Oral adjuvant hormone therapy for early breast cancer, despite its proven importance in terms of survival and prevention of recurrence, does not fall within the scope of clinical pharmacy programs set up for oral anticancer drugs, even though issues of therapeutic adherence have been clearly identified. The aim of our study was to explore the perception of healthcare professionals regarding the prescription and dispensing of this hormone therapy, in order to identify the risks for these patients and determine the clinical pharmacy actions that could address these risks.

Lipomas are mesenchymal neoplasms that affect the head and neck region in about 13% of cases. However, they are rarely reported in the pediatric population. We here report the case of a 6-month-old infant with no notable medical history, admitted for the management of a large left lateral cervical mass that had been progressing for 4 months. Ear, nose and throat (ENT) examination revealed a large left lateral cervical mass extending to the submental area, approximately 7cm in length, with no signs of compression. Cervical CT scan showed a fat-density mass, consistent with a lipoma. The patient underwent exploratory cervicotomy with excision of the mass. Histological analysis confirmed the diagnosis of lipoma. The clinical outcome was favorable, with no recurrence after 15 months of follow-up. Although rare in the pediatric population, cervical lipomas should be considered in infants with a cervical swelling. Its clinical manifestation is similar to that of a cystic lymphangioma.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare CD-30+/ALK- T-cell lymphoma. The combination of a textured breast implant, bacterial contamination and genetic predisposition appears to be necessary for the development of BIA-ALCL. The National Comprehensive Cancer Network (NCCN) has established guidelines for both diagnosis and treatment. Early detection of the disease is essential to ensure a cure. At an early stage and for the vast majority of patients, treatment consists of implant removal with associated total capsulectomy. We share our experience with the presentation of a case of BIA-ALCL discovered following the appearance of a periprosthetic seroma, 19 years after the fitting of breast implants.

Monocytes, circulating mononuclear phagocytes, play a fundamental role in innate immunity and the maintenance of tissue homeostasis. Using advanced technologies like flow cytometry, the characterization of monocytes has evolved from a simplistic view of a homogeneous population to a more complex understanding of a heterogeneous system comprising three main subtypes: classical monocytes (CD14++CD16-), intermediate monocytes (CD14++CD16+), and non-classical monocytes (CD14+CD16++). The identification of these subpopulations has enabled precise characterization of their functional profiles, enhancing the understanding of their roles in various pathological contexts, particularly in oncology. While anti-tumoral functions of monocytes have been clearly established in certain categories of cancers through tumor antigen presentation, induction of cytotoxic responses, and inhibition of metastatic progression, their role in promoting the development and progression of other cancers has also been highlighted during recent years. The utilization of monocytes in cancer immunotherapy presents promising opportunities, particularly by reprogramming their activity to enhance anti-tumoral responses or suppress their pro-tumoral functions. This review provides a comprehensive analysis of recent advances in the phenotypic and functional diversity of monocytes and their role in tumor progression, while highlighting emerging therapeutic strategies targeting these cells to optimize cancer treatment.

The most common cancer in women is breast cancer (BC). MicroRNA-21 was one of the first oncomiRs to be found at elevated levels in a number of malignancies, including gliomas, BC, and colorectal cancer (miR-21). MiRNA is associated with processes such as apoptosis, invasion, metastasis, and proliferation, which are known features of cancer. This study aimed to investigate the molecular basis and clinical significance of miR-21 in BC, as microRNAs play a critical role in this disease.

