Beleaguered directors of obstetrics/gynecology residency programs may be relieved to know that a new application platform for all ob.gyn. residency applications is poised to come into effect for the 2024-25 cycle.

In a recent joint announcement, the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said the new system, ResidencyCAS, offered by Liaison Centralized Application Service, will replace the Electronic Residency Application Service (ERAS). ERAS was implemented some 25 years ago by the Association of American Medical Colleges.
 

Efficiencies and lower costs

Potential startup glitches aside, the transition will allegedly lower skyrocketing application fees and provide enhanced efficiencies and a better user experience than ERAS. So far, ob.gyn. is first and the only specialty to jump ship from the established platform. But if other specialties follow suit making the new software the norm, that will have a serious impact on ERAS’s revenues, said J. Bryan Carmody, MD, MPH, a pediatric nephrologist at the Children’s Hospital of the King’s Daughters, Norfolk, Va., who closely monitors and writes about residency selection and discussed the coming transition in a recent blog posting.

courtesy Children’s Hospital of the King’s Daughters

“My feeling is that the average program director thinks that ERAS is functional but there are not many, if any, who are in love with ERAS,” Dr. Carmody said in an interview. “I think ERAS will benefit from having a competitor.”

A major drawback for applicants with the removal of ob.gyn. from ERAS, which handles almost all medical specialties, is that those seeking acceptance in more than one specialty will now need to apply twice and incur two sets of costs. “A substantial fraction of applicants do that and now they’ll have to navigate two different systems and collect and format all their documents for both, which will be burdensome,” he said.
 

Holistic review

According to the ACOG announcement, the new technology promises to manage the deluge of applications more efficiently and, most important, to allow program directors to evaluate candidates holistically in order to better meet the specific needs of different communities.

courtesy University of Michigan

“The platform makes it much easier to review applicants for important characteristics other than academic, and It will cost applicants about 20% less,” said Maya M. Hammoud, MD, MBA, professor and association chair for education, obstetrics, and gynecology at the University of Michigan, Ann Arbor, and past president of APGO.

So far the announced switch has been positively received. “People are very excited about the change, especially when they see the video,” Dr. Hammoud said.

For Adi Katz, MD, director of gynecology and director of the obstetrics and gynecology residency program at Lenox Hill Hospital, New York, the change signals a step in the right direction, especially when it comes to application reviewing. “The number of applications has been increasing tremendously in the past few years. We have four residency spots and we get almost 900 applications for them, ” she said. “Under the present system it’s hard to give a fair review to all the applicants, and we hope that with change we’ll be able to give each one the attention they deserve.”

An important feature, added Dr. Katz, is that the new software will allow directors to do intuitive, “gut-level” screenings with the help of AI. In this approach, large numbers of candidates can be screened based on intuition in relation to their formal criteria.

Residency program administrators have long sought more holistic ways of screening applicants, and AI has the potential to provide insights into who’s a good fit by finding patterns in very complex data.

“Of course, we won’t know for sure if it’s the right move until we start using the platform,” Dr. Katz said.

courtesy ACOG

“There are many factors beyond academic standing that can help determine which individual applicants would be the best fit for each unique program,” AnnaMarie Connolly, MD, chief of education and academic affairs at ACOG, said in an interview. ”In particular, improved holistic review will allow programs and applicants to better ensure alignment that, for example, considers factors such as applicants’ clinical interests, academic interests, and past life experiences.”

Updated data science is expected better align ob.gyn. programs and applicants, and improve staff efficiency at no cost to programs, Dr. Connolly added. Good alignment of residents with programs is especially important in a patient-interactive specialty such as ob.gyn. Webinars will prepare users to apply the new system.

According to the promotional video, ResidencyCAS integrates all components of application from candidates’ letters and credentials to lists of program directors, applicant reviews, and specialty data analytics. Collecting recommendations and credentials is expected to be streamlined. The software is currently used by 31 U.S. health care professions and across 31,000 programs.

“It’s clear that ob.gyn. residency applicants and ob.gyn. programs have been frustrated by certain aspects of the former application system, one of which being high costs,” Dr. Connolly added. “The feedback we’ve received indicates that programs are excited about a more streamlined process.”
 

AAMC strikes back

Not all groups are so enthusiastic, however, including, understandably, the AAMC, which expressed “surprise and dismay” at the switch.

courtesy AAMC

“While it is too early to fully understand the consequences of this development – intended and unintended – the AAMC remains committed to creating a fair and equitable process for learners, medical schools, and programs,” wrote AAMC spokespersons David J. Skorton, MD, AAMC’s CEO, and Alison J. Whelan, MD, chief academic officer in a statement. “We are concerned that ob.gyn. program data will no longer be part of the numerous and longstanding AAMC data and research efforts.”

Those efforts include the Residency Readiness Survey, multidecade institution-level data and analytics, and future cross-specialty innovations. Lost with the changeover, the AAMC warned, may be the cross-specialty data it has collected, analyzed, and shared since ERAS’s inception, in particular its advocacy, research, and data support for the ob.gyn. community following the 2022 Supreme Court ruling in Dobbs v. Jackson.
 

Evolution of specialty application

In a blog posting, Dr. Carmody outlined the evolution of the specialty residency application process. Pre-ERAS application was slow, cumbersome, and done by mail. With the introduction of ERAS, applicants were able to put their information on floppy discs and submit them to the dean’s office, hopefully triggering interview offers via email. The new approach was originally piloted in partnership with ob.gyn. program directors and now ERAS finds itself in a first-in, first-out situation.

Over the years, program directors suffocating under the weight of applications have periodically asked the AAMC to share data or make changes to ERAS protocols or policies, including those on the sharing of collected information. “Its my perception that frustration about the AAMC’s data sharing was one of the things that led to the change,” Dr. Carmody said. While acknowledging that data sharing must be carefully done, he noted that, when program directors asked to see ERAS data to answer important questions, they were often refused.

While it appears that AAMC’s improvement efforts have not gone far or fast enough, the association pointed to significant efforts to streamline applications. It stressed its ongoing commitment to cooperation “with learners, medical schools, and the ERAS program community to further consider the implications of ACOG’s announcement.” It recently announced a collaboration with Thalamus-connecting the docs, a new interview-management software system the AAMC expects will accelerate innovation across the transition-to-residency process.

“We have many questions and few answers at this time,” Dr. Skorton and Dr. Whelan wrote, “and we will work diligently to fully understand the consequences and keep open communication with all of our constituents.”
 

Financial impact

Ob.gyn., an important but relatively small specialty, represented only 2.8% of the 2022 residency applications on ERAS and $3,362,760 of its $120 million in revenue that year, Dr. Carmody noted. That’s with 2,613 ob.gyn. applicants submitting an average of 63-83 applications depending on their background.

But if the defection of ob.gyn. starts a stampede among program directors in other branches of medicine to ResidencyCAS or some other new platform, that would cost ERAS substantially more.

“The next few years are going to be very telling,” said Dr. Carmody. Although competition may act as a catalyst for needed improvements to ERAS, if momentum grows, the comfortable inertia of staying with a known system may soon be overcome. “And the more specialties that switch, the more that will deprive the AAMC of the revenue it needs to improve the product.”

Dr. Carmody and Dr. Katz disclosed no relevant conflicts of interest with regard to their comments.

Beleaguered directors of obstetrics/gynecology residency programs may be relieved to know that a new application platform for all ob.gyn. residency applications is poised to come into effect for the 2024-25 cycle.

In a recent joint announcement, the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said the new system, ResidencyCAS, offered by Liaison Centralized Application Service, will replace the Electronic Residency Application Service (ERAS). ERAS was implemented some 25 years ago by the Association of American Medical Colleges.
 

