Englewood Hospital and Medical Center

Abstract Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous, non-invasive condition characterized by the proliferation of malignant epithelial cells within the duct, with variable risk of progression to invasive disease. Current standard treatment involves surgical resection followed by possible adjuvant endocrine therapy and/or adjuvant radiation. However, a substantial proportion of DCIS may never progress to invasive disease and thus may be overtreated with the current standard of care. Consequently, active surveillance (AS) is emerging as a treatment option for patients with DCIS. DCIS is definitely a risk factor for breast cancer, and should be reframed as an opportunity for preventive intervention. RECAST (Re-evaluating Conditions for Active Surveillance Suitability as Treatment) is a Phase II adaptive platform trial studying the efficacy of up front endocrine therapy to identify appropriate candidates for long-term active surveillance versus those who would benefit from standard surgical treatment. Patients with hormone receptor positive DCIS of any grade undergo baseline breast MRI and are randomized to one of four hormonal therapy regimens, including standard endocrine therapy, z-endoxifen, elacestrant or HAV-008 with the potential to offer equivalent or improved benefit with less adverse effects. Serial MRI at 3 and 6 months is then used to evaluate change in background parenchymal enhancement (BPE) and DCIS lesion. Patients deemed low risk based on imaging response have the option to continue AS and avoid surgery and radiation and continue their endocrine therapy for 3 years. The primary endpoint of the trial is to determine whether novel endocrine therapy increases the fraction of patients who will be suitable for long-term AS as measured by the fraction of patients who remain on active surveillance at 7 months compared to control. To date, over 50 patients are enrolled in the trial. Our target accrual of 400 patients. A total of 17 (34%) patients have reported an AE, all grade 1 or 2, with no serious adverse events reported and no safety signals identified. Of the 50 patients currently on treatment, 25 have reached or gone beyond the 6-month mark and 22 (88%) of those patients remain on active surveillance with a median follow up of 351 days. At the 3 month point, one patient progressed on imaging and two chose to come off surveillance due to other reasons. At 6 months, 8% (2/25) progressed on imaging and one additional patient has proceeded to surgery at the 1 year point. One patient who went on to have surgery was found to have invasive disease (pT1bN0). Robust accrual continues at sixteen currently active sites with five more sites anticipated to open in the next few months. The shift to using hormonal therapy in the neoadjuvant setting allows investigators to assess response to endocrine therapy, characterize risk of progression to invasive cancer and helps to better inform treatment-making decisions before continuing AS or proceeding with surgery, and appropriately assesses the value of endocrine risk reduction prior to surgery to avoid it. The trial uses a patient-centered approach and gives all patients a window of opportunity to assess their response as well as medication tolerability to make an informed decision about treatment approach. Citation Format: K. C. Hewitt, C. Yau, R. Mukhtar, C. Thompson, J. Hui, K. Westbrook, J. Jackson, C. Carruthers, C. Farley, S. Bommakanti, K. Brownson, B. Fan, I. Meszoely, T. Balija, M. H. Mcnatt, P. Gilman, J. Marti, T. Li, S. Horton, A. Borowsky, J. Rosenbluth, L. Esserman. Initial results from RECAST DCIS: Multicenter platform trial testing active surveillance and novel endocrine therapy agents for DCIS management [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 PS3-03-08.

This study aimed to determine if sodium-glucose co-transporter-2 inhibitors (SGLT2i) use in diabetic patients leads to erythrocytosis and increases the incidence of arterial and venous thrombosis events. This is a retrospective cohort study using records from over 50 U.S. healthcare organizations. Adults with type 2 diabetes who received SGLT2i therapy were compared to those on glucagon-like peptide-1 receptor agonists (GLP1RA) or dipeptidyl peptidase-4 inhibitors (DPP4i). The primary outcome was the risk of erythrocytosis, defined by elevated hemoglobin and hematocrit levels. Secondary outcomes included arterial and venous thromboembolic events. Propensity score matching was applied to balance baseline characteristics, and Cox proportional hazards regression models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results demonstrated that compared to SGLT2i use, DPP4i use was associated with a significantly higher risk of erythrocytosis in both male (hemoglobin > 16.5 g/dL: HR 1.954 [1.909–2.001]) and female (hemoglobin > 16 g/dL: HR 1.873 [1.803–1.947]) patients with type 2 diabetes. Similarly, GLP1RA use was associated with a significantly higher risk of erythrocytosis in both male (HR 1.605 [1.573, 1.636] and female (HR 1.697 [1.640, 1.755]) patients compared to SGLT2i use. Compared with DPP4i users, SGLT2i users had less cardiovascular events, except for increased stroke/TIA in females (HR 1.744 [1.654–1.839]). Compared with GLP1RA, SGLT2i use was associated with a decrease risk of MACE in both men and women, but higher risk for other cardiovascular and peripheral vascular events. Among SGLT2i users, those who developed erythrocytosis had increased incidence of thromboembolic events compared to those without erythrocytosis. Lastly, among SGLT2i patients treated for their erythrocytosis, the men who discontinued SGLT2i had increased risks of stroke/TIA, MI, and limb ischemia, while women had increased risk of stroke/TIA, MI, and venous thrombosis. Those who received anti-platelet therapy were associated with elevated risks of stroke/TIA, MI, venous thrombosis, and limb ischemia. In contrast, patients who receive phlebotomy had no significant difference in the outcomes. Therefore, regular monitoring of hematologic parameters is recommended for early detection and modified therapeutic strategies should be considered to reduce complication risks. Further studies are needed to establish effective strategies to reduce complications in this population.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-31726-3.