Over the past decade, targeted therapies have significantly improved the prognosis of metastatic breast cancer. CDK4/6 and PARP inhibitors are now gaining traction in the adjuvant setting, and their potential use in the neoadjuvant context is also being explored. This review presents an analysis of the current scientific evidence and associated clinical perspectives. CDK4/6 inhibitors act on cell cycle dysregulation, commonly observed in hormone receptor-positive breast cancers. In the adjuvant setting, abemaciclib and ribociclib have shown improvements in progression-free survival (PFS) in the monarchE and NATALEE trials, respectively, leading to their approval by the European Medicines Agency. In the neoadjuvant context, although these agents have demonstrated a reduction in proliferation markers such as Ki67, their impact on clinical practice remains limited to date. PARP inhibitors are based on the concept of synthetic lethality, specifically targeting cancers with germline BRCA1 or BRCA2 mutations. In the adjuvant setting, the OlympiA trial demonstrated a significant improvement in both PFS and overall survival (OS). In the neoadjuvant setting, these agents have also shown effects on pathological markers, though the clinical relevance of these findings has yet to be clearly established. Overall, these results underscore the growing role of targeted therapies in the adjuvant management of breast cancer. The identification and validation of predictive biomarkers will be crucial in optimizing their use, both in adjuvant and neoadjuvant settings.

The indications for axillary lymph node dissection (ALND) have been reduced in breast cancer surgery. At the same time, maintenance treatments have become more complex. This paradox makes it essential to assess whether de-escalation might underestimate lymph node invasion, resulting in a loss of chance for patients eligible for these treatments. The aim is to determine the factors for lymph node invasion ≥4N+ in primary surgery, and for complete histological lymph node non-response in neoadjuvant chemotherapy, and then to assess the proportion of patients with an indication for ALND, and the proportion of patients eligible for enhanced maintenance treatment, in 2023. This is a single-centre retrospective study conducted at the Centre Antoine Lacassagne, involving patients treated for breast cancer with subclinical lymph node involvement between 2014 and 2020. In primary surgery, 62.9% had lymph node involvement <4N+. The predictive factor for lymph node involvement ≥4N+ was loss of ovality on ultrasound (P=0.01). After neoadjuvant chemotherapy, 45.7% had a complete histological lymph node response. MRI of the breast and axilla was the best predictor of this response (P=0.007). Twenty-nine percent of primary surgery patients were eligible for sentinel node therapy, with only one eligible for maintenance treatment. After neoadjuvant chemotherapy, 46% could have avoided ALND without compromising maintenance treatments. Under the new recommendations, 35% of patients could have avoided ALND. Ultrasound is the best preoperative examination for primary surgery. MRI is preferable for predicting response to neoadjuvant chemotherapy. There is no loss of chance for patients eligible for the new adjuvant treatments.

Breast cancer is the second most common cause of brain metastases, after lung cancer. The risk of developing brain metastases varies according to the molecular subtype of breast cancer, with a higher incidence for triple-negative or HER2-positive cancers. The discovery of brain metastases, whether synchronous or metachronous, is a turning point in oncology management, and requires discussion at a neuro-oncology multidisciplinary consultation meeting to assess the value and modalities of local treatment by surgery and/or radiotherapy (stereotactic or total brain). Systemic treatments also play a major role in the control of breast cancer brain metastases. The most abundant literature on brain metastases concerns HER2-positive breast cancers, with robust data on the intracerebral efficacy of tyrosine kinase inhibitors (tucatinib, neratinib) and drug-conjugated antibodies (trastuzumab deruxtecan). The size of the brain metastases, whether they are stable or progressive, any previous irradiation, whether the brain involvement is symptomatic or not, the extracerebral evolution of the disease, the patient's general condition and the systemic options available must all be taken into account before deciding on a therapeutic strategy. This article does not deal with the specific management of leptomeningeal disease, which will be the subject of a separate article.

Hormone therapy is essential in the adjuvant management of early-stage HR+ breast cancer. Risk assessment for recurrence is a fundamental pillar in guiding therapeutic strategies and personalizing patient care. Tumors with a low risk of recurrence, eligible for treatment de-escalation, can be managed with standard hormone therapy. High-risk or intermediate-risk tumors warrant intensified approaches, including targeted therapies. This article reviews recent questions regarding the extension of hormone therapy to ovarian suppression and current strategies, with a focus on clinical studies such as OlympiA, monarchE, and NATALEE, which currently guide therapeutic decisions.

