Liver metastases of hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer patients: an ominous sign - editorial

Sep 29, 2026

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Editorial discussing how cancer care advances in tumor molecular biology, tumor microenvironment, and multimodality strategies may improve outcomes, yet treatment resistance persists. Highlights a JCMA article on everolimus-based real-world treatment for HR+/HER2− metastatic breast cancer, focusing on factors predicting progression-free survival and overall survival. Emphasizes that liver metastases are a dominant unfavorable prognostic indicator, potentially explaining therapeutic failure and mortality, while clarifying the clinical significance relative to CNS metastases.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Editorial

Rationale: cancer burden and resistance

Real-world everolimus outcomes in HR+/HER2− metastatic breast cancer

Prognostic impact of liver vs CNS metastases

Clinical significance and need for further clarification

J Chin MedAssoc Editorial Liver metastases of hormone receptor-positive/ human epidermal growth factor receptor 2-negative metastatic breast cancer patients: an ominous sign Peng-Hui Wanga,b,c,* aDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cFemale Cancer Foundation, Taipei, Taiwan, ROC Besides metabolic syndrome-associated diseases, such as diabetes mellitus, atherosclerotic cardiovascular disease, which pose major global health challenges,1–4 cancer has become the leading cause of disability and mortality in both genders.5,6 The incidence of cancers, regardless of origin, has continued to rise steeply, and the trend appears unending, except for certain types of cancers, particularly oncovirus-related cancers, such as cervical cancer,7–9 liver cancer,10 and other rare tumors, which be more effectively controlled or even eradicated through effective screening strategy, preventive vaccination, and accurate early diagnosis, particularly before occurrence of invasive cancer status, blocking transmission of infectious microorganisms, and precise targeted therapies. Additionally, cancers not only cause direct damage to the affected organ but also lead to organ dysfunction and, ultimately, the loss of life. In this editorial, we discuss how recent advances—including improved understanding of tumor molecular biology, the tumor microenvironment, and the importance of multimodality treatment strategies—may have begun to change the outlook for cancer care.11–16 However, there is still a proportion of cancer patients who are resistant to treatment and eventually die of the disease. Many hypotheses have been proposed to overcome therapeutic resistance, and one of the most feasible strategies is combination therapy—a multimodality approach. Recently, Dr. Kao published an important article in the Journal of the Chinese Medical Association (JCMA) addressing the real-world outcomes of everolimus-based treatment for hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer (HR+/HER2− mBC) .17 Although the outcomes of HR+/HER2− mBC patients are expected to be poor—because more than half had received at least three prior lines of systemic therapy, were in relatively poor overall physical condition, and faced a high risk of treatment resistance—the study still provides valuable insights.17 The authors investigated factors associated with worse prognosis in *Address correspondence. Dr. Peng-Hui Wang, Department of Obstetricsand Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail addresses phwang@vghtpe.gov.tw](ROC. E-mail addresses phwang@vghtpe.gov.tw); [pongpongwang@gmail.com](pongpongwang@gmail.com) (P.-H. Wang). Conflicts of interest: Dr. Peng-Hui Wang, an editorial board member at the Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. Journal of Chinese Medical Association. (2025) 88: 899-901. Received October 3, 2025; accepted October 6, 2025. doi: 10. 1097/JCMA.0000000000001308 Copyright © 2025, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) these mBC patients who had received everolimus-based therapy.17 Multivariate analysis was used to adjust for other confounding factors and identify significant and independent predictors for both progression-free survival (PFS) and overall survival (OS) .17 The results showed that both liver and central nervous system (CNS) metastases were strong independent risk factors associated with shorter PFS, with hazard ratio (HR) of 1.43 (95% CI, 1.08-1.90) and 2.16 (95% CI, 1.34-3

FAQs

What is the main message of this editorial?

The editorial argues that liver metastases represent a strongly unfavorable prognostic indicator in HR+/HER2− metastatic breast cancer and deserves clearer clinical emphasis beyond a generalized statement of worse outcomes.

What treatment and patient context are discussed from the referenced JCMA study?

The editorial discusses real-world outcomes of everolimus-based treatment in HR+/HER2− metastatic breast cancer patients, including the high risk of treatment resistance reflected by prior systemic therapies and overall condition.

How do liver metastases and CNS metastases relate to progression-free survival and overall survival?

Both liver and CNS metastases are described as strong independent risk factors for shorter progression-free survival, while liver metastases are highlighted as the dominant factor for worst overall survival; CNS metastases are not statistically significant for overall survival in the cited results.

Sep 29, 2026

Uploaded by Hazel