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Additional file 1. Fig. S1. Ipatasertib and taselisib determines antitumor effects in MDAMB361 cells. a Ipatasertib and taselisib reduce cell proliferation and ability to prevent clonogenic formation after daily administration for 10 days of IC30 doses for each drug or at fixed drug dose of 1µM, expressed as % of CTL. Each experiment is representative of three independent experiments. b Ipatasertib and taselisib treatment impair 3D tumor spheroid derived from MDAMB361 breast cancer cells. Representative images of first generation 3D tumor spheroid, exposed to ipatasertib and taselisib, administrated to IC30 doses for 72h. Tumor cell growth was reduced. Quantification of ATP was used to measure reduction of cellular growth, expressed as % of CTL. Each experiment is representative of three independent experiments. Statistically significant results are reported (*** indicates P < 0.0005, ** indicates P < 0.005 and * indicates P < 0.05). c The exposure to fixed dose (IC50) of ipatasertib and taselisib induces the reduction of expression of phospho-mTOR, associated with the increase of autophagy signaling, as showed by increase of LC3 II/LC3 I ratio by immunoblot assay by reduction of p62 and increase of ATG5 after 24h of exposure in MDAMB361 cells (*** indicates P < 0.0005, ** indicates P < 0.005 and * indicates P < 0.05). d The addition of CQ 10µM to ipatasertib and taselisib (IC50) induces accumulation of LC3II and p62 protein expression after 24h, due the reduction of autophagic flux, while expression of cleaved parp was not significant increased in taselisib +CQ and in ipatasertib+CQ groups in MDAMB361 cell line. e Representative confocal images of MDAMB361 cell lines immuno-stained with anti-LC3IIb antibody reveals accumulation of autophagosomes (green dots) in treatments with ipatasertib, taselisib, CQ or combinations, due to the induction of autophagy or reduction of autophagic flux exerted by CQ. (*** indicates P < 0.0005, ** indicates P < 0.005 and * indicates P < 0.05). Fig. S2. Ipatasertib and taselisib induce cell cycle alteration as well as apoptosis in Breast cancer cells. a The reduction in proliferation was also associated with perturbation in the cell cycle, after 24h of treatment with ipatasertib and taselisib at IC30 doses, leading to an increase in the G1/G2 phase depending on the cell lines (MCF7, SKBR3, MDAMB361 and MDAMB231) expressed as % of CTL (b) or apoptosis measured by enhancement of Annexin V-FITC and Propidium Iodide, after 24 of treatment at IC30 doses, expressed as % of CTL. Similar representative experiments have yielded similar results. Statistically significant results were reported (*** indicates P < 0.0005, ** indicates P < 0.005 and * indicates P < 0.05). Fig. S3. Ipatasertib and taselisib induce autophagy in MDAMB231 cells. Representative confocal images of MDAMB231 cells overexpressing GFP-LC3 and immuno-stained with anti-p62 ab, reveal accumulation of autophagosomes (green dots) that colocalise with p62 (Merge) in CQ treatments, due to the reduction in autophagic flux exerted by CQ. Ipatasertib, taselisib and CQ were administered at a 10µM dose for 24h. Similar representative experiments yielded similar results. Statistically significant results were reported (*** indicates P < 0.0005, ** indicates P < 0.005 and * indicates P < 0.05). Fig. S4. Chloroquine potentiate antitumor effects induced by ipatasertib and taselisib. a The addition of CQ 1-10-20µM to ipatasertib or taselisib inhibits cell proliferation measured by SRB assay after 48h in MCF7 and SKBR3, and 72h in MDAMB361 on treatments indicated, expressed as % of CTL. Each experiment is representative of three independent experiments. (b) The addition of CQ 10µM to ipatasertib and taselisib (IC30 for MCF7, SKBR3, MDAMB361 and 10µM for MDAMB231) causes an increase of cytotoxicity measured by LDH release after 24h, expressed as % of CTL. Each experiment is representative of three independent experiments. Statistically significant results were reported (*** indicates P < 0.0005, ** indicates P < 0.005 and * indicates P < 0.05). Fig. S5. Taselisib induce anti-proliferative effects via autophagy mediated by ATG5. a ATG-5-siRNA transfection in MDAMB231 cell lines induces a relevant reduction in ATG5 protein expression compared with the control non-transfected or scramble transfected cells within 24 h from transfection b) In the SRB-based proliferation assay, TAS+ATG5-siRNA and TAS+ATG5-siRNA+paclitaxel groups showed a significant reduction in the proliferation rate after 72h of treatment. Ipatasertib and taselisib were administered at a 1µM dose and paclitaxel at a 0.5nM dose. Statistically significant results were reported (* indicates p < 0.05).