Efficiencies and lower costs

Potential startup glitches aside, the transition will allegedly lower skyrocketing application fees and provide enhanced efficiencies and a better user experience than ERAS. So far, ob.gyn. is first and the only specialty to jump ship from the established platform. But if other specialties follow suit making the new software the norm, that will have a serious impact on ERAS’s revenues, said J. Bryan Carmody, MD, MPH, a pediatric nephrologist at the Children’s Hospital of the King’s Daughters, Norfolk, Va., who closely monitors and writes about residency selection and discussed the coming transition in a recent blog posting.

courtesy Children’s Hospital of the King’s Daughters

“My feeling is that the average program director thinks that ERAS is functional but there are not many, if any, who are in love with ERAS,” Dr. Carmody said in an interview. “I think ERAS will benefit from having a competitor.”

A major drawback for applicants with the removal of ob.gyn. from ERAS, which handles almost all medical specialties, is that those seeking acceptance in more than one specialty will now need to apply twice and incur two sets of costs. “A substantial fraction of applicants do that and now they’ll have to navigate two different systems and collect and format all their documents for both, which will be burdensome,” he said.
 

Holistic review

According to the ACOG announcement, the new technology promises to manage the deluge of applications more efficiently and, most important, to allow program directors to evaluate candidates holistically in order to better meet the specific needs of different communities.

courtesy University of Michigan

“The platform makes it much easier to review applicants for important characteristics other than academic, and It will cost applicants about 20% less,” said Maya M. Hammoud, MD, MBA, professor and association chair for education, obstetrics, and gynecology at the University of Michigan, Ann Arbor, and past president of APGO.

So far the announced switch has been positively received. “People are very excited about the change, especially when they see the video,” Dr. Hammoud said.

For Adi Katz, MD, director of gynecology and director of the obstetrics and gynecology residency program at Lenox Hill Hospital, New York, the change signals a step in the right direction, especially when it comes to application reviewing. “The number of applications has been increasing tremendously in the past few years. We have four residency spots and we get almost 900 applications for them, ” she said. “Under the present system it’s hard to give a fair review to all the applicants, and we hope that with change we’ll be able to give each one the attention they deserve.”

An important feature, added Dr. Katz, is that the new software will allow directors to do intuitive, “gut-level” screenings with the help of AI. In this approach, large numbers of candidates can be screened based on intuition in relation to their formal criteria.

Residency program administrators have long sought more holistic ways of screening applicants, and AI has the potential to provide insights into who’s a good fit by finding patterns in very complex data.

“Of course, we won’t know for sure if it’s the right move until we start using the platform,” Dr. Katz said.

courtesy ACOG

“There are many factors beyond academic standing that can help determine which individual applicants would be the best fit for each unique program,” AnnaMarie Connolly, MD, chief of education and academic affairs at ACOG, said in an interview. ”In particular, improved holistic review will allow programs and applicants to better ensure alignment that, for example, considers factors such as applicants’ clinical interests, academic interests, and past life experiences.”

Updated data science is expected better align ob.gyn. programs and applicants, and improve staff efficiency at no cost to programs, Dr. Connolly added. Good alignment of residents with programs is especially important in a patient-interactive specialty such as ob.gyn. Webinars will prepare users to apply the new system.

According to the promotional video, ResidencyCAS integrates all components of application from candidates’ letters and credentials to lists of program directors, applicant reviews, and specialty data analytics. Collecting recommendations and credentials is expected to be streamlined. The software is currently used by 31 U.S. health care professions and across 31,000 programs.

“It’s clear that ob.gyn. residency applicants and ob.gyn. programs have been frustrated by certain aspects of the former application system, one of which being high costs,” Dr. Connolly added. “The feedback we’ve received indicates that programs are excited about a more streamlined process.”
 

AAMC strikes back

Not all groups are so enthusiastic, however, including, understandably, the AAMC, which expressed “surprise and dismay” at the switch.

courtesy AAMC

“While it is too early to fully understand the consequences of this development – intended and unintended – the AAMC remains committed to creating a fair and equitable process for learners, medical schools, and programs,” wrote AAMC spokespersons David J. Skorton, MD, AAMC’s CEO, and Alison J. Whelan, MD, chief academic officer in a statement. “We are concerned that ob.gyn. program data will no longer be part of the numerous and longstanding AAMC data and research efforts.”

Those efforts include the Residency Readiness Survey, multidecade institution-level data and analytics, and future cross-specialty innovations. Lost with the changeover, the AAMC warned, may be the cross-specialty data it has collected, analyzed, and shared since ERAS’s inception, in particular its advocacy, research, and data support for the ob.gyn. community following the 2022 Supreme Court ruling in Dobbs v. Jackson.
 

Evolution of specialty application

In a blog posting, Dr. Carmody outlined the evolution of the specialty residency application process. Pre-ERAS application was slow, cumbersome, and done by mail. With the introduction of ERAS, applicants were able to put their information on floppy discs and submit them to the dean’s office, hopefully triggering interview offers via email. The new approach was originally piloted in partnership with ob.gyn. program directors and now ERAS finds itself in a first-in, first-out situation.

Over the years, program directors suffocating under the weight of applications have periodically asked the AAMC to share data or make changes to ERAS protocols or policies, including those on the sharing of collected information. “Its my perception that frustration about the AAMC’s data sharing was one of the things that led to the change,” Dr. Carmody said. While acknowledging that data sharing must be carefully done, he noted that, when program directors asked to see ERAS data to answer important questions, they were often refused.

While it appears that AAMC’s improvement efforts have not gone far or fast enough, the association pointed to significant efforts to streamline applications. It stressed its ongoing commitment to cooperation “with learners, medical schools, and the ERAS program community to further consider the implications of ACOG’s announcement.” It recently announced a collaboration with Thalamus-connecting the docs, a new interview-management software system the AAMC expects will accelerate innovation across the transition-to-residency process.

“We have many questions and few answers at this time,” Dr. Skorton and Dr. Whelan wrote, “and we will work diligently to fully understand the consequences and keep open communication with all of our constituents.”
 

Financial impact

Ob.gyn., an important but relatively small specialty, represented only 2.8% of the 2022 residency applications on ERAS and $3,362,760 of its $120 million in revenue that year, Dr. Carmody noted. That’s with 2,613 ob.gyn. applicants submitting an average of 63-83 applications depending on their background.

But if the defection of ob.gyn. starts a stampede among program directors in other branches of medicine to ResidencyCAS or some other new platform, that would cost ERAS substantially more.

“The next few years are going to be very telling,” said Dr. Carmody. Although competition may act as a catalyst for needed improvements to ERAS, if momentum grows, the comfortable inertia of staying with a known system may soon be overcome. “And the more specialties that switch, the more that will deprive the AAMC of the revenue it needs to improve the product.”

Dr. Carmody and Dr. Katz disclosed no relevant conflicts of interest with regard to their comments.

Beleaguered directors of obstetrics/gynecology residency programs may be relieved to know that a new application platform for all ob.gyn. residency applications is poised to come into effect for the 2024-25 cycle.

In a recent joint announcement, the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said the new system, ResidencyCAS, offered by Liaison Centralized Application Service, will replace the Electronic Residency Application Service (ERAS). ERAS was implemented some 25 years ago by the Association of American Medical Colleges.
 

