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Background: In North America and Europe return to work (RTW) rates vary among breast cancer(BC) survivors from 24-66% and 53-82% after 06 and 36 months of diagnosis, respectively. In 2017an observational study evaluated return to work among Brazilian patients treated in one publichospital in São Paulo, and described RTW rates of 30.3 and 60.4%, after 12 and 24 months of BCdiagnosis, respectively. The aim of the present study was to evaluate RTW rates among a broaderpopulation of Brazilian patients with BC, including patients treated in private hospitals, and todescribe factors associated with this outcome.Patients and Methods: Patients with BC registered on the portal of the NGO Instituto Oncoguia, oneof the largest Brazilian cancer patient support organization, and patients treated in one of the cancercenters from the Oncoclínicas group in Bahia, Rio de Janeiro or São Paulo. Patients received anemail invitation to participate in this study by answering an online survey. Inclusion criteria:Women with BC, diagnosed with stage I-IV within 12 to 36 months from survey date, age 18-65,with paid work before BC, who answered question related to returning to work after the diagnosis.The Institutional Review Board (IRB) of the Hospital Santo Antônio/Obras Sociais Irmã Dulce, inSalvador- Bahia, approved the study.Results: 124 women fulfilled all inclusion criteria and agreed to participate on this online survey.Most patients were white (71.8%), had college degree or higher education (74.2%) and were fromthe southeast region in Brazil (67.7%). Overall, 70.2% of patients returned to work after BCdiagnosis; 21.8% stayed away from work for < 6 months, 26.6% for 6-12 months, 22.6% for 12-24months, 19.3% for more than 24 months and 9.7% did not answer this question. Most participantswere treated in private hospitals/clinics (82%), reported they liked their job (64.5%) and receivedsupport from employer (56.4%), but only 33.1% indicated had been offered work adjustments aftercancer diagnosis. From the 29.8% that did not RTW, 78.4% declared they wished to return. Only19.3% said that they had no difficulties in returning to work. Most common difficulties to RTWwere difficulty concentrating (34.7%) and adjusting to working hours (19.3%). In the multivariateanalysis, factors associated with positive RTW outcomes included being treated in a private versuspublic hospital (OR: 13.74, CI95% 1.76-106.96; p = 0.012) and job satisfaction (OR: 4,69,CI95% 1.10-19.98; p = 0.036). Factors associated with negative RTW outcomes included > 24. months away from work (OR: 0.02, IC95% 0.01-0.32; p = 0.004) and depression diagnosed afterBC (OR: 0.13, IC95% 0.01-0.91; p = 0.04). A limitation of this study is the use of a conveniencesample, thus, the associations found are limited to the participating women .Conclusion: Differences in RTW rates in private versus public hospitals may explain the betterRTW rate found in this cohort, in contrast with previous study conducted with Brazilian patientstreated in a public hospital in São Paulo. Ultimately, identifying patients who will likely experiencedifficulties to RTW (patients who developed depression after BC and those not satisfied with theirjobs) can hopefully trigger patient support strategies. Organizations and government should betterassist patients in the rehabilitation work process and with possible career transitions. Citation Format: Luciana Landeiro, Luciana Holtzde Camargo Barros, Lycia TramujasVasconcellos Neumann, André Marques Santos, Anna Carolina Arena Siqueira, Rafael Kaliks. Return to work after breast cancer: Disparities among patients treated in public and private hospitals in Brazil [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-17.