The present analysis focuses on real-world data of Everolimus-Exemestane in advanced HR+ve, HER2-ve elderly breast cancer patients (aged 65 years) included in the EVA study, with unique findings in those aged 70 years.Data are collected from clinical records and analysed according to age cut-off (65 years; 65 - 69 years and {greater than or equal to} 70 years). Relationship of analyzed variables with response were tested by mean of a Mantel-Haenszel chi square test. Time to event analysis was described by Kaplan Meier approach and association with baseline characteristics was analysed by stratified log-rank test and proportional hazard model.From July 2013 to December 2015, the EVA study enrolled overall 404 pts. 154 patients out of 404 (38,1%) were aged {greater than or equal to} 65 years, of whom 87 were {greater than or equal to} 70 years. Median duration of EVE treatment was 28.5 weeks (95% CI 19.0 - 33.8) in patients aged 65-69 years and 24,4 weeks (95% CI 19,2 - 33,2) in those aged {greater than or equal to} 70 years. Fewer patients aged 65 years received the highest EVE Dose-Intensity (7.5 mg/day) in comparison to younger patients (49,6% vs. 66,8%). Grade 3-4 toxicities occurred to 55 patients (35,7%), mainly stomatitis (10,9%), rash (5,8%) and non-infectious pneumonitis (NIP) (3,6%). Some toxicities, such as weight loss and anaemia were peculiarly observed in patients aged {greater than or equal to} 70 years. Five treatment-related deaths were collected (3,2%).EVE-EXE combination remains one of the potential treatments in HR+ patients also for elderly ones.

Several studies have highlighted the key role of chronic inflammation in breast cancer development, progression, metastasis, and therapeutic outcome. These processes are mediated through a variety of cytokines and hormones that exert their biological actions either locally or distantly via systemic circulation. Recent findings suggest that positive psychosocial experiences, including psychotherapeutic interventions and therapeutic mind-body protocols, can modulate the inflammatory response by reducing the expression of genes/proteins associated with inflammation and stress-related pathways. Our preliminary results indicate that a specific mind-body therapy (MBT-T) could induce a significant reduction of the release of different cytokines and chemokines, such as SCGF&beta, SDF-1&alpha, MCP3, GRO&alpha, LIF, and IL-18, in the sera of breast cancer patients compared to a control group, suggesting that MBT-T could represent a promising approach to improve the wellness and outcome of breast cancer patients.

The addition of adjuvant chemotherapy to hormonal therapy is often considered questionable in patients with estrogen receptor-positive early breast cancer. Low risk of disease relapse after endocrine treatment alone and/or a low sensitivity to chemotherapy are reasons behind not all patients benefit from chemotherapy. Most of the patients could be exposed to unnecessary treatment- related adverse events and health care costs when treatment decision-making is based only on classical clinical histological features. Gene expression profile has been developed to refine physician’s decision-making process and to tailor personalized treatment to patients. In particular, these tests are designed to spare patients the side effects of unnecessary treatment, and ensure that adjuvant chemotherapy is correctly recommended to patients with early breast cancer. In this review, we will discuss the main diagnostic tests and their potential clinical applications (Oncotype DX, MammaPrint, PAM50/Prosigna, EndoPredict, MapQuant Dx, IHC4, and Theros-Breast Cancer Gene Expression Ratio Assay).