Efficiencies and lower costs

Potential startup glitches aside, the transition will allegedly lower skyrocketing application fees and provide enhanced efficiencies and a better user experience than ERAS. So far, ob.gyn. is first and the only specialty to jump ship from the established platform. But if other specialties follow suit making the new software the norm, that will have a serious impact on ERAS’s revenues, said J. Bryan Carmody, MD, MPH, a pediatric nephrologist at the Children’s Hospital of the King’s Daughters, Norfolk, Va., who closely monitors and writes about residency selection and discussed the coming transition in a recent blog posting.

courtesy Children’s Hospital of the King’s Daughters

“My feeling is that the average program director thinks that ERAS is functional but there are not many, if any, who are in love with ERAS,” Dr. Carmody said in an interview. “I think ERAS will benefit from having a competitor.”

A major drawback for applicants with the removal of ob.gyn. from ERAS, which handles almost all medical specialties, is that those seeking acceptance in more than one specialty will now need to apply twice and incur two sets of costs. “A substantial fraction of applicants do that and now they’ll have to navigate two different systems and collect and format all their documents for both, which will be burdensome,” he said.
 

Holistic review

According to the ACOG announcement, the new technology promises to manage the deluge of applications more efficiently and, most important, to allow program directors to evaluate candidates holistically in order to better meet the specific needs of different communities.

courtesy University of Michigan

“The platform makes it much easier to review applicants for important characteristics other than academic, and It will cost applicants about 20% less,” said Maya M. Hammoud, MD, MBA, professor and association chair for education, obstetrics, and gynecology at the University of Michigan, Ann Arbor, and past president of APGO.

So far the announced switch has been positively received. “People are very excited about the change, especially when they see the video,” Dr. Hammoud said.

For Adi Katz, MD, director of gynecology and director of the obstetrics and gynecology residency program at Lenox Hill Hospital, New York, the change signals a step in the right direction, especially when it comes to application reviewing. “The number of applications has been increasing tremendously in the past few years. We have four residency spots and we get almost 900 applications for them, ” she said. “Under the present system it’s hard to give a fair review to all the applicants, and we hope that with change we’ll be able to give each one the attention they deserve.”

An important feature, added Dr. Katz, is that the new software will allow directors to do intuitive, “gut-level” screenings with the help of AI. In this approach, large numbers of candidates can be screened based on intuition in relation to their formal criteria.

Residency program administrators have long sought more holistic ways of screening applicants, and AI has the potential to provide insights into who’s a good fit by finding patterns in very complex data.

“Of course, we won’t know for sure if it’s the right move until we start using the platform,” Dr. Katz said.

courtesy ACOG

“There are many factors beyond academic standing that can help determine which individual applicants would be the best fit for each unique program,” AnnaMarie Connolly, MD, chief of education and academic affairs at ACOG, said in an interview. ”In particular, improved holistic review will allow programs and applicants to better ensure alignment that, for example, considers factors such as applicants’ clinical interests, academic interests, and past life experiences.”

Updated data science is expected better align ob.gyn. programs and applicants, and improve staff efficiency at no cost to programs, Dr. Connolly added. Good alignment of residents with programs is especially important in a patient-interactive specialty such as ob.gyn. Webinars will prepare users to apply the new system.

According to the promotional video, ResidencyCAS integrates all components of application from candidates’ letters and credentials to lists of program directors, applicant reviews, and specialty data analytics. Collecting recommendations and credentials is expected to be streamlined. The software is currently used by 31 U.S. health care professions and across 31,000 programs.

“It’s clear that ob.gyn. residency applicants and ob.gyn. programs have been frustrated by certain aspects of the former application system, one of which being high costs,” Dr. Connolly added. “The feedback we’ve received indicates that programs are excited about a more streamlined process.”
 

AAMC strikes back

Not all groups are so enthusiastic, however, including, understandably, the AAMC, which expressed “surprise and dismay” at the switch.

courtesy AAMC

“While it is too early to fully understand the consequences of this development – intended and unintended – the AAMC remains committed to creating a fair and equitable process for learners, medical schools, and programs,” wrote AAMC spokespersons David J. Skorton, MD, AAMC’s CEO, and Alison J. Whelan, MD, chief academic officer in a statement. “We are concerned that ob.gyn. program data will no longer be part of the numerous and longstanding AAMC data and research efforts.”

Those efforts include the Residency Readiness Survey, multidecade institution-level data and analytics, and future cross-specialty innovations. Lost with the changeover, the AAMC warned, may be the cross-specialty data it has collected, analyzed, and shared since ERAS’s inception, in particular its advocacy, research, and data support for the ob.gyn. community following the 2022 Supreme Court ruling in Dobbs v. Jackson.
 

Evolution of specialty application

In a blog posting, Dr. Carmody outlined the evolution of the specialty residency application process. Pre-ERAS application was slow, cumbersome, and done by mail. With the introduction of ERAS, applicants were able to put their information on floppy discs and submit them to the dean’s office, hopefully triggering interview offers via email. The new approach was originally piloted in partnership with ob.gyn. program directors and now ERAS finds itself in a first-in, first-out situation.

Over the years, program directors suffocating under the weight of applications have periodically asked the AAMC to share data or make changes to ERAS protocols or policies, including those on the sharing of collected information. “Its my perception that frustration about the AAMC’s data sharing was one of the things that led to the change,” Dr. Carmody said. While acknowledging that data sharing must be carefully done, he noted that, when program directors asked to see ERAS data to answer important questions, they were often refused.

While it appears that AAMC’s improvement efforts have not gone far or fast enough, the association pointed to significant efforts to streamline applications. It stressed its ongoing commitment to cooperation “with learners, medical schools, and the ERAS program community to further consider the implications of ACOG’s announcement.” It recently announced a collaboration with Thalamus-connecting the docs, a new interview-management software system the AAMC expects will accelerate innovation across the transition-to-residency process.

“We have many questions and few answers at this time,” Dr. Skorton and Dr. Whelan wrote, “and we will work diligently to fully understand the consequences and keep open communication with all of our constituents.”
 

Financial impact

Ob.gyn., an important but relatively small specialty, represented only 2.8% of the 2022 residency applications on ERAS and $3,362,760 of its $120 million in revenue that year, Dr. Carmody noted. That’s with 2,613 ob.gyn. applicants submitting an average of 63-83 applications depending on their background.

But if the defection of ob.gyn. starts a stampede among program directors in other branches of medicine to ResidencyCAS or some other new platform, that would cost ERAS substantially more.

“The next few years are going to be very telling,” said Dr. Carmody. Although competition may act as a catalyst for needed improvements to ERAS, if momentum grows, the comfortable inertia of staying with a known system may soon be overcome. “And the more specialties that switch, the more that will deprive the AAMC of the revenue it needs to improve the product.”

Dr. Carmody and Dr. Katz disclosed no relevant conflicts of interest with regard to their comments.

A large brain imaging study of adults with six different psychiatric illnesses shows that heterogeneity in regional gray matter volume deviations is a general feature of psychiatric illness, but that these regionally heterogeneous areas are often embedded within common functional circuits and networks.

The findings suggest that “targeting brain circuits, rather than specific brain regions, may be a more effective way of developing new treatments,” study investigator Ashlea Segal said in an email.

The findings also suggest that it’s “unlikely that a single cause or mechanism of a given disorder exists, and that a ‘one-size-fits-all’ approach to treatment is likely only appropriate for a small subset of individuals. In fact, one size doesn’t fit all. It probably doesn’t even fit most,” said Ms. Segal, a PhD candidate with the Turner Institute for Brain and Mental Health’s Neural Systems and Behaviour Lab at Monash University in Melbourne.

“Focusing on brain alterations at an individual level allows us to develop more personally tailored treatments,” Ms. Segal added.

