This article describes the Trauma Healing Project (THP: www.http//healingattention.org), the Survivor Voices study (n = 351), and the complementary nature of community- campus partnerships (CCP) and community-based participatory action research methodology (PAR). Survivor Voices-a random digit telephone survey developed by, conducted, analyzed, and disseminated by survivors of abuse and violence, university researchers, and students-was designed to learn from survivors about what hurt and about what helped with regard to how people responded to their trauma, and what they recommend for trauma healing. We feature our CCP, including challenges faced, how we have addressed those challenges, and profile our current findings. We describe how PAR and CCPs can be very useful tools toward the development of a community-wide effort to reduce violence and support trauma healing.
Purpose of review
To critically analyze the available evidence on oligometastatic breast cancer and to suggest therapeutic approaches for optimal management of these patients.
Recent findings
Unlike metastatic breast cancer, which remains incurable, patients with a limited number and extent of metastatic lesions, that is, oligometastatic disease, might achieve disease control and long-term survival when radical therapy of the primary tumor, if present, and metastatic disease is added to standard systemic therapy. However, the lack of a clear definition, variety of presentations, and the absence of biomarkers makes oligometastatic breast cancer a poorly understood clinical entity for which there is no standard treatment.
Summary
Improvements in systemic therapies along with radical treatment of the primary tumor and metastatic lesions, together with optimization in the use of imaging tools, may help to increase the percentage of patients with metastatic breast cancer who achieve no-evidence-of-disease status or, at least, chronification of the disease. However, the fundamental question remains: which patients may benefit the most from a radical therapeutic approach? In this article, we propose strategies for the appropriate selection and comprehensive management of these patients.
Background: T-DM1, a HER2-targeted antibodyedrug conjugate, and atezolizumab, a PD-L1-targeted monoclonal antibody, have shown clinical benefit in HER2-positive and triple-negative breast cancer (BC), respectively. In addition to its cytotoxic effects, T-DM1 potentiates antitumor immunity with a synergistic effect observed in preclinical models when combining PD-L1 and HER2 inhibitors. Exploratory analyses of the randomized, phase 2 KATE2 study suggested a progression free survival (PFS) and overall survival (OS) benefit with atezolizumab plus T-DM1 compared to T-DM1 alone in pre-treated patients with HER2-positive and PD-L1-positive locally advanced (LA)/ metastatic (M)BC. These data support further study of T-DM1 plus atezolizumab in this patient population.Trial design: KATE3 (NCT04740918) is an ongoing randomized, multicenter, doubleblind, Phase 3 study of T-DM1 with atezolizumab or placebo in trastuzumab-(AE pertuzumab) and taxane-pretreated LA/MBC with centrally-determined HER2-positive and PD-L1epositive (assessed 6 months before study entry) unresectable LA/MBC. Patients must have received 2 prior lines of therapy for MBC and experienced disease progression during or after LA/MBC therapy or during or within 6 months after (neo)adjuvant therapy. Previous adjuvant T-DM1 is allowed if disease recurrence occurred >6 months after completing T-DM1 treatment. Previous treatment with CD137 agonists and PD-(L)1etargeted agents is allowed. Patients are randomized 1:1 to 3-weekly cycles of T-DM1 3.6 mg/kg and atezolizumab 1200 mg or T-DM1 3.6 mg/ kg and placebo. Randomization is stratified by hormone receptor status, disease status, and world region. The multiple primary endpoints are investigator-assessed PFS and OS. Secondary endpoints include objective response rate, response duration, PFS assessed by a blinded independent central review committee, PFS and OS in those with brain metastases at baseline, central nervous system PFS, patient-reported outcomes, and safety. Approximately 350 patients will be enrolled at approximately
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