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New Perspectives in the Management of Breast Cancer

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 10361

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Special Issue Editors

Prof. Dr. Sonia Santander Ballestín

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Guest Editor

Facultad de Medicina, Universidad de Zaragoza, C. de Pedro Cerbuna, 12, 50009 Zaragoza, Spain
Interests: clinical nutrition; pharmacology; endocrine disorders; diet
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. María José Luesma

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Guest Editor

Facultad de Medicina, Universidad de Zaragoza, C. de Pedro Cerbuna, 12, 50009 Zaragoza, Spain
Interests: obesity; quality of life; body image
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Breast cancer is the most common tumor among women in developed countries. Although it is one of the tumors with the longest survival, mainly due to advances in early detection and treatments, it is important to take into account new perspectives in its management. The approach to breast cancer in terms of future perspectives must take into account multidisciplinary aspects. Thus, early diagnosis tools, the use of new treatments, as well as a nutritional approach based on physical and mental well-being, could allow greater success in the treatment of patients.

Continuous research and the dissemination of new findings are essential to improving the diagnosis, treatment, and prevention of this disease. Through this initiative in the journal Cancers, we aim to support and promote research that can make a significant difference in the fight against breast cancer.

Our goal is to bring together a collection of articles that address breast cancer from multiple perspectives, including, but not limited to, the following:

Advances in early detection and innovative diagnostics.
New therapies and approaches in treatment.
Epidemiological studies and risk factors.
Psychosocial impact on patients and their families.
Innovations in patient care and attention.
The importance of nutrition.
The importance of physical exercise.

Instructions for Authors: Articles must be original and have not been previously published. We invite researchers, clinicians, and health professionals to share their studies, systematic reviews, and theoretical analyses that can significantly contribute to the knowledge and management of breast cancer.

We request that manuscripts be prepared following our Cancers journal guidelines. Additionally, we remind you that all articles will undergo a rigorous peer review process to ensure the quality and relevance of the published content.

We are confident that your valuable contribution will be an indispensable resource for our readers and will significantly contribute to the advancement of knowledge in this crucial area of medicine. We look forward to receiving your manuscripts and thank you in advance for your participation in this important initiative.

Prof. Dr. Sonia Santander Ballestín
Prof. Dr. María José Luesma
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

breast cancer
treatment
nutrition
physical exercise
psychosocial impact

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Published Papers (9 papers)

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Research

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12 pages, 1171 KiB

Open AccessArticle

Survival Outcomes of Luminal Metastatic Breast Cancer Patients According to Changes in Molecular Subtype at Re-Biopsy: Insights from the GIM-13—AMBRA Study

by Marina Elena Cazzaniga, Paolo Pronzato, Domenico Amoroso, Grazia Arpino, Francesco Atzori, Alessandra Beano, Laura Biganzoli, Giancarlo Bisagni, Livio Blasi, Cristina Capello, Rita Chiari, Alessia D’Alonzo, Michelino De Laurentiis, Angela Denaro, Alessandra Fabi, Daniele Farci, Francesco Ferraù, Elena Fiorio, Alessandra Gennari, Francesco Giotta, Filippo Giovanardi, Vanesa Gregorc, Lorenzo Livi, Emanuela Magnolfi, Anna Maria Mosconi, Raffaella Palumbo, Palma Pugliese, Carlo Putzu, Giuseppina Rosaria Rita Ricciardi, Ferdinando Riccardi, Laura Scortichini, Simon Spazzapan, Pierosandro Tagliaferri, Nicola Tinari, Giuseppe Tonini, Anna Maria Vandone and Giorgio Mustacchi Show full author list Hide full author list

Cancers 2025, 17(10), 1715; https://doi.org/10.3390/cancers17101715 - 20 May 2025