Regional heterogeneity, the authors write, “thus offers a plausible explanation for the well-described clinical heterogeneity observed in psychiatric disorders, while circuit- and network-level aggregation of deviations is a putative neural substrate for phenotypic similarities between patients assigned the same diagnosis.”

The study was published online in Nature Neuroscience
 

Beyond group averages

For decades, researchers have mapped brain areas showing reduced gray matter volume (GMV) in people diagnosed with a variety of mental illnesses, but these maps have only been generated at the level of group averages, Ms. Segal explained.

“This means that we understand how the brains of people with, say, schizophrenia, differ from those without schizophrenia on average, but we can’t really say much about individual people,” Ms. Segal said.

For their study, the researchers used new statistical techniques developed by Andre Marquand, PhD, who co-led the project, to characterize the heterogeneity of GMV differences in 1,294 individuals diagnosed with one of six psychiatric conditions and 1,465 matched controls. Dr. Marquand is affiliated with the Donders Institute for Brain, Cognition, and Behavior in Nijmegen, the Netherlands.

These techniques “allow us to benchmark the size of over 1,000 different brain regions in any given person relative to what we should expect to see in the general population. In this way, we can identify, for any person, brain regions showing unusually small or large volumes, given that person’s age and sex,” Ms. Segal told this news organization.

The clinical sample included 202 individuals with autism spectrum disorder, 153 with attention-deficit/hyperactivity disorder (ADHD), 228 with bipolar disorder, 161 with major depressive disorder, 167 with obsessive-compulsive disorder, and 383 individuals with schizophrenia.

Confirming earlier findings, those with psychiatric illness showed more GMV deviations than healthy controls, the researchers found.

However, at the individual level, deviations from population expectations for regional gray matter volumes were “highly heterogeneous,” affecting the same area in less than 7% of people with the same diagnosis, they note. “This result means that it is difficult to pinpoint treatment targets or causal mechanisms by focusing on group averages alone,” Alex Fornito, PhD, of Monash University, who led the research team, said in a statement.

“It may also explain why people with the same diagnosis show wide variability in their symptom profiles and treatment outcomes,” Dr. Fornito added.

Yet, despite considerable heterogeneity at the regional level across different diagnoses, these deviations were embedded within common functional circuits and networks in up to 56% of cases. 

The salience-ventral attention network, for example, which plays a central role in cognitive control, interoceptive awareness, and switching between internally and externally focused attention, was implicated across diagnoses, with other neural networks selectively involved in depression, bipolar disorder, schizophrenia, and ADHD.

The researchers say the approach they developed opens new opportunities for mapping brain changes in mental illness.

“The framework we have developed allows us to understand the diversity of brain changes in people with mental illness at different levels, from individual regions through to more widespread brain circuits and networks, offering a deeper insight into how the brain is affected in individual people,” Dr. Fornito said in a statement.

The study had no commercial funding. Ms. Segal, Dr. Fornito, and Dr. Marquand report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A large brain imaging study of adults with six different psychiatric illnesses shows that heterogeneity in regional gray matter volume deviations is a general feature of psychiatric illness, but that these regionally heterogeneous areas are often embedded within common functional circuits and networks.

The findings suggest that “targeting brain circuits, rather than specific brain regions, may be a more effective way of developing new treatments,” study investigator Ashlea Segal said in an email.

The findings also suggest that it’s “unlikely that a single cause or mechanism of a given disorder exists, and that a ‘one-size-fits-all’ approach to treatment is likely only appropriate for a small subset of individuals. In fact, one size doesn’t fit all. It probably doesn’t even fit most,” said Ms. Segal, a PhD candidate with the Turner Institute for Brain and Mental Health’s Neural Systems and Behaviour Lab at Monash University in Melbourne.

“Focusing on brain alterations at an individual level allows us to develop more personally tailored treatments,” Ms. Segal added.

Regional heterogeneity, the authors write, “thus offers a plausible explanation for the well-described clinical heterogeneity observed in psychiatric disorders, while circuit- and network-level aggregation of deviations is a putative neural substrate for phenotypic similarities between patients assigned the same diagnosis.”

The study was published online in Nature Neuroscience
 

Beyond group averages

For decades, researchers have mapped brain areas showing reduced gray matter volume (GMV) in people diagnosed with a variety of mental illnesses, but these maps have only been generated at the level of group averages, Ms. Segal explained.

“This means that we understand how the brains of people with, say, schizophrenia, differ from those without schizophrenia on average, but we can’t really say much about individual people,” Ms. Segal said.

For their study, the researchers used new statistical techniques developed by Andre Marquand, PhD, who co-led the project, to characterize the heterogeneity of GMV differences in 1,294 individuals diagnosed with one of six psychiatric conditions and 1,465 matched controls. Dr. Marquand is affiliated with the Donders Institute for Brain, Cognition, and Behavior in Nijmegen, the Netherlands.

These techniques “allow us to benchmark the size of over 1,000 different brain regions in any given person relative to what we should expect to see in the general population. In this way, we can identify, for any person, brain regions showing unusually small or large volumes, given that person’s age and sex,” Ms. Segal told this news organization.

The clinical sample included 202 individuals with autism spectrum disorder, 153 with attention-deficit/hyperactivity disorder (ADHD), 228 with bipolar disorder, 161 with major depressive disorder, 167 with obsessive-compulsive disorder, and 383 individuals with schizophrenia.

Confirming earlier findings, those with psychiatric illness showed more GMV deviations than healthy controls, the researchers found.

However, at the individual level, deviations from population expectations for regional gray matter volumes were “highly heterogeneous,” affecting the same area in less than 7% of people with the same diagnosis, they note. “This result means that it is difficult to pinpoint treatment targets or causal mechanisms by focusing on group averages alone,” Alex Fornito, PhD, of Monash University, who led the research team, said in a statement.

“It may also explain why people with the same diagnosis show wide variability in their symptom profiles and treatment outcomes,” Dr. Fornito added.

Yet, despite considerable heterogeneity at the regional level across different diagnoses, these deviations were embedded within common functional circuits and networks in up to 56% of cases. 

The salience-ventral attention network, for example, which plays a central role in cognitive control, interoceptive awareness, and switching between internally and externally focused attention, was implicated across diagnoses, with other neural networks selectively involved in depression, bipolar disorder, schizophrenia, and ADHD.

The researchers say the approach they developed opens new opportunities for mapping brain changes in mental illness.

“The framework we have developed allows us to understand the diversity of brain changes in people with mental illness at different levels, from individual regions through to more widespread brain circuits and networks, offering a deeper insight into how the brain is affected in individual people,” Dr. Fornito said in a statement.

The study had no commercial funding. Ms. Segal, Dr. Fornito, and Dr. Marquand report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A large brain imaging study of adults with six different psychiatric illnesses shows that heterogeneity in regional gray matter volume deviations is a general feature of psychiatric illness, but that these regionally heterogeneous areas are often embedded within common functional circuits and networks.

The findings suggest that “targeting brain circuits, rather than specific brain regions, may be a more effective way of developing new treatments,” study investigator Ashlea Segal said in an email.

The findings also suggest that it’s “unlikely that a single cause or mechanism of a given disorder exists, and that a ‘one-size-fits-all’ approach to treatment is likely only appropriate for a small subset of individuals. In fact, one size doesn’t fit all. It probably doesn’t even fit most,” said Ms. Segal, a PhD candidate with the Turner Institute for Brain and Mental Health’s Neural Systems and Behaviour Lab at Monash University in Melbourne.

“Focusing on brain alterations at an individual level allows us to develop more personally tailored treatments,” Ms. Segal added.

