR: 0.62, 95% CI: 0.55–0.69). Women living with HIV also had lower incidence across tumor sizes, with SIRs (95% CI) of 0.66 (0.59–0.73), 0.65 (0.57–0.73), and 0.80 (0.66–0.98) for small, medium, and large tumors, respectively, and across tumor grades, with SIRs (95% CI) of 0.54 (0.45–0.65), 0.55 (0.49–0.61), and 0.70 (0.67–0.80) for grade 1, 2, and 3 tumors, respectively.
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Circulating tumor DNA dynamics predict the response to neoadjuvant chemotherapy but not long-term outcomes in PIK3CA-mutated breast cancer. Here, researchers evaluated the relationship between circulating tumor deoxyribonucleic acid (ctDNA) patterns at baseline and presurgery and long-term outcomes among patients with PIK3CA-mutated breast cancer treated with neoadjuvant chemotherapy (NAC). Patients were categorized into 4 groups based on ctDNA patterns: persistent negative (ctDNA-negative at baseline and presurgery), cleared (ctDNA-positive at baseline, ctDNA-negative at surgery), persistent positive (ctDNA-positive at baseline and presurgery) and post-NAC emergent (ctDNA-negative at baseline, ctDNA-positive at presugery). Tumor DNA was collected from 113 primary breast cancer tumors, and 36 (32%) harbored PIK3CA mutations; 34 of 36 patients with PIK3CA mutations had plasma samples available. Most patients were in the persistent-negative (n=17) or cleared (n=14) groups; 2 patients were in the persistent-positive group and 1 was in the post-NAC-emergent group. All patients had ctDNA negativity after surgery. Nine patients (26%) experienced pathologic complete response, 5 from the persistent-negative group and 4 from the cleared group. At median follow-up of 96 months, distant metastasis occurred in 3 patients in the persistent-negative group, 1 patient in the cleared group, and 1 patient in the persistent-positive group. These findings suggest that presurgical ctDNA patterns are not predictive of long-term outcomes among patients with PIK3CA-mutated breast cancer who received NAC.
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Estimating trends in early-onset breast cancer incidence in the United States by race and molecular subtype, 2011-2019. Researchers analyzed data from the National Program of Cancer Registries from 2011 to 2019 to estimate trends in early-onset (diagnosis between 20–49 years of age) breast cancer rates by molecular subtype and race. A total of 436,591 patients with early-onset breast cancer were included for analysis. The incidence of hormone receptor–positive (HR+), HER2– breast cancer rates significantly increased from 2011 to 2019 among Asian/Pacific Islander (A/PI) patients (annual percentage change [APC]: 5.55%), from 2015 to 2019 among American Indian/Alaskan Native (AI/AN) patients (APC: 8.18%), and from 2017 to 2019 among Black (APC: 4.39%) and White (APC: 2.80%) patients. Among Black and White patients, incidence of HR+, HER2+ cases increased from 2011 to 2015 (APC: 5.49% and 3.99%, respectively), then decreased from 2015 to 2019 (APC: –1.72% and –2.27%, respectively). HR+, HER2+ incidence increased sharply for A/PI patients from 2011 to 2013 (APC: 16.30%), then more slowly from 2013 to 2019 (APC: 2.80%). From 2011 to 2015, rates of HR–, HER2+ breast cancer significantly increased among Black and A/PI patients (APC: 7.27% and 6.21%, respectively), whereas rates decreased in latter years for Black patients (2015–2019 APC: –5.53%) and AI/AN patients (2016–2019 APC: –18.27%). Incidence of HR–, HER2– breast cancer decreased significantly among White (2011–2016 APC: –3.16%), A/PI (2011–2017 APC: –2.02%) and Black (2011–2013 APC: –5.35%; 2013–2019 APC: –1.33%) patients.
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