Viewed by 126

Abstract

Introduction: The treatment of MBC patients is guided by receptor status, with re-biopsy at relapse recommended to reassess hormone receptor (HR) status. Various treatment options are available for HER2-veMBC, including CDK4/6 inhibitors, PARP inhibitors, and checkpoint inhibitors. The study highlights the importance of determining receptor subtype for guiding treatment choices. Patients and Methods: The GIM 13 AMBRA study is a longitudinal cohort study involving 42 centers in Italy. It includes data from 939 HER2- MBC patients enrolled between May 2015 and September 2020. The study analyzes the impact of HR expression changes on clinical outcomes using Kaplan–Meier survival curves and other statistical methods. Results: Among the 939 patients, 588 were rebiopsied at first relapse. The study found no significant differences in disease-free survival (DFS), progression-free survival (PFS), or overall survival (OS) between patients whose tumors changed molecular subtype and those who did not. However, post-progression survival from first-line treatment (PPS1) was different between the two groups. Discussion: The study confirms the phenomenon of receptor discordance between primary tumors and metastases. It emphasizes the need for re-biopsy in recurrent MBC to guide treatment strategies. The findings align with previous studies and highlight the importance of understanding receptor changes for improving patient outcomes. Conclusions: The GIM 13 AMBRA study provides valuable insights into the impact of molecular subtype changes on survival outcomes in Luminal MBC patients. It underscores the importance of re-biopsy and personalized treatment strategies in managing metastatic breast cancer. Full article

(This article belongs to the Special Issue New Perspectives in the Management of Breast Cancer)

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12 pages, 1556 KiB

Open AccessArticle

Effects of DHA Oral Supplementation on Plasma Resolvin D1 and D2 Levels in Naïve Breast Cancer Patients

by Alessio Molfino, Giovanni Imbimbo, Gerardo Salerno, Luana Lionetto, Alessandro De Luca, Maurizio Simmaco, Carmen Gallicchio, Orietta Picconi, Maria Ida Amabile and Maurizio Muscaritoli

Cancers 2025, 17(10), 1694; https://doi.org/10.3390/cancers17101694 - 18 May 2025

Viewed by 229

Abstract

Background/Objectives: Specialized pro-resolving lipid mediators, such as resolvins derived from omega-3 fatty acids, play a key role in resolving inflammation and restoring homeostasis. Resolvin D1 and D2, derived from docosahexaenoic acid (DHA), have demonstrated inflammation pro-resolving properties and potential anticancer effects. This study aimed to evaluate the effects of oral DHA supplementation on plasma resolvin D1 and D2 levels in breast cancer patients and in controls, and by stratifying the patients by disease presentation (sporadic, familial, BRCA1/2 mutated) and immunohistochemical characteristics. Methods: This is a single-center, interventional, controlled study conducted in women with breast cancer and women with benign breast disease, serving as controls. Participants consumed DHA (2 g/day) as algal oil syrup for 10 consecutive days. Plasma resolvin D1 and D2 levels were measured at baseline (T0) and after supplementation (T1) using ELISA kits. Results: At baseline, breast cancer patients exhibited higher plasma resolvin D1 levels compared to controls (median 21.3 vs. 7.3 pg/mL, p = 0.039), with no significant difference in resolvin D2. Following DHA supplementation, resolvin D1 and D2 significantly increased in BRCA1/2-mutated patients (+185.8% and +101.2%, p = 0.037, p = 0.028, respectively). Conversely, the familial breast cancer group showed a significant decrease in resolvin D1 (p = 0.015). Patients with low Ki67 expression showed greater increase over time of resolvin D2 levels compared to those with high Ki67 expression (p = 0.046). Conclusions: DHA supplementation modulated resolvin levels in breast cancer patients, with significant increase in BRCA1/2-mutated patients, suggesting enhanced inflammation pro-resolving responses. The reduction in resolvin D1 in the familial group highlights a potential dysregulated response. These findings indicate the potential of resolvins as biomarkers of resolution of inflammation and novel therapeutic targets in breast cancer. Full article

(This article belongs to the Special Issue New Perspectives in the Management of Breast Cancer)