Regional heterogeneity, the authors write, “thus offers a plausible explanation for the well-described clinical heterogeneity observed in psychiatric disorders, while circuit- and network-level aggregation of deviations is a putative neural substrate for phenotypic similarities between patients assigned the same diagnosis.”

The study was published online in Nature Neuroscience
 

Beyond group averages

For decades, researchers have mapped brain areas showing reduced gray matter volume (GMV) in people diagnosed with a variety of mental illnesses, but these maps have only been generated at the level of group averages, Ms. Segal explained.

“This means that we understand how the brains of people with, say, schizophrenia, differ from those without schizophrenia on average, but we can’t really say much about individual people,” Ms. Segal said.

For their study, the researchers used new statistical techniques developed by Andre Marquand, PhD, who co-led the project, to characterize the heterogeneity of GMV differences in 1,294 individuals diagnosed with one of six psychiatric conditions and 1,465 matched controls. Dr. Marquand is affiliated with the Donders Institute for Brain, Cognition, and Behavior in Nijmegen, the Netherlands.

These techniques “allow us to benchmark the size of over 1,000 different brain regions in any given person relative to what we should expect to see in the general population. In this way, we can identify, for any person, brain regions showing unusually small or large volumes, given that person’s age and sex,” Ms. Segal told this news organization.

The clinical sample included 202 individuals with autism spectrum disorder, 153 with attention-deficit/hyperactivity disorder (ADHD), 228 with bipolar disorder, 161 with major depressive disorder, 167 with obsessive-compulsive disorder, and 383 individuals with schizophrenia.

Confirming earlier findings, those with psychiatric illness showed more GMV deviations than healthy controls, the researchers found.

However, at the individual level, deviations from population expectations for regional gray matter volumes were “highly heterogeneous,” affecting the same area in less than 7% of people with the same diagnosis, they note. “This result means that it is difficult to pinpoint treatment targets or causal mechanisms by focusing on group averages alone,” Alex Fornito, PhD, of Monash University, who led the research team, said in a statement.

“It may also explain why people with the same diagnosis show wide variability in their symptom profiles and treatment outcomes,” Dr. Fornito added.

Yet, despite considerable heterogeneity at the regional level across different diagnoses, these deviations were embedded within common functional circuits and networks in up to 56% of cases. 

The salience-ventral attention network, for example, which plays a central role in cognitive control, interoceptive awareness, and switching between internally and externally focused attention, was implicated across diagnoses, with other neural networks selectively involved in depression, bipolar disorder, schizophrenia, and ADHD.

The researchers say the approach they developed opens new opportunities for mapping brain changes in mental illness.

“The framework we have developed allows us to understand the diversity of brain changes in people with mental illness at different levels, from individual regions through to more widespread brain circuits and networks, offering a deeper insight into how the brain is affected in individual people,” Dr. Fornito said in a statement.

The study had no commercial funding. Ms. Segal, Dr. Fornito, and Dr. Marquand report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Association of body mass index (BMI) with cardiometabolic risk score (CRS) and obesity-related protein score (OPS) and the relation between CRS and OPS in postmenopausal women indicated that weight control for the reduction of cardiometabolic risks may also help prevent breast cancer (BC).

Major finding: A 1-kg/m² increase in BMI per year increased CRS in both premenopausal (0.057 units; P = .025) and postmenopausal women (0.054 units; P = .033) and increased OPS by 0.588 units (P = .001) in postmenopausal women. A significant association was also observed between CRS and OPS in post-menopausal women (β 0.281, P = .034).

Study details: This longitudinal study included 444 healthy women age 35-64 years.

Disclosures: This study was funded by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Xu B et al. Temporal relationships between BMI and obesity-related predictors of cardiometabolic and breast cancer risk in a longitudinal cohort. Sci Rep. 2023;13:12361 (Jul 31). doi: 10.1038/s41598-023-39387-w

Key clinical point: Association of body mass index (BMI) with cardiometabolic risk score (CRS) and obesity-related protein score (OPS) and the relation between CRS and OPS in postmenopausal women indicated that weight control for the reduction of cardiometabolic risks may also help prevent breast cancer (BC).

Major finding: A 1-kg/m² increase in BMI per year increased CRS in both premenopausal (0.057 units; P = .025) and postmenopausal women (0.054 units; P = .033) and increased OPS by 0.588 units (P = .001) in postmenopausal women. A significant association was also observed between CRS and OPS in post-menopausal women (β 0.281, P = .034).

Study details: This longitudinal study included 444 healthy women age 35-64 years.

Disclosures: This study was funded by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Xu B et al. Temporal relationships between BMI and obesity-related predictors of cardiometabolic and breast cancer risk in a longitudinal cohort. Sci Rep. 2023;13:12361 (Jul 31). doi: 10.1038/s41598-023-39387-w

Key clinical point: Association of body mass index (BMI) with cardiometabolic risk score (CRS) and obesity-related protein score (OPS) and the relation between CRS and OPS in postmenopausal women indicated that weight control for the reduction of cardiometabolic risks may also help prevent breast cancer (BC).

Major finding: A 1-kg/m² increase in BMI per year increased CRS in both premenopausal (0.057 units; P = .025) and postmenopausal women (0.054 units; P = .033) and increased OPS by 0.588 units (P = .001) in postmenopausal women. A significant association was also observed between CRS and OPS in post-menopausal women (β 0.281, P = .034).

Study details: This longitudinal study included 444 healthy women age 35-64 years.

Disclosures: This study was funded by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Xu B et al. Temporal relationships between BMI and obesity-related predictors of cardiometabolic and breast cancer risk in a longitudinal cohort. Sci Rep. 2023;13:12361 (Jul 31). doi: 10.1038/s41598-023-39387-w

Key clinical point: Women, particularly post-menopausal women, with diabetes mellitus (DM) faced a higher risk of developing different subtypes of breast cancer (BC).

Major finding: Women with DM had a 20% greater risk of developing BC (risk ratio [RR] 1.20; 95% CI 1.11-1.29), with the risk persisting only in postmenopausal women (RR 1.12; 95% CI 1.07-1.17). The risk of estrogen receptor-negative BC (RR 1.16; 95% CI 1.04-1.30) and triple-negative BC (RR 1.41; 95% CI 1.01-1.96) subtypes increased in patients with DM.

Study details: This meta-analysis of 70 cohort and case-control studies included premenopausal and postmenopausal women with or without DM who developed BC.

Disclosures: JM Chan received funding from the Cancer League Foundation. RE Graff, the corresponding author, declared being supported by a Young Investigator Award from the Prostate Cancer Foundation.

Source: Xiong F et al. Diabetes and incidence of breast cancer and its molecular subtypes: A systematic review and meta-analysis. Diabetes Metab Res Rev. 2023;e3709 (Aug 7). doi: 10.1002/dmrr.3709

Key clinical point: Women, particularly post-menopausal women, with diabetes mellitus (DM) faced a higher risk of developing different subtypes of breast cancer (BC).

Major finding: Women with DM had a 20% greater risk of developing BC (risk ratio [RR] 1.20; 95% CI 1.11-1.29), with the risk persisting only in postmenopausal women (RR 1.12; 95% CI 1.07-1.17). The risk of estrogen receptor-negative BC (RR 1.16; 95% CI 1.04-1.30) and triple-negative BC (RR 1.41; 95% CI 1.01-1.96) subtypes increased in patients with DM.

Study details: This meta-analysis of 70 cohort and case-control studies included premenopausal and postmenopausal women with or without DM who developed BC.

