Berkshire Health Systems

Abstract Introduction: Neoadjuvant chemotherapy (CT) with pembrolizumab (P) is standard for most patients (pts) with high-risk early TNBC. Biomarkers for the addition of P to CT are lacking. The prognostic and predictive value of TILs in pts who receive neoadjuvant CT+P vs CT alone and the significance of change in TILs from pre- to post-treatment samples remains unclear. Methods: From the prospective DFCI Multicenter TNBC Registry, pts with stage I-III TNBC who received neoadjuvant CT or CT+P were identified. Stromal TILs were scored in tumor samples at baseline (BL) and surgery (if residual disease, RD). TILs were evaluated as a continuous and binary variable using a threshold selected based on BL distribution. Fisher’s exact test was used to compare TILs between CT and CT+P, and between RCB groups. Association with pathologic complete response (pCR) and with recurrence-free (RFS), distant recurrence-free (DRFS) and overall survival (OS) were evaluated using logistic regression and Cox proportional hazards models, respectively, adjusting for clinical stage and neoadjuvant treatment. All statistical tests were two-sided (significance p < 0.05). Results: Between 5/2019-1/2024, 121 TNBC pts were identified; 18 (14.9%) stage I, 49 (40.5%) stage II, 52 (43.0%) stage III, 2 (1.7%) unknown. 19 (15.7%) had germline BRCA1/2 mutations. 49 (40.5%) received CT and 72 (59.5%) CT+P, with anthracycline-based CT in 40 (81.6%) and 62 (86.1%) pts, respectively. The pCR rate was 51.0% (25/49; 95% CI 36.3-65.6%) with CT alone and 58.3% (42/72; 95% CI 46.1-69.8%) with CT+P. Median follow-up was 2.2 years (interquartile range [IQR] 1.4-3.9): CT, 4.2 years (IQR 3.4-5.1); CT+P, 1.7 years (IQR 1.2-2.2). 115 pts had TILs scored at BL and 41 at RD, of whom 35 had paired samples. BL TILs (range 0-90%) were categorized by quartiles (5%, 10%, 30%) with 10% used for primary analysis. Both BL and RD TILs did not differ between CT vs CT+P as a continuous variable (BL p=0.11; RD p=0.56) or ≥10% cutoff (BL p=0.62; RD p=0.56). High BL TILs (≥ 10%) were significantly associated with pCR and this did not differ by treatment (interaction p=0.36). No association was observed between TILs (at BL or RD) and RCB class (TILs as continuous variable: BL p=0.36, RD p=0.84; or 10% cutoff: BL p=0.31, RD p=0.86). High BL TILs (≥ 10%) were associated with longer RFS (aHR 0.15, p=0.01), DRFS (aHR 0.17, p=0.01) and OS (aHR 0.19, p=0.05; or as a continuous variable, aHR per 5-unit increase 0.46, p=0.05). Neither TILs in RD nor increase from BL to RD (in 14/35 pts, 40%) were associated with RFS, DRFS or OS. Conclusion: In this multicenter TNBC cohort, BL TILs were reinforced as a prognostic marker for pCR, regardless of the addition of P to CT. TILs at RD and changes during neoadjuvant therapy were not prognostic. Additional follow-up for survival outcomes is ongoing. Citation Format: R. S. Lee, Q. Jin, B. Binboga Kurt, B. Koca, J. Gomez Tejeda Zanudo, A. Patel, A. Barkell, J. Baginska, O. M. Cunningham, C. E. Stever, T. S. Parker, T. Rahman, M. Luo, I. G. Martino, B. M. Drummey, S. A. Virani, K. Santos, J. Bsat, C. Snow, N. Tung, S. Lo, M. G. Faggen, N. Sinclair, N. Ahmad, M. Constantinou, S. Sinclair, J. L. Meisel, S. A. Kirschner, T. A. King, R. Salgado, E. A. Mittendorf, N. U. Lin, N. Tayob, E. P. Winer, E. C. de Bruin, S. M. Tolaney, A. Moeini, A. C. Garrido-Castro. Association of tumor-infiltrating lymphocytes (TILs) with outcomes in patients with early TNBC treated with neoadjuvant chemotherapy with or without pembrolizumab [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-07-18.