Adjuvant radiotherapy for breast cancer has demonstrated its benefit both in terms of local control and overall survival. However, it now appears possible to de-escalate both the indications and the technical modalities of treatment. Some of these new approaches are already validated, while others require further studies. Hypofractionation has been the subject of several trials, which have shown that shorter regimens (42.5Gy in 16 fractions, 41.6Gy in 13 fractions, or 40Gy in 15 fractions) are equivalent to longer schedules. It can be proposed for almost all patients and can be complemented, if necessary, by a boost to the original tumor volume. Accelerated partial breast irradiation, which can be used in patients with favourable local prognosis (tumor size≤3cm, unifocal, hormone receptor-positive, no HER2 overexpression), is ideally delivered via interstitial brachytherapy, as accelerated 3D radiotherapy has not yet shown benefit in this setting. However, partial breast irradiation can be delivered using moderate hypofractionation with 3D radiotherapy. Intraoperative radiotherapy, which has more restrictive indications, is an interesting alternative for elderly patients. Patient selection for these approaches must be rigorous and depends partly on the technique chosen. Patients should be fully informed about the potential side effects of each technique.

Past decade was marked by development of several new drug for HR+/HER2- metastatic breast cancer leading to several major question in terms of strategy. We propose here to review state of art in terms of targeted therapy for advanced luminal breast cancer and how treatment strategy will be more and more personalized in a near future.

The diagnosis of B- and T-cell lymphomas relies on a multidisciplinary approach that combines morphological, immunological (via flow cytometry - FCM), and genetic analyses. The integration of cytological evaluation from tissue biopsy imprints with FCM enables rapid diagnostic orientation, which is valuable for guiding further complementary investigations. This atlas illustrates the main types of B- and T-cell lymphomas using cytology images, FCM data, and histological analyses derived from lymph node and splenic samples. The FCM profiles were established using routinely employed antibody panels. While results may show slight variations depending on the cytometer settings and fluorochromes used, they remain generally comparable across different instruments. An orientation panel consisting of 16 antibodies is used for the initial classification of lymphomas, with specific markers allowing for subsequent assessment of antigen expression according to cell type and pathological context. The combined study of cytological and histological features provides an integrated perspective of lymphoid pathology.

The incidence of kidney cancer is rising. It is the 7th most common cancer in men and the 10th most common in women. Diagnosis is based on imaging (thoraco-abdominopelvic computed tomography scan +/- abdominal magnetic resonance) and histopathology. Clear cell carcinoma is the most frequently observed histological subtype. Management of localized kidney cancer involves surgery or ablative treatments. Active surveillance is indicated in the indolent oligometastatic setting with local treatment in case of localized progression. Apart from this specific situation, two first-line therapeutic strategies are recommended in the metastatic setting : a dual immunotherapy regimen or the combination of immunotherapy with an antiangiogenic tyrosine kinase inhibitor. Both combinations have demonstrated superior survival outcomes compared to sunitinib, the previous standard of care until 2019. Treatment selection should be individualized, considering the characteristics of the disease (histology, tumour burden, location of metastases and if they are threatening, speed of progression), potential side effects of the treatments, the patient's general health, comorbidities and preferences.

Hematologic malignancies often present with nonspecific symptoms, and the increasing use of MRI for various indications has led to the incidental detection of bone marrow signal anomalies, which can prompt further diagnostic evaluation. When such anomalies are identified, additional investigations, including bone marrow examination, may be necessary to exclude a neoplastic process. However, some signal anomalies are physiological, potentially leading to unnecessary further assessments. The incidence of these anomalies is currently unknown, no guidelines exist for their management and they are an increasingly source of costly investigations. This article illustrates the difficulties of interpreting these MRI anomalies through clinical cases, and proposes a multidisciplinary diagnostic approach.

