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Breast cancer has historically been a disease for which immunotherapy was largely unavailable. Recently, the use of immune checkpoint inhibitors (ICIs) in combination with chemotherapy for the treatment of advanced/metastatic triple-negative breast cancer (TNBC) has demonstrated efficacy, including longer progression-free survival and increased overall survival in subsets of patients. Based on clinical benefit in randomized trials, ICIs in combination with chemotherapy for the treatment of some patients with advanced/metastatic TNBC have been approved by the United States (US) Food and Drug Administration (FDA), expanding options for patients. Ongoing questions remain, however, about the optimal chemotherapy backbone for immunotherapy, appropriate biomarker-based selection of patients for treatment, the optimal strategy for immunotherapy treatment in earlier stage disease, and potential use in histological subtypes other than TNBC. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew upon the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for breast cancer, including diagnostic testing, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence-based and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with breast cancer.

PurposeTo independently evaluate the impact of axillary surgery type and regional lymph node radiation (RLNR) on breast cancer-related lymphedema (BCRL) rates in patients with breast cancer.Patients and methodsFrom 2005 to 2018, 1,815 patients with invasive breast cancer were enrolled in a lymphedema screening trial. Patients were divided into the following 4 groups according to axillary surgery approach: sentinel lymph node biopsy (SLNB) alone, SLNB+RLNR, axillary lymph node dissection (ALND) alone, and ALND+RLNR. A perometer was used to objectively assess limb volume. All patients received baseline preoperative and follow-up measurements after treatment. Lymphedema was defined as a ≥ 10% relative increase in arm volume arising > 3 months postoperatively. The primary end point was the BCRL rate across the groups. Secondary end points were 5-year locoregional control and disease-free-survival.ResultsThe cohort included 1,340 patients with SLNB alone, 121 with SLNB+RLNR, 91 with ALND alone, and 263 with ALND+RLNR. The overall median follow-up time after diagnosis was 52.7 months for the entire cohort. The 5-year cumulative incidence rates of BCRL were 30.1%, 24.9%, 10.7%, and 8.0% for ALND+RLNR, ALND alone, SLNB+RLNR, and SLNB alone, respectively. Multivariable Cox models adjusted for age, body mass index, surgery, and reconstruction type showed that the ALND-alone group had a significantly higher BCRL risk (hazard ratio [HR], 2.66; P = .02) compared with the SLNB+RLNR group. There was no significant difference in BCRL risk between the ALND+RLNR and ALND-alone groups (HR, 1.20; P = .49) and between the SLNB-alone and SLNB+RLNR groups (HR, 1.33; P = .44). The 5-year locoregional control rates were similar for the ALND+RLNR, ALND-alone, SLNB+RLNR, and SLNB-alone groups (2.8%, 3.8%, 0%, and 2.3%, respectively).ConclusionAlthough RLNR adds to the risk of lymphedema, the main risk factor is the type of axillary surgery used.

As students transition into middle school they must successfully negotiate a new, larger peer context to attain or maintain high social standing. The goal of this study was to examine the extent to which the maintenance, attainment, and loss of a cool status over the course of the sixth grade is associated with student and classroom levels of physical, verbal, and relational aggression. To address this goal, we studied a sample of 1985 (55% girls) ethnically diverse adolescents from 99 sixth grade classrooms in the United States. Attaining a cool status at any point across the school year was associated with stronger aggressive reputations. Additionally, classroom norms for aggressive behavior moderated the association between changes in aggression over the school year and the stability of coolness such that students who maintained their coolness across the school year showed greater increases in their verbally aggressive reputations from fall to spring when they were in classrooms with higher levels of aggression. The findings illustrate the importance of fitting in with social norms for maintaining a high social status among a new set of peers in middle school. (Contains 2 tables.)

The goal of the study was to examine whether social motives (social mimicry, mutual attraction, and unreciprocated attraction) predict changes in antisocial behavior across middle school grades. The 2,003 initial participants (55% girls) were drawn from a larger longitudinal study of urban public school students: 44% Latino, 26% African-American, 10% Asian, 9% Caucasian, and 11% multiracial. Analyses of peer nominations and teacher-rated behavior included five waves of data between the fall of sixth grade and the spring of eighth grade (n = 1,260-1,347 for longitudinal analyses). Supporting the social mimicry hypothesis, students who associated peer-directed aggression with high social status in the beginning of middle school engaged in elevated levels of antisocial conduct during the second year in the new school. Additionally, unreciprocated attraction toward peers who bully others in the beginning of middle school was related to increased antisocial behavior in the last year of middle school. No support was obtained for the mutual attraction hypothesis. The findings provide insights about possible social motives underlying susceptibility to negative peer influence.