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14 pages, 1030 KiB

Open AccessArticle

The Role of Engagement in Virtual Reality to Enhance Emotional Well-Being in Breast Cancer Patients: A Mediation Analysis

by Hélène Buche, Aude Michel, Royce Anders and Nathalie Blanc

Cancers 2025, 17(5), 840; https://doi.org/10.3390/cancers17050840 - 28 Feb 2025

Cited by 1 | Viewed by 964

Abstract

Introduction: Virtual reality (VR) has garnered increasing attention in oncology due to its potential to enhance patient care by alleviating anxiety and emotional distress. The present work evaluates the hypothesis proposed by a recent theoretical model that engagement and the sense of presence are key mediators that impact the degree of beneficial effects that VR may have on the emotional well-being of breast cancer patients. Methods: This study draws on data from three previous studies comprising 156 breast cancer patients. The psychological variables of well-being studied included emotional dimensions measured before and after exposure to a virtual environment, as well as factors related to immersive qualities. Correlation and mediation analyses were conducted to explore relationships among said variables, namely, one’s tendency to be immersed in an activity, engagement, spatial presence, and emotional well-being (i.e., valence and arousal) of the patients. Results: Engagement plays a crucial mediating role between tendency of immersion, spatial presence, and positive emotional responses. Patients with a greater tendency toward immersion and higher engagement in the virtual environment showed significant emotional improvements. However, tendency of immersion and spatial presence alone did not directly lead to more positive emotional experiences; their influence was primarily exerted through engagement. Conclusions: Engagement emerges as a fundamental lever for maximizing the psychological benefits of VR in oncology. Clinical interventions using VR should prioritize optimizing engagement in immersive environments to improve patients’ emotional state throughout their cancer treatment journey. Full article

(This article belongs to the Special Issue New Perspectives in the Management of Breast Cancer)

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16 pages, 826 KiB

Open AccessArticle

Comparison of Survival Outcomes of Breast-Conserving Surgery Plus Radiotherapy with Mastectomy in Early Breast Cancer Patients: Less Is More?

by Chularat Duangkaew, Areewan Somwangprasert, Kirati Watcharachan, Phanchaporn Wongmaneerung, Wasana Ko-iam, Issara Kaweewan and Chagkrit Ditsatham

Cancers 2025, 17(4), 591; https://doi.org/10.3390/cancers17040591 - 9 Feb 2025

Viewed by 1848

Abstract

Purpose: To compare the survival outcomes of early-stage breast cancer patients treated with breast-conserving therapy (BCT) and mastectomy. Method: This retrospective study includes 1330 early-stage breast cancer patients treated at Chiang Mai University (CMU) hospital, using data from the Chiang Mai Cancer Registry between 2004 and 2015. Information pertinent to patients and their treatment was collected for analysis. Time-to-event analysis was performed using Kaplan–Meier methods. Results: The baseline characteristics of 1330 patients showed significant differences between the BCT and mastectomy groups in terms of age, tumor size, and tumor location. BCT patients were younger, had smaller tumors, and exhibited less nodal involvement. Propensity score matching created a balanced cohort of 534 patients where differences persisted in age and tumor size. Univariate analysis revealed significant survival associations for BCT, younger age, and smaller tumor size. Multivariate analysis confirmed these factors, with BCT showing an adjusted hazard ratio (HR) of 0.58 (95% CI: 0.36–0.93; p = 0.023) compared to mastectomy. Kaplan–Meier survival analysis demonstrated a significant survival advantage for BCT, particularly in HER2-enriched and triple-negative subtypes. The 15-year overall survival was 80.01% in the BCT group versus 64.33% in the mastectomy group (p < 0.001). Conclusions: This study reveals key differences between outcomes following breast-conserving therapy (BCT) and mastectomy patients, including age and tumor characteristics. BCT showed improved overall survival, particularly in HER2-enriched and triple-negative breast cancers. However, our study’s limitations may affect the results. These findings suggest that BCT may offer survival benefits for specific subtypes, highlighting the importance of personalized treatment approaches. Full article

(This article belongs to the Special Issue New Perspectives in the Management of Breast Cancer)

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16 pages, 1983 KiB

Open AccessArticle

Hypnosis Sedation Used in Breast Oncologic Surgery Significantly Decreases Perioperative Inflammatory Reaction

by Martine Berliere, Fabienne Roelants, François P. Duhoux, Amandine Gerday, Nathan Piette, Camille Lacroix, Marie-Agnes Docquier, Vasiliki Samartzi, Maude Coyette, Jennifer Hammer, Nassim Touil, Houda Azzouzi, Philippe Piette and Christine Watremez

