BackgroundTriple negative breast cancer (TNBC) represents 15–20% of breast cancers. Due to its heterogeneity and high rates of relapse, there is a need to optimize treatment efficacy. Platinum chemotherapy is still controversial and currently not recommended as first-line treatment for TNBC. Recent studies have shown promising activity of this regimen. This study was done to evaluate the effect of platinum chemotherapy on pathologic complete response (pCR) after neoadjuvant treatment for early TNBC and progression-free survival (PFS) in metastatic TNBC.MethodsA systematic search of Pubmed, Embase, Cochrane, Clinical trials databases and hand search were done to identify randomized controlled trials (RCTs) investigating the use of platinum-based chemotherapy in adults with TNBC. Studies were appraised using the Cochrane Collaboration tool. Using the random effects model, pooled Odds ratios (ORs) with 95% confidence intervals (CI) for pCR, and Hazard Ratios (HRs) with 95%CI for PFS were analyzed.ResultsEleven RCTs were included (N = 2946). Platinum-based chemotherapy showed pCR benefit of 40%vs27% (OR1.75,95% CI 1.46–2.62,p < 0.0001) in the neo-adjuvant setting. Subgroup analysis showed increased pCR rates (44.6%vs27.8%) with platinum plus taxane regimen (p < 0.0001). In metastatic TNBC, three RCTs were analyzed (N = 531), platinum treatment did not show PFS advantage (HR1.16,95%CI 0.90–1.49,p = 0.24).ConclusionPlatinum chemotherapy is associated with increased pCR rates in TNBC, hence it is a viable option for patients in the neoadjuvant setting. Subgroup analysis showed that the combination of platinum and taxanes (Carboplatin/Paclitaxel) improved pCR. However, no PFS advantage was seen in metastatic TNBC. Given the current conflicting data in metastatic TNBC, further exploration with additional powered studies is needed.

Methods: A retrospective cohort of 300 patients, was used to develop 'CanAssist-Breast'(CAB)-an immunohistochemistry based test comprising 5 biomarkers plus three clinical parameters (Tumor size, node status and grade) using machine learning based algorithm. Retrospective clinical validation on 850þ cases was performed and Kaplan Meier survival analysis, multivariate analysis was performed to assess robustness of the test. Results: CanAssist-Breast classifies patients into 'low or high' risk of recurrence based on recurrence score on a scale of 1-100 with a cut off at 15.5. Clinical validation of CAB showed distant metastasis-free survival (DMFS) was significantly different between low-(DMFS: 95%) and high-risk (DMFS 80%) groups in the validation cohort treated with hormone therapy alone (n ¼ 195) and in the entire validation cohort of 857 patients as well. In multivariate analysis, CAB risk score was the most significant independent predictor of distant recurrence with a hazard ratio of 4.25 (P ¼ 0.009). Patients stratified as high-risk by CAB have 19% chemotherapy benefit. We also show that CAB can further identify discrete low-and high-risk sub-groups within IHC4 intermediate risk group and also in a node and age independent manner. Conclusions: To our knowledge, CAB is the first machine learning based prognostic risk of recurrence prediction classifier using a combination of unique biomarkers and clinicopathological parameters. We believe that CAB enables accurate treatment planning in early stage HRþ/HER2-breast cancer patients in low-resource settings.Legal entity responsible for the study: OncoStem Diagnostics.

