{
  "abstract": "Background Managing multiple sclerosis (MS) in cancer survivors is complex due to immune system interactions and the impact of treatment. Limited guidance exists on disease-modifying therapy (DMT) use during and after chemotherapy. This study examined how DMT decisions in breast cancer influence MS outcomes and whether chemotherapy itself affects MS disease activity.Methods Data were obtained from the MSBase registry, including 172 individuals with MS and breast cancer who received chemotherapy, and 229 for whom chemotherapy data were not available. Survival analyses assessed time to first relapse and confirmed disability progression (CDP) after cancer diagnosis, with DMT modelled as a time-varying covariate. Propensity score matching compared outcomes between those who received cancer chemotherapy adjuvant to their MS treatment and matched controls receiving standard MS treatment alone.Results Post-chemotherapy MS management varied, with most clinicians de-escalating or withholding DMTs. Older age was associated with lower relapse risk (HR = 0.90, 95% CI: 0.93–0.97, p = 0.001). Chemotherapy had a protective effect on time to first relapse (HR 0.58, 95% robust CI: 0.37 to 0.95, p = 0.03) compared to matched controls receiving standard MS treatment. Chemotherapy was not associated with a significant effect on CDP (HR 0.68, 95% robust CI: 0.38–1.23, p=0.06).Conclusion Chemotherapy was associated with better relapse outcomes compared to standard therapy in matched controls, supporting withholding or de-escalating DMTs during cancer treatment. DMT reinitiation should be guided by individual risk assessment and may be less indicated in older individuals, who demonstrated a lower relapse risk following chemotherapy.",
  "authors": [
    {
      "affiliations": [
        "School of Translational Medicine, Monash University, Melbourne, VIC, Australia",
        "Neuroscience, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Cassie Nesbitt"
    },
    {
      "affiliations": [
        "School of Translational Medicine, Monash University, Melbourne, VIC, Australia"
      ],
      "name": "Paul Sanfilippo"
    },
    {
      "affiliations": [
        "School of Translational Medicine, Monash University, Melbourne, VIC, Australia"
      ],
      "name": "Chao Zhu"
    },
    {
      "affiliations": [
        "Izmir University of Economics, Medical Point Hospital, Izmir, Turkey"
      ],
      "name": "Serkan Ozakbas"
    },
    {
      "affiliations": [
        "CHUM and Universite de Montreal, Montreal, Canada"
      ],
      "name": "Alexandre Prat"
    },
    {
      "affiliations": [
        "CHUM and Universite de Montreal, Montreal, Canada"
      ],
      "name": "Marc Girard"
    },
    {
      "affiliations": [
        "CHUM and Universite de Montreal, Montreal, Canada"
      ],
      "name": "Pierre Duquette"
    },
    {
      "affiliations": [
        "Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia",
        "CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia"
      ],
      "name": "Tomas Kalincik"
    },
    {
      "affiliations": [
        "Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia",
        "CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia"
      ],
      "name": "Izanne Roos"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Box Hill Hospital, Box Hill, VIC, Australia",
        "Eastern Health Clinical School, Monash University, Box Hill Melbourne, VIC, Australia"
      ],
      "name": "Katherine Buzzard"
    },
    {
      "affiliations": [
        "Neuroscience, Alfred Health, Melbourne, VIC, Australia",
        "Department of Neurosciences, Box Hill Hospital, Box Hill, VIC, Australia",
        "Eastern Health Clinical School, Monash University, Box Hill Melbourne, VIC, Australia"
      ],
      "name": "Olga Skibina"
    },
    {
      "affiliations": [
        "S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy"
      ],
      "name": "Matteo Foschi"
    },
    {
      "affiliations": [
        "S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy"
      ],
      "name": "Andrea Surcinelli"
    },
    {
      "affiliations": [
        "Department of Neurology, Medical Faculty, Karadeniz Technical University, Trabon, Turkey"
      ],
      "name": "Cavit Boz"
    },
    {
      "affiliations": [
        "Hunter New England Health, John Hunter Hospital, Newcastle, NSW, Australia"
      ],
      "name": "Jeannette Lechner-Scott"
    },
    {
      "affiliations": [
        "Second Faculty of Medicine,Charles University and Motol University Hospital, Prague, Czech"
      ],
      "name": "Jana Libertinova"
    },
    {
      "affiliations": [
        "Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy, Catania, Italy"
      ],
      "name": "Francesco Patti"
    },
    {
      "affiliations": [
        "Perron Institute for Neurological and Translational Science, Sir Charles Gairdner Hospital, QEIIMC, University of Western Australia, Nedlands, WA, Australia"
      ],
      "name": "Allan Kermode"
    },
    {
      "affiliations": [
        "Perron Institute for Neurological and Translational Science, Sir Charles Gairdner Hospital, QEIIMC, University of Western Australia, Nedlands, WA, Australia"
      ],
      "name": "Marzena Pedrini"
    },
    {
      "affiliations": [
        "Perron Institute for Neurological and Translational Science, Sir Charles Gairdner Hospital, QEIIMC, University of Western Australia, Nedlands, WA, Australia"
      ],
      "name": "William Carroll"
    },
    {
      "affiliations": [
        "Brain and Mind Centre, Sydney, NSW, Australia"
      ],
      "name": "Michael Barnett"
    },
    {
      "affiliations": [
        "Department of Neurology, Royal Brisbane Hospital, Brisbane, QLD, Australia"
      ],
      "name": "Bruce Taylor"
    },
    {
      "affiliations": [
        "Department of Neurology, Royal Brisbane Hospital, Brisbane, QLD, Australia"
      ],
      "name": "Suzanne Hodgkinson"
    },
    {
      "affiliations": [
        "Brain and Mind Centre, Sydney, NSW, Australia"
      ],
      "name": "Michael Barnett"
    },
    {
      "affiliations": [
        "Department of Neurology, Royal Brisbane Hospital, Brisbane, QLD, Australia",
        "University of Queensland, Brisbane, QLD, Australia"
      ],
      "name": "Pamela Mccombe"
    },
    {
      "affiliations": [
        "Concord Repatriation General Hospital, Sydney, NSW, Australia"
      ],
      "name": "Stephen Reddel"
    },
    {
      "affiliations": [
        "Concord Repatriation General Hospital, Sydney, NSW, Australia"
      ],
      "name": "Steve Vucic"
    },
    {
      "affiliations": [
        "Concord Repatriation General Hospital, Sydney, NSW, Australia"
      ],
      "name": "Sudarshini Ramanathan"
    },
    {
      "affiliations": [
        "Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia"
      ],
      "name": "Richard Macdonell"
    },
    {
      "affiliations": [
        "Austin Health, Melbourne, VIC, Australia"
      ],
      "name": "Nevin John"
    },
    {
      "affiliations": [
        "Monash University, Clayton, VIC, Australia"
      ],
      "name": "Mark Slee"
    },
    {
      "affiliations": [
        "Flinders University, Adelaide, SA, Australia"
      ],
      "name": "Anneke Van der Walt"
    },
    {
      "affiliations": [
        "Department of Neurology, Royal Brisbane Hospital, Brisbane, QLD, Australia"
      ],
      "name": "Helmut Butzkueven"
    },
    {
      "affiliations": [
        "School of Translational Medicine, Monash University, Melbourne, VIC, Australia",
        "Neuroscience, Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Vilija Jokubaitis"
    }
  ],
  "title": "YI6 MS outcomes in breast cancer survivors and the influence of chemotherapy",
  "uid": "19db2b4b-05c2-5a82-91bf-2f7bb811409f"
}