BackgroundAlzheimer's disease is the leading cause of dementia and is rapidly increasing among the Asian American population. The Asian Cohort for Alzheimer's Disease (ACAD) was launched to address the underrepresentation of Asian American subjects in clinical research. The purpose of this report is to describe and evaluate the feasibility of a culturally informed and community‐engaged genetic‐clinical study.MethodsOlder Korean American adults were recruited and cognitive, early lifestyles, and neurological assessment data were collected along with biological samples. A purposeful sampling method was utilized, and bilingual Korean registered nurses and neurologists collected the data. Consensus meetings were held to review each case and to make a diagnosis of normal control (NC), subjective cognitive complaints (SCC), mild cognitive impairment (MCI), and dementia.ResultsA total of 60 participants were recruited during the 12‐month period from 2020 to 2021, meeting the targeted number of participants. The mean age of the participants was 79.58 (±8.05) with a range of 60‐101. Seventy percent (70%) of participants were female and 80% had at least high school education. The length of stay in the U.S. was 35.23 (±13.36) years, 66.67% had limited English proficiency, and 16.67% lived alone. 67.67%, 63.33%, and 43.33% of participants reported having hypertension, high cholesterol and diabetes, respectively. Fifty‐four participants completed cognitive assessment batteries and neurological assessments, and the biological samples were collected from 49 participants (33 blood and 16 saliva). Six participants who missed the neurological exams either relocated to live closer to their relatives or forgot the data collection appointment. Among 54 participants, 22 (36.67%) were NC and 32 participants had some cognitive deficit (25% dementia, 10% MCI, and 18.33% SCC).ConclusionsSuccessful implementation of an ACAD study depends on several factors including close collaboration with participants, community recruiters, data collectors, clinicians, and biological sample handling to ensure that any data collection times and locations are participant friendly. This pilot study offered new insight into Alzheimer's disease and related dementia studies with Korean American older adults including the feasibility of community engaged recruitment and data collection on cognition, lifestyle, neurological examination, biological sampling, and lessons learned from this study.

ABSTRACTGastric cancer (GC) remains a major cause of cancer‐related mortality worldwide, driven by late‐stage diagnoses and poor survival outcomes. Leukemia inhibitory factor (LIF) and leukemia inhibitory factor receptor (LIFR) are increasingly recognized as critical players in GC pathophysiology, though their exact roles are not fully understood. LIF, a multifunctional cytokine in the interleukin‐6 family, signals through the LIFR/gp130 complex and activates oncogenic pathways such as JAK/STAT3, MAPK/ERK, and Hippo‐YAP. Emerging evidence indicates that LIF drives tumor progression by promoting epithelial–mesenchymal transition, immune evasion, and chemoresistance. Clinically, high LIF expression is associated with poor prognosis, peritoneal metastasis, and resistance to chemotherapy and immunotherapy. This review explores the molecular mechanisms of LIF/LIFR signaling in GC, highlighting its potential as a prognostic biomarker and therapeutic target.Mini ConclusionThe LIF/LIFR pathway contributing to gastric cancer is complex with context‐dependent pro‐ versus anti‐tumorigenic roles in GC progression, marking it as a significant biomarker and target for future therapies.