Background Cancer care during the Covid‐19 pandemic has been challenging especially in a developing country such as the Philippines. Oncologists were advised to prioritize chemotherapy based on the absolute benefit that the patient may receive, which outbalances the risks of Covid‐19 infection. The results of this study will allow re‐examination of how to approach cancer care during the pandemic and ultimately, help optimize treatment recommendations during this crisis. Aim This study described the factors contributing to treatment delays during the pandemic and their impact on disease progression. Materials and results This retrospective cohort study was done in St. Luke's Medical Center, a private tertiary healthcare institution based in Metro Manila, Philippines, composed of two facilities in Quezon City and Global City. Patients with solid malignancy with ongoing systemic cancer treatment prior to the peak of the pandemic were identified. Clinical characteristics and treatment data were compared between those with delayed and continued treatments. Multivariate analysis was done to determine factors for treatment delays and association of delays with disease progression and Covid‐19 infection. Of the 111 patients, 33% experienced treatment delays and 67% continued treatment during the pandemic. There was a higher percentage of patients on palliative intent who underwent treatment delay, and 64% of delays were due to logistic difficulties. Treatment delays were significantly associated with disease progression ( p < .0001). There was no evidence of association between delay or continuation of treatment and risk of Covid‐19 infection. Conclusions There was no difference in Covid‐19 infection between those who delayed and continued treatment during the pandemic; however, treatment delays were associated with a higher incidence of disease progression. Our findings suggest that the risks of cancer progression due to treatment delays exceed the risks of Covid‐19 infection in cancer patients implying that beneficial treatment should not be delayed as much as possible. Logistic hindrances were also identified as the most common cause of treatment delay among Filipino patients, suggesting that efforts should be focused into assistance programs that will mitigate these barriers to ensure continuity of cancer care services during the pandemic.

neoadjuvant immunotherapy and neoadjuvant chemotherapy upon multiple shortterm outcome.Results: This systematic review and meta-analysis included 10 trials of neoadjuvant immunotherapy and 11 neoadjuvant chemotherapy involving 1755 patients. Patients received PD-1/PD-L1 inhibitors alone (13.3%; 95%CI, 9.0%-19.3%) had lower objective response rate (ORR) compared to PD-1/PD-L1 inhibitors plus chemotherapy (62.5%; 95%CI, 54.4%-70.0%) or chemotherapy (41.6%; 95%CI, 36.8%-46.7%) while neoadjuvant PD-1/PD-L1 inhibitors plus chemotherapy (36.2%; 95%CI, 19.2%-57.6%) achieved elevated complete pathological complete response (pCR) eclipsing PD-1/PD-L1 inhibitors alone (10.6%; 95%CI, 6.5%-16.9%) and standard chemotherapy (7.5%; 95%CI, 5.7%-9.8%). Neoadjuvant chemotherapy (87.2%; 95%CI, 74.9%-94.0%) has numerically lower R0 resection rate in contrast to neoadjuvant PD-1/PD-L1 inhibitors alone (92.7%; 95%CI, 83.4%-97.0%) and PD-1/PD-L1 inhibitors plus chemotherapy (91.6%; 95%CI, 84.3%-95.7%). Subgroup analysis showed that increased proportion of stage III patients receiving neoadjuvant chemotherapy (p¼0.025, Spearman r¼0.761) may be correlated with lower R0 resection rate while no significant correlation was found in PD-1/PD-L1-based neoadjuvant treatment.Conclusions: Compared to neoadjuvant chemotherapy, immunotherapy-based regimens provided superior pathological response along with higher complete resection rate especially for stage III disease. Immunotherapy combined chemotherapy as neoadjuvant setting may be a more preferable clinical option currently.

We report a case of a 64-year-old Filipino male who initially presented with chronic cough, easy fatigability, and weight loss. Work-ups lead to a diagnosis of lung adenocarcinoma with epidermal growth factor receptor (EGFR) exon 19 deletion. Patient was placed on targeted therapy with Afatinib. He was able to complete 17 months of targeted therapy with relatively stable disease before experiencing recurrence of easy fatigability. Work-ups then lead to a diagnosis of a high-grade neuroendocrine tumor consistent with small cell lung carcinoma (SCLC). Afatinib was then discontinued and the patient was started on Carboplatin and Etoposide. However, after only one cycle, the patient's symptoms progressed and the patient eventually expired. Histological transformation of EGFR-mutant adenocarcinoma to SCLC as a mechanism of resistance to targeted therapy has been documented in literature since 2006. However, to our knowledge, this is the first fully-documented case of histologic transformation occurring in a Filipino patient. As molecular targeted therapy and immunotherapy become standard-of-care in our country, it is of paramount importance that clinicians and pathologists are aware of the various mechanisms of resistance that can occur as a result of these treatments.