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Trastuzumab emtansine improves long-term survival in HER2 breast cancer

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A clinical trial has found that, in patients with high-risk HER2-positive breast cancer, post-surgery, or adjuvant, treatment with trastuzumab emtansine (T-DM1) reduced the long-term risk of death or invasive disease by 46 per cent and improved survival compared to trastuzumab alone.

The findings provide long-term evidence that T-DM1 is an effective adjuvant treatment for this population of breast cancer patients, supporting initial results with three-year follow-up published in the NEJM in 2019, which found that TDM1 reduced the risk of death or invasive disease by 50 per cent.

“KATHERINE is a landmark clinical trial that found T-DM1 had such improved activity relative to trastuzumab that the results were reported earlier than had been anticipated when the study was originally designed. The results changed the standard of care globally for patients with HER2-positive early breast cancer,” said lead author Charles Geyer Jr., professor in the Division of Malignant Hematology and Medical Oncology at the Pitt School of Medicine, UPMC Hillman and UPMC Magee-Womens Hospital.

“We continued to follow patients to understand the full magnitude of the benefit, and we now show that T-DM1 leads to stable long-term improvements in invasive disease-free survival and improves overall survival.”

T-DM1 is an antibody-drug conjugate that combines trastuzumab and a chemotherapy drug called emtansine. When trastuzumab attaches to the HER2 receptor on cancer cells, it acts like a trojan horse, allowing emtansine to more effectively enter the cancer cells and kill them from within.

The KATHERINE trial included 1,486 patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer who had residual invasive disease in the breast or axillary lymph node after pre-surgery, or neoadjuvant, treatment with taxane-based chemotherapy and the HER2-targeted agent trastuzumab and surgical removal of the tumour.

These patients are at high risk of cancer recurrence and death.

After surgery, patients were randomly assigned to receive adjuvant standard trastuzumab or T-DM1.

At 7-years follow up, invasive disease-free survival was 80.8 per cent with adjuvant T-DM1 and 67.1 per cent with adjuvant trastuzumab alone. Overall survival was 89.1 per cent with T-DM1 and 84.4 per cent with trastuzumab alone.

Although adverse events were higher in the T-DM1 group (26.1 per cent) compared to patients who received trastuzumab (15.7 per cent), the overall safety of the drug was considered acceptable.

According to Geyer, an important finding was the consistent benefit of T-DM1 across patient subgroups. The analysis showed an approximately 50 per cent reduction in risk of death and invasive disease regardless of the extent of disease at presentation, hormone receptor status, neoadjuvant treatment regimen, pathological node status at surgery, age and race.

“When I started my career in oncology, we knew that some breast cancers were more aggressive, but we didn’t know why,” said Geyer.

“From the excitement of identifying HER2 gene amplification and resultant protein overexpression as a targetable oncogene, through the development of drugs targeting HER2 amplification and evaluating them in landmark clinical trials, I’ve had the privilege of being part of the HER2 story, and it’s incredibly satisfying to have been part of research effort that has led to a new standard of care for patients with this disease.”

Now, Geyer and his colleagues are investigating a promising new antibody-drug candidate called trastuzumab deruxtecan, or T-DXd, for certain groups of patients such as those with lower expression levels of the HER2 protein who didn’t respond as well to T-DM1 as patients with high HER2 expression.

“As oncologists, we are greedy,” said Geyer. “We will never be satisfied until we reach 100 per cent cancer-free survival outcomes for our breast cancer patients.”

Fertility

AI could transform ovarian care through personalisation, study finds

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AI could transform ovarian care by personalising cancer and fertility treatment, but more clinical validation is needed before routine use.

A systematic review and meta-analysis found AI models showed high diagnostic accuracy for ovarian cancer when combining data such as ultrasound scans and blood test results.

Across 81 studies, AI models correctly identified ovarian cancer in around nine out of 10 cases, with pooled rates of 89 to 94 per cent.

They were also highly accurate at ruling out ovarian cancer when it was not present, with specificity of 85 to 91 per cent.

The analysis also found that explainable AI tools could predict complete surgical cytoreduction in advanced ovarian cancer.

Complete surgical cytoreduction means removing all visible cancer during surgery, which can be an important goal in treatment planning.

The tools achieved a pooled AUC of 0.87. AUC is a measure of how well a model distinguishes between different outcomes, with higher scores showing stronger performance.

In reproductive medicine, AI algorithms helped physicians optimise ovarian stimulation protocols and predict follicular growth during IVF.

Ovarian stimulation is the use of hormones to encourage the ovaries to produce eggs, while follicles are the small sacs in the ovaries where eggs develop.

The review found AI could reliably model ovarian response in IVF with a pooled AUC of 0.81.

However, researchers said challenges remain in translating promising research findings into routine clinical practice.

They identified substantial variation across studies, driven by retrospective study designs, variable AI systems and a lack of standardised validation.

Only 22 per cent of analysed studies reported prospective, multicentre external validation, where models are tested forward in time across multiple healthcare settings.

The authors called for rigorous validation to help close the gap between research and routine clinical practice, alongside standardised methodological and reporting frameworks, smooth integration with clinical workflow and robust governance to support responsible and ethical AI use.

They concluded: “Artificial intelligence is a transformative force in the management of ovarian conditions.

“In gynaecologic oncology, AI enhances every phase of care, from early detection and accurate diagnosis to prognostic stratification and surgical planning.”

In reproductive medicine, AI personalises ovarian stimulation and refines the diagnosis of heterogenous endocrine disorders such as PCOS.