e22536 Background: Tumor lysis syndrome (TLS) is an oncologic emergency characterized by metabolic disturbances that can lead to organ failure. The largest prior analysis was a National Inpatient Sample (NIS) study examining inpatient mortality and outcomes from 2010 to 2013. However, with advancements in oncology therapies, an updated analysis is warranted. This study examines trends in TLS from 2016–2020 using NIS data. Methods: The NIS database was analyzed for patients with TLS (ICD-10 code E88.3) and associated malignancies from 2016 to 2020. Logistic and linear regression models were employed to identify predictors of mortality and length of stay (LOS), respectively. Results: We identified 14,798 TLS-related hospital discharges. The incidence rate (per 100,000 discharges) increased from 31.63 in 2016 to 54.75 in 2020 (p < .01). Inpatient mortality was 22.1% without significant improvement over the years. The mean LOS was 13.7 days. Primary malignancies associated with TLS included acute lymphoblastic leukemia (ALL) (21.1%), acute myeloid leukemia (AML) (20.9%), chronic lymphocytic leukemia (CML) (7.35%), and chronic myeloid leukemia (CML) (3.45%). Non-Hodgkin lymphoma (NHL) comprised 31.5% of cases, predominantly non-follicular subtypes (20.57%), followed by Hodgkin lymphoma (HL) (0.7%) and multiple myeloma (MM) (5.68%). Solid tumors accounted for 9.32% of cases. Complications occurred in 70.06% of patients, with acute kidney injury (AKI) present in 65.8% being the most common, 10.5% of whom required dialysis. Logistic regression analysis identified predictors of mortality, including age (odds ratio [OR] 1.01), Charlson Comorbidity Index (OR 1.12), and weekend admission (OR 1.59). Liquid malignancies were associated with lower mortality risk compared to solid tumors (table 1). No significant associations with mortality or LOS were found for race, income, gender, primary payer, hospital size, or insurance status. Dialysis (OR 21.6) and AKI (OR 3.7) were strongly associated with higher mortality. Conclusions: This study represents the largest recent analysis of TLS using NIS data. The incidence of TLS has risen compared to prior analyses, potentially reflecting an increased prevalence of acute leukemias and increased life expectancy in the United States. Liquid malignancies accounted for 90.86% of TLS cases. This increase is likely influenced by the broader use of immune checkpoint inhibitors (ICIs) as first line in solid tumors, a therapy that exhibits a low incidence of TLS. These findings emphasize the need for proactive interventions to reduce incidence of TLS, particularly in an increasingly aging population. Mortality. Mortality (%) OR P value Solid tumors 34.9 Reference NHL 31.5 0.64 0.05 AML 18.4 0.79 0.02 ALL 26.0 0.23 <0.01 CML 12.3 0.50 0.04 CLL 15.3 0.42 <0.01 MM 16.7 0.50 <0.01 HL 5.1 0.43 <0.01

Abstract Introduction: Spontaneous coronary artery dissection (SCAD), once considered rare, is now recognized to account for approximately 4% of acute coronary syndrome cases and up to 22-43% of myocardial infarction cases in women. Although SCAD patients lack typical atherosclerotic risk factors, the prevalence of hypertension and hyperlipidemia is like that of age-matched controls, further complicating the diagnosis. Case description: A 45-year-old female with a history of hypertension, obstructive sleep apnea, and sickle cell trait presented with a one-month history of intermittent chest pain. Initially, the pain was central, non-radiating, described as “air stuck in my chest,” and lasted 30 minutes. It was not associated with exertion and increased in frequency over the month. On presentation, the pain intensified and radiated down her right arm. She had no family history of premature coronary artery disease. On examination, she was hemodynamically stable, and her physical exam was unremarkable, aside from a BMI of 44. Laboratory evaluation showed a hemoglobin level of 13.8 g/dL, an unremarkable complete metabolic panel, a lipase level of 17 U/L, total cholesterol of 202 mg/dL, and LDL of 140 mg/dL. Beta HCG was negative. Initial troponin was 402 ng/L and peaked at 6620 ng/L. The electrocardiogram showed a normal sinus rhythm without ischemic changes. Echocardiogram revealed mild concentric left ventricular hypertrophy, normal left ventricular systolic function, and normal wall motion. Coronary angiography demonstrated 90% distal narrowing of the right postero-lateral branch, while the left anterior descending and left circumflex arteries were normal but tortuous. The patient was diagnosed with type 2B SCAD, with no coronary intervention performed, and subsequently discharged on dual antiplatelet therapy, metoprolol, and atorvastatin. Discussion: Patients with SCAD typically present with acute chest pain, often radiating to the arm in 52% of cases. However, some patients report atypical pain, described as burning, pleuritic, tearing, or positional. Interestingly, this patient described her pain as feeling like “air being stuck in her chest,” and her symptoms persisted for one month prior to presentation. An accurate diagnosis of SCAD is imperative, as management differs from that of a typical atherosclerotic plaque rupture myocardial infarction. Acutely, a conservative approach without coronary intervention is preferred. Additionally, these patients require counselling on the risks of recurrent SCAD and persistent chest pain, among other concerns. A high index of suspicion should be maintained, especially in this demographic, to initiate timely treatment and avert mortality.