Background Neratinib has efficacy in central nervous system (CNS) metastases from HER2‐positive metastatic breast cancer (MBC). We report outcomes among patients with CNS metastases at baseline from the phase III NALA trial of neratinib plus capecitabine (N + C) versus lapatinib plus capecitabine (L + C). Materials and Methods NALA was a randomized, active‐controlled trial in patients who received two or more previous HER2‐directed regimens for HER2‐positive MBC. Patients with asymptomatic/stable brain metastases (treated or untreated) were eligible. Patients were assigned to N + C (neratinib 240 mg per day, capecitabine 750 mg/m2 twice daily) or L + C (lapatinib 1,250 mg per day, capecitabine 1,000 mg/m2 twice daily) orally. Independently adjudicated progression‐free survival (PFS), overall survival (OS), and CNS endpoints were considered. Results Of 621 patients enrolled, 101 (16.3%) had known CNS metastases at baseline (N + C, n = 51; L + C, n = 50); 81 had received prior CNS‐directed radiotherapy and/or surgery. In the CNS subgroup, mean PFS through 24 months was 7.8 months with N + C versus 5.5 months with L + C (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.41–1.05), and mean OS through 48 months was 16.4 versus 15.4 months (HR, 0.90; 95% CI, 0.59–1.38). At 12 months, cumulative incidence of interventions for CNS disease was 25.5% for N + C versus 36.0% for L + C, and cumulative incidence of progressive CNS disease was 26.2% versus 41.6%, respectively. In patients with target CNS lesions at baseline (n = 32), confirmed intracranial objective response rates were 26.3% and 15.4%, respectively. No new safety signals were observed. Conclusion These analyses suggest improved PFS and CNS outcomes with N + C versus L + C in patients with CNS metastases from HER2‐positive MBC. Implications for Practice In a subgroup of patients with central nervous system (CNS) metastases from HER2‐positive breast cancer after two or more previous HER2‐directed regimens, the combination of neratinib plus capecitabine was associated with improved progression‐free survival and CNS outcomes compared with lapatinib plus capecitabine. These findings build on previous phase II and III studies describing efficacy of neratinib in the prevention and treatment of CNS metastases, and support a role for neratinib as a systemic treatment option in the management of patients with HER2‐positive brain metastases following antibody‐based HER2‐directed therapies., This article reports outcomes among HER2‐positive breast cancer patients with central nervous system metastases at baseline from the phase III NALA trial of neratinib plus capecitabine versus lapatinib plus capecitabine.

Background: The development of central nervous system (CNS) metastases presents a considerable challenge in metastatic breast cancer (MBC) due to the limited availability of evidence-based treatments. Up to 50% of patients with HER2-positive (HER2+) MBC develop CNS metastases during the course of their disease. Neratinib, an irreversible pan-HER tyrosine kinase inhibitor, has demonstrated activity against CNS metastases in HER2+ MBC in two phase 2 studies (NEfERT-T, TBCRC 022) and one phase 3 study (NALA); significant benefits for predefined CNS endpoints were reported in NEfERT-T and confirmed in NALA. Here we present an exploratory analysis of patients from NALA with CNS involvement at enrollment. Methods: NALA was an international, randomized, open-label, active-controlled, phase 3 study in patients with HER2+ MBC who had received ≥2 lines of HER2-directed therapy in the metastatic setting (ClinicalTrials.gov: NCT01808573). Patients with asymptomatic metastatic brain disease managed with stable doses of corticosteroids for ≥14 days prior to randomization were eligible, whereas patients with symptomatic or unstable brain metastases were excluded. Patients were randomized (1:1 ratio) to neratinib (N; 240 mg qd po) + capecitabine (C; 750 mg/m2 bid po) or lapatinib (L; 1250 mg qd po) + C (1000 mg/m2 bid po). Co-primary endpoints were centrally assessed progression-free survival (PFS) and overall survival (OS). Intervention for symptomatic metastatic CNS disease was a secondary endpoint. CNS disease at baseline was defined as patients with treated or untreated disease in the ‘brain’ assessed by investigator at enrollment. CNS imaging was not mandatory at screening. Results: Of the 621 patients enrolled in NALA, 101 (16%) had documented baseline CNS disease and 520 (74%) had no CNS disease at baseline. Patients with CNS disease had a lower performance status and were more likely to have hormone receptor-negative disease than those with no CNS disease; no major imbalances of baseline characteristics were noted between treatment arms. Overall, 78 (77%) patients had previously received CNS radiation [whole brain, n=59 (58%); stereotactic, n=17 (17%); unknown, n=2 (2%)], and 5 (5%) patients had undergone CNS surgery. Median treatment duration was 5.7 (IQR 2.8-8.5) months for N, and 3.5 (IQR 2.1-6.9) months for L. PFS, OS, and cumulative incidence of interventions for symptomatic CNS disease are summarized in the table. No new safety signals were detected. Conclusions: Regardless of the status of CNS metastases at baseline, patients appeared to have better outcomes in the N+C arm compared with the L+C arm. Table. Efficacy outcomes in patients with and without CNS disease at baselineIntention-to-treat (n=621)CNS metastases at baseline – Yes (n=101)CNS metastases at baseline – No (n=520)N+C (n=307)L+C (n=314)N+C (n=51)L+C (n=50)N+C (n=256)L+C (n=264)PFSaHazard ratio (95% CI)0.76 (0.63–0.93)0.66 (0.41–1.05)0.76 (0.62–0.94)P-value0.00590.07410.0099Restricted mean PFSb, months8.86.67.85.59.06.9Difference, months2.22.32.1OSHazard ratio (95% CI)0.88 (0.72–1.07)0.90 (0.59–1.38)0.85 (0.68–1.06)P-value0.20860.63520.1517Restricted mean OSb, months24.022.216.415.425.623.6Difference, months1.71.02.0Incidence of CNS interventionOverall cumulative incidencec, %22.7629.1940.1347.7919.1624.65P-value0.0430.4300.067aCentrally confirmed; bRestriction prespecified as 24 months for PFS, and 48 months for OS; c % requiring intervention for CNS disease (competing risk model) Citation Format: Cristina Saura, Larisa Ryvo, Sara Hurvitz, William Gradishar, Beverly Moy, Suzette Delaloge, Sung-Bae Kim, Mafalda Oliveira, Maureen Trudeau, Ming-Shen Dai, Barbara Haley, Ron Bose, Luciana Landeiro, Judith Bebchuk, Aimee Frazier, Kiana Keyvanjah, Richard Bryce, Adam Brufsky. Impact of neratinib on outcomes in HER2-positive metastatic breast cancer patients with central nervous system disease at baseline: Findings from the phase 3 NALA trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD13-09.