PCOS, or polycystic ovary syndrome, is a hormonal condition that can affect periods, skin, weight and fertility.

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Cancer

Three cancer innovators shortlisted for Femtech World Award

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Femtech World is delighted to reveal the shortlist for this year’s Women’s Cancer Innovation award.

The award, sponsored by Endomag, will honour a groundbreaking innovation dedicated to the prevention, early detection treatment or ongoing care of cancers that uniquely or disproportionately affect women.

Endomag is a medical technology company devoted to improving the global standard of cancer care.

Its Sentimag system, Magseed marker and Magtrace lymphatic tracer are used by thousands of the world’s leading physicians and cancer centres.

After careful review of this year’s submissions, we are delighted to announce the three shortlisted entries for the Women’s Cancer Innovation Award 2026.

Auria is tackling one of the most stubborn problems in breast cancer screening: the 66 per cent of women who simply don’t participate.

Rather than improving existing imaging pathways, Auria is creating an entirely new access layer: a non-invasive, at-home test that detects protein biomarkers for breast cancer in tears.

Auria’s test, a CLIA-certified Lab Developed Test, has been validated across more than 2,000 patients in multiple clinical studies with collaborators including MD Anderson Cancer Center and Stanford University.

It reports a sensitivity of 93 per cent and a negative predictive value of 98 per cent.

Founded on six years of combined research at the University of Barcelona and UC Irvine, The Blue Box has developed a non-invasive, urine-based test that detects breast cancer by analysing volatile organic compound (VOC) signatures – no radiation, no compression, no imaging facility required.

The test achieves a sensitivity of 88.42 per cent, outperforming mammography by 15 per cent overall, and by 30 per cent specifically in women with dense breasts. 

The technology could function as a first-line screening tool in primary care settings, as a complement to mammography for high-density patients, or as an accessible alternative in healthcare systems where imaging infrastructure is limited.

Celbrea is a disposable and affordable thermal screening device that empowers women of all ages to stay on top of monitoring their breast health.

The device aims to add to doctors’ existing standard evaluation protocols with a quick, painless examination. Celbrea does not replace a mammogram but simply provides an additional way to screen for breast disease, including breast cancer.

The device consisting of two disposable pads with photochromic sensors. The pads are self-applied to each breast for 15 minutes.

1188 nano-sensors are embedded within a biocompatible multilayer pad, accurately measuring any temperature differences on the surface of the breast using liquid crystal thermographic technology.

What happens next

The shortlisted entries will now be judge by an Endomag representative who will reveal the winner at a virtual awards event on June 19.

Winners will receive a trophy and will be interviewed by a Femtech World journalist.

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Insight

Common cancer marker may play active role in preventing the disease, study finds

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Ki-67, a protein used to measure tumour growth, may also help prevent chromosome errors that drive cancer, a study suggests.

The findings could change how scientists view Ki-67, a marker commonly used in breast cancer and other tumours to assess how quickly cancer cells are growing.

Researchers found the protein may help preserve genome stability by maintaining the structural integrity of centromeres, key parts of chromosomes that help ensure DNA is shared correctly during cell division.

The research was led by professor Paola Vagnarelli at Brunel University of London in collaboration with scientists at the University of Edinburgh and the Technical University of Berlin.

Professor Vagnarelli said: “Doctors already measure Ki-67 to see how aggressive a cancer might be. But our results suggest it is actually helping maintain genome stability.

“That means it may be more than a marker. It could potentially also be a therapeutic target.”

The study examined three proteins that attach to chromosomes during cell division and help rebuild the molecular system that tells each new cell what kind of cell it is.

Every human cell carries identical DNA. What makes a liver cell different from a brain cell is which genes are switched on and which are kept inactive.

When a cell divides, that entire system of switches must be rebuilt. The three proteins involved in this process were Ki-67, Repo-Man and PNUTS.

Vagnarelli’s team developed a method that individually removes each protein from a living cell at the precise point of division. Older techniques could not isolate that moment cleanly.

They found that cells rely on all three proteins to reset themselves after division, but each failed in a different way when removed.

Without PNUTS, gene activity spiralled out of control and thousands of genes switched on at once.

Without Repo-Man, cells escaped safety checkpoints that usually stop damaged or abnormal cells from continuing to divide.

“What we didn’t expect was how clean the separation was,” said Vagnarelli.

Each protein fails in its own specific way. There is no redundancy, no safety net. Which means there are three separate points at which this process can go wrong.

“When the system breaks down, cells can emerge with the wrong number of chromosomes. That condition, called aneuploidy, is seen in disorders such as Down syndrome and in many cancers.

“We also found that these chromosome errors can trigger inflammatory signals inside the cell.”

Aneuploidy means a cell has too many or too few chromosomes, which can disrupt normal growth and function.

Inflammatory signals are chemical messages that can make a cell behave as if it is responding to injury or infection.

“These cells behave almost as if they are under attack,” said Vagnarelli.

“The immune response switches on because the genome is unstable.

“That link between chromosome imbalance and inflammation could help explain patterns we see in several diseases.”

The researchers said the findings may help cancer scientists better understand how chromosome instability, loss of gene regulation and cells dividing before they are ready contribute to tumour growth.

They said understanding the normal machinery that prevents these errors may help researchers find ways to push cancer cells into making mistakes they cannot survive.

“We now have a clearer map of the machinery that resets the cell after division,” said Vagnarelli.

“That knowledge gives us a starting point for thinking about new therapeutic approaches.”

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