ObjectivesA measure that encompasses both benefits and harms at the individual patient level may facilitate comparisons between treatment options and improve shared decision-making. The objective of this study was to develop a patient reported measure to capture overall experience (including both benefits and harms) of treatment using rheumatoid arthritis (RA) as a case example.MethodsHierarchies for treatment benefits are known. Therefore, we developed a hierarchy of adverse events (AEs) using a series of trajectory mapping and paired comparison surveys. We subsequently used these data to construct a paired comparison survey, asking patients to compare options including both a specified level of benefit and an AE. These data were used to generate a hierarchy of overall experience on treatment.Results782 participants completed a series of three surveys. The trajectory mapping procedure and a paired comparison survey led to the generation of a hierarchy of AEs with nine levels ranging from No AEs to irreversible serious complications. In a third survey, in which AEs were paired with benefits, participants’ ratings generated a 6-level hierarchy of overall experiences ranging from Major improvement + No, mild or manageable AEs (Level 1) to No improvement + Irreversible AEs (Level 6).ConclusionsUsing a trajectory mapping approach, we developed a patient reported measure representing the distribution of patients’ overall experiences on treatment. The intent of this measure is to enable patients and their physicians to compare the percentage of patients experiencing each level of outcome, from most to least desirable, across treatments.

Preventing heart failure (HF) rehospitalizations requires examination of evidence-based research, which may lead to opportunities to improve on care transitions upon discharge from an acute care setting. This review was conducted to identify current literature in HF and disease management without focusing specifically on disease management programs. The purpose of this study was to conduct a systematic review of the literature to better understand how to structure interventions for HF patients upon transition from the hospital to home and to outline critical research gaps. Patients recently hospitalized for HF or at high risk for HF decompensation should be considered for comprehensive heart failure disease management (HFDM) and/or structured HF interventions. Level 1 evidence demonstrated positive benefits from HFDM programs, structured telephone support, and telemonitoring interventions as an effective component of contemporary multidisciplinary HF management. Based on the evidence from this critique, key features and recommendations are provided. Also discussed is the State Action on Avoidable Rehospitalizations program, which may provide acute care centers in Massachusetts an opportunity to create an ideal transition home for HF patients.

inherent diagnostic accuracy.Dr. Hilden lists some of these limitations in his letter; another important one is its global interpretation, which does not translate well into clinical practice (1 ).The partial area under the ROC curve in the clinically relevant range of false-positive rates, or falsenegative rates, is a useful alternative measure of inherent diagnostic accuracy.Dr. Hilden advocates performance measures that incorporate the pretest probability of disease and the clinical benefit and loss of correct and incorrect diagnoses.These measures are extremely useful, but they are not measures of inherent test accuracy.Our recent review (2 ) focused on problems with the analysis of ROC curves, without critiquing issues of study design.I would encourage investigators to carefully consider the objectives of their study and use the most relevant measure of diagnostic test accuracy.

Journal Article Getting to the bottom of a sentinel event Get access Doreen Hutchinson, M.B.A. Doreen Hutchinson, M.B.A. Vice President, Patient Care Services Fairview Hospital Berkshire Health Systems 29 Lewis Avenue Great Barrington, MA 01230 dhutchinson@bhs1.org Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 56, Issue 20, 15 October 1999, Pages 2031–2032, https://doi.org/10.1093/ajhp/56.20.2031 Published: 15 October 1999

Struma ovarii is a teratoma of the ovaries that contains a large amount of thyroid tissue. Like the cervical thyroid gland, this ectopic thyroid tissue can become autonomous. We present a case of hyperthyroidism caused by thyroid tissue in a large ovarian cystic teratoma and provide detailed endocrinological, radiological, and pathological preoperative and postoperative data. This is also the first documented case of struma ovarii in association with a secreting pituitary tumor. In addition, we provide a retrospective pathological analysis of 1390 surgically removed ovarian tumors at 2 major academic centers.

Risk assessment for complex mixtures is not merely a theoretical problem but a “real-life” one. Most common human exposures involve multiple chemicals and agents in combination. To illustrate, cigarette smoke contains more than 3,800 different chemicals including at least 40 carcinogens (i.e., known human or animal carcinogens) (41). More than 300 different toxic chemicals, including approximately 50 carcinogens, have been detected both in ambient air (18, 56) and in drinking water (29).