The treatment of rectal cancer has evolved dramatically in recent years. Today, specialists have more options to choose from, ranging from primary surgical resection with or without neoadjuvant treatment to an organ-preserving strategy (such as Watch-and-Wait) after total neoadjuvant treatment. The aim of this article is to review the advantages, limits, and risks of the Watch-and-Wait strategy for the treatment of rectal cancer.

The incidence of thyroid cancer has risen sharply in recent decades. While most thyroid cancers are low-risk and have an excellent prognosis, a minority of patients develop advanced-stage disease with increased morbidity and mortality. An individualized approach is essential to optimize oncological outcomes while minimizing treatment-related complications. Molecular biology plays a growing role in the preoperative assessment of malignancy risk. Therapeutic de-escalation has been underway for a decade with active surveillance of thyroid cancer <10 mm, a decrease in the extent of initial surgery, and a decrease in postoperative radioactive iodine administration. Close collaboration between endocrinologists, pathologists, nuclear medicine physicians, radiologists, and surgeons remains critical to diagnosis and management.

Locoregional treatment of breast cancer is based on surgery of the breast and axilla, radiotherapy of the breast or chest wall and regional lymph node areas. A progressive therapeutic de-escalation was carried out in order to reduce the impact of the treatments. This de-escalation will be considered for breast treatment and for lymph node area during primary surgical treatment and for neo-adjuvant chemotherapy.

Oncoplasty techniques have been progressively and widely carried out in clinical practice after the description of the different procedures adapted to breast volumes and tumor locations. Surgery with oncoplasty makes it possible to reduce the rate of reoperation, for large tumors, with a local recurrence rate and overall survival rate at least equivalent to standard conservative surgeries. When surgery with oncoplasty is offered as an alternative to a mastectomy, the therapeutic implications must be the subject of informed and precise information so that the patient can make a choice between these two possibilities. Surgical expertise is necessary with the completion of initial and/or secondary, theoretical and practical training. If a total mastectomy is indicated for therapeutic or prophylactic purposes, it is more and more often possible to offer the patient immediate breast reconstruction if she wishes. Radiotherapy to the reconstructed breast and the need for adjuvant chemotherapy are no longer obstacles to this treatment proposal to the extent that the patient is requesting it and the risks of complications have been assessed and accepted. Reconstruction by breast implant remains the most used but autologous techniques and in particular lipomodeling make it possible to postpone the placement of foreign bodies.

Leptomeningeal disease (LMD) from breast cancer is defined by the invasion of the leptomeninges and cerebrospinal fluid (CSF) by tumor cells. Historically associated with a very poor prognosis and survival measured in weeks, their management has evolved considerably. Therapeutic advances, such as the introduction of targeted therapies, and a better understanding of the pathophysiology of LMD now enable earlier diagnosis through dedicated MRI sequences and optimized CSF analysis. The EANO-ESMO classification notably distinguishes type I LMD (cytology-positive), which carries a worse prognosis but is more sensitive to intrathecal (IT) treatments, from type II LMD (negative or uncertain cytology), often more responsive to local-regional approaches like radiotherapy. Data from large retrospective cohorts highlight the importance of combination therapies: systemic treatments, IT injections, radiotherapy, as well as early symptomatic and palliative care. This multidisciplinary approach improves median survival, now reaching several months, and can even surpass 10 months in HER2+ cases. Innovative clinical trials, such as ETIC-LM (NCT05800275) - a French phase II study evaluating the combination of IT trastuzumab, oral tucatinib, and oral capecitabine offer encouraging new strategies for patient care. Although the prognosis remains poor, recent advancements suggest a more hopeful future, providing better disease control and improved quality of life for patients with LMD from breast cancer.

Lung cancer is the leading cause of death worldwide. It occurs mainly in smokers, but also in 25% of cases in non-smokers. As regards metastatic stages, while immunotherapy has led to improved overall survival, smoking status may potentially influence its effectiveness. The objective of this study was to analyze its effectiveness as first-line treatment for advanced non-small cell lung cancers (NSCLC) according to patient smoking status.