Disclosures: JM Chan received funding from the Cancer League Foundation. RE Graff, the corresponding author, declared being supported by a Young Investigator Award from the Prostate Cancer Foundation.

Source: Xiong F et al. Diabetes and incidence of breast cancer and its molecular subtypes: A systematic review and meta-analysis. Diabetes Metab Res Rev. 2023;e3709 (Aug 7). doi: 10.1002/dmrr.3709

Key clinical point: Women, particularly post-menopausal women, with diabetes mellitus (DM) faced a higher risk of developing different subtypes of breast cancer (BC).

Major finding: Women with DM had a 20% greater risk of developing BC (risk ratio [RR] 1.20; 95% CI 1.11-1.29), with the risk persisting only in postmenopausal women (RR 1.12; 95% CI 1.07-1.17). The risk of estrogen receptor-negative BC (RR 1.16; 95% CI 1.04-1.30) and triple-negative BC (RR 1.41; 95% CI 1.01-1.96) subtypes increased in patients with DM.

Study details: This meta-analysis of 70 cohort and case-control studies included premenopausal and postmenopausal women with or without DM who developed BC.

Disclosures: JM Chan received funding from the Cancer League Foundation. RE Graff, the corresponding author, declared being supported by a Young Investigator Award from the Prostate Cancer Foundation.

Source: Xiong F et al. Diabetes and incidence of breast cancer and its molecular subtypes: A systematic review and meta-analysis. Diabetes Metab Res Rev. 2023;e3709 (Aug 7). doi: 10.1002/dmrr.3709

Key clinical point: Use of metformin reduced the incidence of paclitaxel-induced peripheral neuropathy in patients with breast cancer (BC).

Major finding: A significantly lower proportion of patients receiving metformin vs placebo had grade 2 paclitaxel-induced peripheral neuropathy (36.1% vs 67.6%; P = .007).

Study details: This parallel-group trial included 73 patients with BC who were randomly assigned to receive either metformin or placebo 1 week before initiating treatment with paclitaxel.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Bakry HM et al. Efficacy of metformin in prevention of paclitaxel-induced peripheral neuropathy in breast cancer patients: A randomized controlled trial. Front Pharmacol. 2023;14:1181312 (Jul 31). doi: 10.3389/fphar.2023.1181312

Key clinical point: Use of metformin reduced the incidence of paclitaxel-induced peripheral neuropathy in patients with breast cancer (BC).

Major finding: A significantly lower proportion of patients receiving metformin vs placebo had grade 2 paclitaxel-induced peripheral neuropathy (36.1% vs 67.6%; P = .007).

Study details: This parallel-group trial included 73 patients with BC who were randomly assigned to receive either metformin or placebo 1 week before initiating treatment with paclitaxel.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Bakry HM et al. Efficacy of metformin in prevention of paclitaxel-induced peripheral neuropathy in breast cancer patients: A randomized controlled trial. Front Pharmacol. 2023;14:1181312 (Jul 31). doi: 10.3389/fphar.2023.1181312

Key clinical point: Use of metformin reduced the incidence of paclitaxel-induced peripheral neuropathy in patients with breast cancer (BC).

Major finding: A significantly lower proportion of patients receiving metformin vs placebo had grade 2 paclitaxel-induced peripheral neuropathy (36.1% vs 67.6%; P = .007).

Study details: This parallel-group trial included 73 patients with BC who were randomly assigned to receive either metformin or placebo 1 week before initiating treatment with paclitaxel.

Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.

Source: Bakry HM et al. Efficacy of metformin in prevention of paclitaxel-induced peripheral neuropathy in breast cancer patients: A randomized controlled trial. Front Pharmacol. 2023;14:1181312 (Jul 31). doi: 10.3389/fphar.2023.1181312

Key clinical point: In postmenopausal women with estrogen receptor-positive (ER+) human epidermal growth factor receptor 2-positive (HER2+) advanced or metastatic breast cancer (BC), 500 mg fulvestrant (F500) with or without anti-HER2 therapy prolonged the time to treatment failure (TTF) in first- and second-line settings and improved the overall survival (OS) outcomes in those who received chemotherapy-free initial systemic therapy and required longer time to chemotherapy (TTC).

Major finding: F500 improved TTF in the first- and second-line vs third- or later-lines of therapy (6.6 vs 3.7 months; P = .014) and OS in patients who received chemotherapy-free initial systemic therapy and had TTC ≥ 3 years vs < 3 years (hazard ratio 0.32; P = .001).

Study details: This study analyzed 94 postmenopausal women with ER+/HER2+ advanced or metastatic BC from the SAFARI study who received F500 with or without anti-HER2 therapy.

Disclosures: This study was sponsored by Japan Breast Cancer Research Group and AstraZeneca. Several authors declared ties with various sources, including the funding agencies.

Source: Masuyama M et al. Fulvestrant with or without anti-HER2 therapy in patients in a postmenopausal hormonal state and with ER-positive HER2-positive advanced or metastatic breast cancer: A subgroup analysis of data from the Safari study (JBCRG-C06). Cancer Med. 2023 (Aug 1). doi: 10.1002/cam4.6390

Key clinical point: In postmenopausal women with estrogen receptor-positive (ER+) human epidermal growth factor receptor 2-positive (HER2+) advanced or metastatic breast cancer (BC), 500 mg fulvestrant (F500) with or without anti-HER2 therapy prolonged the time to treatment failure (TTF) in first- and second-line settings and improved the overall survival (OS) outcomes in those who received chemotherapy-free initial systemic therapy and required longer time to chemotherapy (TTC).

Major finding: F500 improved TTF in the first- and second-line vs third- or later-lines of therapy (6.6 vs 3.7 months; P = .014) and OS in patients who received chemotherapy-free initial systemic therapy and had TTC ≥ 3 years vs < 3 years (hazard ratio 0.32; P = .001).

Study details: This study analyzed 94 postmenopausal women with ER+/HER2+ advanced or metastatic BC from the SAFARI study who received F500 with or without anti-HER2 therapy.

Disclosures: This study was sponsored by Japan Breast Cancer Research Group and AstraZeneca. Several authors declared ties with various sources, including the funding agencies.

Source: Masuyama M et al. Fulvestrant with or without anti-HER2 therapy in patients in a postmenopausal hormonal state and with ER-positive HER2-positive advanced or metastatic breast cancer: A subgroup analysis of data from the Safari study (JBCRG-C06). Cancer Med. 2023 (Aug 1). doi: 10.1002/cam4.6390

Key clinical point: In postmenopausal women with estrogen receptor-positive (ER+) human epidermal growth factor receptor 2-positive (HER2+) advanced or metastatic breast cancer (BC), 500 mg fulvestrant (F500) with or without anti-HER2 therapy prolonged the time to treatment failure (TTF) in first- and second-line settings and improved the overall survival (OS) outcomes in those who received chemotherapy-free initial systemic therapy and required longer time to chemotherapy (TTC).

Major finding: F500 improved TTF in the first- and second-line vs third- or later-lines of therapy (6.6 vs 3.7 months; P = .014) and OS in patients who received chemotherapy-free initial systemic therapy and had TTC ≥ 3 years vs < 3 years (hazard ratio 0.32; P = .001).

Study details: This study analyzed 94 postmenopausal women with ER+/HER2+ advanced or metastatic BC from the SAFARI study who received F500 with or without anti-HER2 therapy.

Disclosures: This study was sponsored by Japan Breast Cancer Research Group and AstraZeneca. Several authors declared ties with various sources, including the funding agencies.