Enquanto muitas pessoas vivem bem após o tratamento do câncer, outras podem experimentar uma ampla gama de problemas físicos, psicológicos, sociais e financeiros que podem impactar sua qualidade de vida. Essas questões representam um fardo substancial para pacientes com câncer, suas famílias e cuidadores.

Purpose: An Expert Panel on Breast Cancer and COVID-19 was convened to address the impact of the COVID-19 pandemic for early breast cancer management. Methods: In order to ensure the most clinically relevant information was addressed, essential information was drawn from several of the latest national and international guidelines and another technical document. The Expert Panel met in five virtual closed sessions from November 2020 to May 2021 to consult on the relevant data from evidence-based results. The data gathered were discussed on an online platform (Within3 ®). Results: This paper reports the Expert Panel’s highlights of these meetings’ discussions. In addition, it provides practical recommendations covering topics regarding diagnosis, treatment, and management of breast cancer patients in clinical settings routinely encountered by HCPs amid the COVID-19 pandemic. Conclusions: It was provided guidance on several topics regarding eBC management amid the COVID-19 pandemics to inform safer care practices.

Enquanto muitas pessoas vivem bem após o tratamento do câncer, outras podem experimentar uma ampla gama de problemas físicos, psicológicos, sociais e financeiros que podem impactar sua qualidade de vida (QV). Essas questões representam um fardo substancial para pacientes com câncer, suas famílias e cuidadores.

A morbidade associada ao tratamento de citopenias auto-imunes tornou necessária a busca por novas terapêuticas. Baseado no fato de que o rituximab reage especificamente contra o antígeno CD 20, induzindo depleção de células B e conseqüentemente levando à diminuição na produção de auto-anticorpos, cinco pacientes com citopenias auto-imunes foram tratados com esta droga. Os pacientes eram refratários à terapia convencional e receberam 375 mg/m² de rituximab semanalmente, por um período de quatro semanas. Todos os pacientes apresentaram melhora, seja pelo aumento do número de células (níveis de hemoglobina ou contagem de plaquetas), seja pela suspensão do uso de corticoesteróides. Não foram observadas reações importantes durante infusão do medicamento, ou mesmo episódios de infecção durante acompanhamento subseqüente. Desta forma, o rituximab se mostrou eficaz e seguro para pacientes portadores de anemia hemolítica e púrpura trombocitopênica de etiologia imunológica, sugerindo que esta droga deva fazer parte do arsenal terapêutico utilizado nestas doenças auto-imunes. The morbidity associated with the treatment of autoimmune cytopenias has created a need for new approaches. Based on the fact that rituximab reacts specifically against the CD 20 antigen and induces B-cell depletion interfering with the production of auto-antibodies, five patients with autoimmune cytopenias were treated. All patients were previously refractory to conventional therapy and received 375 mg/m² of rituximab infusion weekly, for four weeks. All patients improved either by increasing the number of cells or by being able to reach steroid suspension. No major reactions occurred during infusion, and no major infections occurred during the follow up. Rituximab appears to be active and safe for patients with autoimmune hemolytic anemia and thrombocytopenia, suggesting that this agent can play an important part in the therapeutic arsenal for autoimmune diseases.