Cancers 2025, 17(1), 49; https://doi.org/10.3390/cancers17010049 - 27 Dec 2024

Cited by 1 | Viewed by 1046

Abstract

Background: Hypnosis sedation has recently been used for anesthesia in breast oncologic surgery. Methods: Between January 2017 and October 2019, 284 patients from our Breast Clinic (Cliniques Universitaires Saint-Luc, Université Catholique de Louvain) and from the Jolimont Hospital were prospectively included in an interventional non-randomized study approved by our two local ethics committees and registered on clinicaltrials.gov (NCT03330117). Ninety-three consecutive patients underwent surgery while on general anesthesia (GA group). Ninety-two consecutive patients underwent surgery while on general anesthesia preceded by a hypnorelaxation session (GAVRH group). Ninety-five consecutive patients underwent surgery while exclusively on hypnosis sedation (HYPS group). Clinical parameters (pain score, anxiety and distress score) were measured on days 0, 1 and 8 for all patients. All evaluable patients underwent NLR (neutrophil-to-lymphocyte ratio) and CRP (C-reactive protein) dosage on days 0, 1 and 8. Results: Pain scores and anxiety scores were statistically lower in the HYPS group on days 1 and 8, as was the duration of NSAID consumption. NLR and CRP values were significantly inferior on day 1 for all patients who benefited from hypnosis sedation. Conclusions: Some benefits of hypnosis sedation (reduction in postoperative pain, decrease in NSAID consumption) are correlated with a significant reduction in inflammatory parameters in the perioperative process. Full article

(This article belongs to the Special Issue New Perspectives in the Management of Breast Cancer)

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12 pages, 843 KiB

Open AccessArticle

Evaluating CDK4/6 Inhibitor Therapy in Elderly Patients with Metastatic Hormone Receptor-Positive, HER2-Negative Breast Cancer: A Retrospective Real-World Multicenter Study

by Palma Fedele, Matteo Landriscina, Lucia Moraca, Antonio Cusmai, Antonio Gnoni, Antonella Licchetta, Chiara Guarini, Laura Lanotte, Maria Nicla Pappagallo, Assunta Melaccio, Guido Giordano, Felicia Maria Maselli, Antonello Pinto, Francesco Giuliani, Vincenzo Chiuri, Francesco Giotta and Gennaro Gadaleta-Caldarola

Cancers 2024, 16(20), 3442; https://doi.org/10.3390/cancers16203442 - 10 Oct 2024

Cited by 2 | Viewed by 1383

Abstract

Background: Metastatic HR+/HER2- breast cancer is commonly treated with CDK4/6 inhibitors in combination with endocrine therapy. However, the efficacy and safety of this approach in elderly patients (≥70 years) remain unclear, particularly in the context of real-world clinical practice. This study aims to evaluate the clinical outcomes and tolerability of CDK4/6 inhibitor treatments in this fragile population, which is often under-represented in randomized clinical trials. Patients and methods: This retrospective multicenter study included elderly patients with metastatic HR+/HER2-negative breast cancer receiving first-line CDK4/6 inhibitors. The primary endpoint was progression-free survival (PFS). The secondary endpoints focused on the overall survival (OS), safety, and tolerability, considering variables such as tumor subtype, age, comorbidities, and treatment specifics. Results: The median PFS and OS were slightly lower than those reported in clinical trials, reflecting the inclusion of a more fragile population. The luminal B subtype was linked to a poorer PFS, while other factors like age, BMI, and ECOG status did not significantly affect the outcomes. A safety analysis indicated a higher incidence of grade 3 or higher toxicities, especially in frail patients, leading to dose reductions. Despite these challenges, CDK4/6 inhibitors were generally well-tolerated, allowing most patients to continue therapy. Conclusions: CDK4/6 inhibitors with endocrine therapy are effective in elderly patients with metastatic HR+/HER2- breast cancer, though careful management is crucial to balance efficacy and minimize adverse events. Full article