Source: Masuyama M et al. Fulvestrant with or without anti-HER2 therapy in patients in a postmenopausal hormonal state and with ER-positive HER2-positive advanced or metastatic breast cancer: A subgroup analysis of data from the Safari study (JBCRG-C06). Cancer Med. 2023 (Aug 1). doi: 10.1002/cam4.6390

Key clinical point: Adjuvant radiotherapy (RT) following breast-conserving surgery (BCS) improved survival outcomes in women age ≥ 70 years with T1-2N0 estrogen receptor-negative (ER−) breast cancer (BC); however, patients age ≥ 80 years or those with T1mic+T1a, T1b tumors did not benefit from it.

Major finding: Overall survival (hazard ratio [HR] 0.62; P < .001) and BC-specific survival (HR 0.71; P = .002) improved significantly in patients who received vs did not receive adjuvant RT. Patients age ≥ 80 years (P = .056) or with clinical stage T1mic+T1a (P = .543) or T1b (P = .329) tumors did not show improvement in OS after receiving RT.

Study details: This study included 4201 women with T1-2N0 ER− BC (from the Surveillance, Epidemiology, and End Results [SEER] study) who were age ≥ 70 years and underwent BCS, of which 2811 women received adjuvant RT.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Chen C et al. The effect of adjuvant radiotherapy after breast-conserving surgery in elderly women with T1-2N0 estrogen receptor-negative breast cancer. PLoS One. 2023;18(8):e0288078 (Aug 3). doi: 10.1371/journal.pone.0288078

Key clinical point: Adjuvant radiotherapy (RT) following breast-conserving surgery (BCS) improved survival outcomes in women age ≥ 70 years with T1-2N0 estrogen receptor-negative (ER−) breast cancer (BC); however, patients age ≥ 80 years or those with T1mic+T1a, T1b tumors did not benefit from it.

Major finding: Overall survival (hazard ratio [HR] 0.62; P < .001) and BC-specific survival (HR 0.71; P = .002) improved significantly in patients who received vs did not receive adjuvant RT. Patients age ≥ 80 years (P = .056) or with clinical stage T1mic+T1a (P = .543) or T1b (P = .329) tumors did not show improvement in OS after receiving RT.

Study details: This study included 4201 women with T1-2N0 ER− BC (from the Surveillance, Epidemiology, and End Results [SEER] study) who were age ≥ 70 years and underwent BCS, of which 2811 women received adjuvant RT.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Chen C et al. The effect of adjuvant radiotherapy after breast-conserving surgery in elderly women with T1-2N0 estrogen receptor-negative breast cancer. PLoS One. 2023;18(8):e0288078 (Aug 3). doi: 10.1371/journal.pone.0288078

Key clinical point: Adjuvant radiotherapy (RT) following breast-conserving surgery (BCS) improved survival outcomes in women age ≥ 70 years with T1-2N0 estrogen receptor-negative (ER−) breast cancer (BC); however, patients age ≥ 80 years or those with T1mic+T1a, T1b tumors did not benefit from it.

Major finding: Overall survival (hazard ratio [HR] 0.62; P < .001) and BC-specific survival (HR 0.71; P = .002) improved significantly in patients who received vs did not receive adjuvant RT. Patients age ≥ 80 years (P = .056) or with clinical stage T1mic+T1a (P = .543) or T1b (P = .329) tumors did not show improvement in OS after receiving RT.

Study details: This study included 4201 women with T1-2N0 ER− BC (from the Surveillance, Epidemiology, and End Results [SEER] study) who were age ≥ 70 years and underwent BCS, of which 2811 women received adjuvant RT.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Chen C et al. The effect of adjuvant radiotherapy after breast-conserving surgery in elderly women with T1-2N0 estrogen receptor-negative breast cancer. PLoS One. 2023;18(8):e0288078 (Aug 3). doi: 10.1371/journal.pone.0288078

Key clinical point: Decreased levels of plasma apolipoprotein M (APOM) were associated with worsened mortality outcomes in patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor-2 negative (HER2−) metastatic breast cancer (BC).

Major finding: Mean baseline plasma APOM levels were significantly lower in patients who had deceased vs survived during the 24-month follow-up period (42.7 vs 52.2 µg/mL; P = .003), and the doubling of plasma APOM levels was associated with an improvement in the overall survival outcomes (adjusted hazard ratio 0.23; P = .001).

Study details: This study measured APOM plasma levels in 75 patients with ER+/HER2− metastatic BC.

Disclosures: This study was partly sponsored by the European Regional Development fund. The authors declared no conflicts of interest.

Source: Muendlein A et al. Plasma apolipoprotein M predicts overall survival in metastatic breast cancer patients. Breast Cancer Res Treat. 2023 (Jul 25). doi: 10.1007/s10549-023-07045-4

Key clinical point: Decreased levels of plasma apolipoprotein M (APOM) were associated with worsened mortality outcomes in patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor-2 negative (HER2−) metastatic breast cancer (BC).

Major finding: Mean baseline plasma APOM levels were significantly lower in patients who had deceased vs survived during the 24-month follow-up period (42.7 vs 52.2 µg/mL; P = .003), and the doubling of plasma APOM levels was associated with an improvement in the overall survival outcomes (adjusted hazard ratio 0.23; P = .001).

Study details: This study measured APOM plasma levels in 75 patients with ER+/HER2− metastatic BC.

Disclosures: This study was partly sponsored by the European Regional Development fund. The authors declared no conflicts of interest.

Source: Muendlein A et al. Plasma apolipoprotein M predicts overall survival in metastatic breast cancer patients. Breast Cancer Res Treat. 2023 (Jul 25). doi: 10.1007/s10549-023-07045-4

Key clinical point: Decreased levels of plasma apolipoprotein M (APOM) were associated with worsened mortality outcomes in patients with estrogen receptor-positive (ER+), human epidermal growth factor receptor-2 negative (HER2−) metastatic breast cancer (BC).

Major finding: Mean baseline plasma APOM levels were significantly lower in patients who had deceased vs survived during the 24-month follow-up period (42.7 vs 52.2 µg/mL; P = .003), and the doubling of plasma APOM levels was associated with an improvement in the overall survival outcomes (adjusted hazard ratio 0.23; P = .001).

Study details: This study measured APOM plasma levels in 75 patients with ER+/HER2− metastatic BC.

Disclosures: This study was partly sponsored by the European Regional Development fund. The authors declared no conflicts of interest.

Source: Muendlein A et al. Plasma apolipoprotein M predicts overall survival in metastatic breast cancer patients. Breast Cancer Res Treat. 2023 (Jul 25). doi: 10.1007/s10549-023-07045-4

Key clinical point: Omission of axillary lymph node dissection (ALND) was associated with lymph node understaging but had no impact on systemic therapy recommendations in patients with clinically node-positive breast cancer (cN+ BC).

Major finding: A higher proportion of patients undergoing ALND vs receiving axillary radiotherapy (ART) were detected with ≥ 4 positive nodes (58.9% vs 33.8%). ALND was not associated with the proportion of patients receiving adjuvant chemotherapy after upfront surgery (adjusted odds ratio [aOR] 0.72; 95% CI 0.19-2.67) or systemic therapy after neoadjuvant chemotherapy (aOR 0.86; 95% CI 0.43-1.70).

Study details: Findings are from a prospective, observational cohort study including 500 patients with cN+ BC who underwent tailored axillary surgery and were randomly assigned to undergo ALND or receive ART.

Disclosures: This study was supported by the Swiss State Secretariat for Education, Research and Innovation, and other sources. Some authors declared receiving grants, personal fees, speaker fees, patient fees or having other ties with various sources including the funding source.