(This article belongs to the Special Issue New Perspectives in the Management of Breast Cancer)

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Review

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20 pages, 812 KiB

Open AccessReview

Advances in CDK4 and 6 Inhibitors: Transforming Breast Cancer Treatment

by Sonia Santander Ballestín, María Abadía Labena, Ana Avedillo-Salas, Cristina Marco Continente, Marina Arribas Blázquez and María José Luesma Bartolomé

Cancers 2025, 17(5), 760; https://doi.org/10.3390/cancers17050760 - 24 Feb 2025

Viewed by 849

Abstract

Background and Objectives: Breast cancer is the most common malignant neoplasm worldwide and the most prevalent one among women. It represents the leading cause of cancer-related death among females. Cyclin-dependent kinase 4 and 6 inhibitors disrupt the cell cycle, inducing cellular senescence and, ultimately, apoptosis. Consequently, they have become a novel type of adjuvant therapy for the treatment of advanced or metastatic breast cancer characterised by positive hormone receptors and human epidermal growth factor receptor 2 (HER-2) negative. Methods: A systematic review was conducted, analysing the available literature on cyclin-dependent kinase 4 and 6 inhibitors published over the last five years. The aim was to evaluate the efficacy and safety of adding these drugs to the standard endocrine therapy for this pathology. Results: The combination of cyclin-dependent kinase 4 and 6 inhibitors with endocrine therapy was shown to improve progression-free survival, overall survival, and chemotherapy-free intervals in patients who received this combination therapy. Conclusions: The addition of CDK4/6 inhibitors to endocrine therapy in the treatment of advanced or metastatic breast cancer with positive hormone receptors and HER-2 negative significantly improved PFS, median survival, and chemotherapy-free intervals compared with the use of hormonal treatments alone or in combination with a placebo. Currently, CDK4/6 inhibitors are becoming established as a new standard treatment for this pathology, offering lower toxicity than chemotherapy. However, it is necessary to deeply investigate the mechanisms of treatment resistance and develop effective therapies to overcome them. Full article

(This article belongs to the Special Issue New Perspectives in the Management of Breast Cancer)

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39 pages, 1154 KiB

Open AccessReview

Targeted Therapy in Breast Cancer: Advantages and Advancements of Antibody–Drug Conjugates, a Type of Chemo-Biologic Hybrid Drugs

by Attrayo Mukherjee and Debasish Bandyopadhyay

Cancers 2024, 16(20), 3517; https://doi.org/10.3390/cancers16203517 - 17 Oct 2024

Viewed by 3206 | Correction

Abstract

Cancer is a significant health challenge globally, with millions of people affected every year, resulting in high morbidity and mortality. Although other treatment options are available with limitations, chemotherapy, either standalone or combined with other therapeutic procedures, is the most commonly used practice of treating cancer. In chemotherapy, cancer cells/malignant tumors are targeted; however, due to less target specificity, along with malignant cells, normal cells are also affected, which leads to various off-target effects (side effects) that impact the patient quality of life. Out of all the different types of cancers, breast cancer is the most common type of cancer in humans worldwide. Current anticancer drug discovery research aims to develop therapeutics with higher potency and lower toxicity, which is only possible through target-specific therapy. Antibody–drug conjugates (ADCs) are explicitly designed to target malignant tumors and minimize off-target effects by reducing systemic cytotoxicity. Several ADCs have been approved for clinical use and have shown moderate to good efficacy so far. Considering various aspects, chemotherapy and ADCs are useful in treating cancer. However, ADCs provide a more focused and less toxic approach, which is especially helpful in cases where resistance to chemotherapy (drug resistance) occurs and in the type of malignancies in which specific antigens are overexpressed. Ongoing ADC research aims to develop more target-specific cancer treatments. In short, this study presents a concise overview of ADCs specific to breast cancer treatment. This study provides insight into the classifications, mechanisms of action, structural aspects, and clinical trial phases (current status) of these chemo-biologic drugs (ADCs). Full article

(This article belongs to the Special Issue New Perspectives in the Management of Breast Cancer)

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