Source: Weber WP et al and the TAXIS Study Writing Group . Association of axillary dissection with systemic therapy in patients with clinically node-positive breast cancer. JAMA Surg. 2023 (Jul 19). doi: 10.1001/jamasurg.2023.2840

Key clinical point: Omission of axillary lymph node dissection (ALND) was associated with lymph node understaging but had no impact on systemic therapy recommendations in patients with clinically node-positive breast cancer (cN+ BC).

Major finding: A higher proportion of patients undergoing ALND vs receiving axillary radiotherapy (ART) were detected with ≥ 4 positive nodes (58.9% vs 33.8%). ALND was not associated with the proportion of patients receiving adjuvant chemotherapy after upfront surgery (adjusted odds ratio [aOR] 0.72; 95% CI 0.19-2.67) or systemic therapy after neoadjuvant chemotherapy (aOR 0.86; 95% CI 0.43-1.70).

Study details: Findings are from a prospective, observational cohort study including 500 patients with cN+ BC who underwent tailored axillary surgery and were randomly assigned to undergo ALND or receive ART.

Disclosures: This study was supported by the Swiss State Secretariat for Education, Research and Innovation, and other sources. Some authors declared receiving grants, personal fees, speaker fees, patient fees or having other ties with various sources including the funding source.

Source: Weber WP et al and the TAXIS Study Writing Group . Association of axillary dissection with systemic therapy in patients with clinically node-positive breast cancer. JAMA Surg. 2023 (Jul 19). doi: 10.1001/jamasurg.2023.2840

Key clinical point: Omission of axillary lymph node dissection (ALND) was associated with lymph node understaging but had no impact on systemic therapy recommendations in patients with clinically node-positive breast cancer (cN+ BC).

Major finding: A higher proportion of patients undergoing ALND vs receiving axillary radiotherapy (ART) were detected with ≥ 4 positive nodes (58.9% vs 33.8%). ALND was not associated with the proportion of patients receiving adjuvant chemotherapy after upfront surgery (adjusted odds ratio [aOR] 0.72; 95% CI 0.19-2.67) or systemic therapy after neoadjuvant chemotherapy (aOR 0.86; 95% CI 0.43-1.70).

Study details: Findings are from a prospective, observational cohort study including 500 patients with cN+ BC who underwent tailored axillary surgery and were randomly assigned to undergo ALND or receive ART.

Disclosures: This study was supported by the Swiss State Secretariat for Education, Research and Innovation, and other sources. Some authors declared receiving grants, personal fees, speaker fees, patient fees or having other ties with various sources including the funding source.

Source: Weber WP et al and the TAXIS Study Writing Group . Association of axillary dissection with systemic therapy in patients with clinically node-positive breast cancer. JAMA Surg. 2023 (Jul 19). doi: 10.1001/jamasurg.2023.2840

Key clinical point: Patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) advanced breast cancer (BC) reported greater clinical benefits with oral vinorelbine + cyclophosphamide + capecitabine (VEX) regimen vs intravenous paclitaxel without experiencing unmanageable adverse events (AE).

Major finding: Oral metronomic VEX vs intravenous paclitaxel significantly improved the median time to treatment failure (8.3 vs 5.7 months; hazard ratio [HR] 0.61; P = .008) and median progression-free survival (11.1 vs 6.9 months; HR 0.67; P = .03). Although the frequency of targeted grade 3 or 4 AE was higher in the VEX vs paclitaxel group (42.9% vs 28.6%), they were mostly manageable.

Study details: Findings are from the phase 2 METEORA-II study including 140 patients with ER+/ERBB2− metastatic BC who were treated with ≥ 1 line of chemotherapy and were randomly assigned to receive oral VEX or weekly intravenous paclitaxel in 4-week cycles.

Disclosures: This study was funded by Pierre-Fabre Pharma Srl and other sources. Some authors declared receiving grants, personal fees, consulting fees, funding, speaker honoraria, and having other ties with various sources, including the funding agencies.

Source: Munzone E et al for the International Breast Cancer Study Group (IBCSG). Efficacy of metronomic oral vinorelbine, cyclophosphamide, and capecitabine vs weekly intravenous paclitaxel in patients with estrogen receptor-positive, ERBB2-negative metastatic breast cancer: Final results from the phase 2 METEORA-II randomized clinical trial. JAMA Oncol. 2023 (Jul 13). doi: 10.1001/jamaoncol.2023.2150

Key clinical point: Patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) advanced breast cancer (BC) reported greater clinical benefits with oral vinorelbine + cyclophosphamide + capecitabine (VEX) regimen vs intravenous paclitaxel without experiencing unmanageable adverse events (AE).

Major finding: Oral metronomic VEX vs intravenous paclitaxel significantly improved the median time to treatment failure (8.3 vs 5.7 months; hazard ratio [HR] 0.61; P = .008) and median progression-free survival (11.1 vs 6.9 months; HR 0.67; P = .03). Although the frequency of targeted grade 3 or 4 AE was higher in the VEX vs paclitaxel group (42.9% vs 28.6%), they were mostly manageable.

Study details: Findings are from the phase 2 METEORA-II study including 140 patients with ER+/ERBB2− metastatic BC who were treated with ≥ 1 line of chemotherapy and were randomly assigned to receive oral VEX or weekly intravenous paclitaxel in 4-week cycles.

Disclosures: This study was funded by Pierre-Fabre Pharma Srl and other sources. Some authors declared receiving grants, personal fees, consulting fees, funding, speaker honoraria, and having other ties with various sources, including the funding agencies.

Source: Munzone E et al for the International Breast Cancer Study Group (IBCSG). Efficacy of metronomic oral vinorelbine, cyclophosphamide, and capecitabine vs weekly intravenous paclitaxel in patients with estrogen receptor-positive, ERBB2-negative metastatic breast cancer: Final results from the phase 2 METEORA-II randomized clinical trial. JAMA Oncol. 2023 (Jul 13). doi: 10.1001/jamaoncol.2023.2150

Key clinical point: Patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (ERBB2−, aka HER2-) advanced breast cancer (BC) reported greater clinical benefits with oral vinorelbine + cyclophosphamide + capecitabine (VEX) regimen vs intravenous paclitaxel without experiencing unmanageable adverse events (AE).

Major finding: Oral metronomic VEX vs intravenous paclitaxel significantly improved the median time to treatment failure (8.3 vs 5.7 months; hazard ratio [HR] 0.61; P = .008) and median progression-free survival (11.1 vs 6.9 months; HR 0.67; P = .03). Although the frequency of targeted grade 3 or 4 AE was higher in the VEX vs paclitaxel group (42.9% vs 28.6%), they were mostly manageable.

Study details: Findings are from the phase 2 METEORA-II study including 140 patients with ER+/ERBB2− metastatic BC who were treated with ≥ 1 line of chemotherapy and were randomly assigned to receive oral VEX or weekly intravenous paclitaxel in 4-week cycles.

Disclosures: This study was funded by Pierre-Fabre Pharma Srl and other sources. Some authors declared receiving grants, personal fees, consulting fees, funding, speaker honoraria, and having other ties with various sources, including the funding agencies.

Source: Munzone E et al for the International Breast Cancer Study Group (IBCSG). Efficacy of metronomic oral vinorelbine, cyclophosphamide, and capecitabine vs weekly intravenous paclitaxel in patients with estrogen receptor-positive, ERBB2-negative metastatic breast cancer: Final results from the phase 2 METEORA-II randomized clinical trial. JAMA Oncol. 2023 (Jul 13). doi: 10.1001/jamaoncol.2023.2150