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  • A Mass Outbreak of Electric-type Pokémon in Pokémon Scarlet and Pokémon Violet

    A Mass Outbreak of Electric-type Pokémon in Pokémon Scarlet and Pokémon Violet

    It’s time for an electrifying event in Pokémon Scarlet and Pokémon Violet during a mass outbreak of Electric-type Pokémon. From Thursday, July 3, 2025, at 5:00 p.m. PDT to Sunday, July 6, 2025, at 4:59 p.m. PDT, you’ll encounter groups of Dedenne, Pawmi, Pachirisu, Morpeko, Plusle, and Minun throughout the Paldea region, the land of Kitakami, and the Terarium at Blueberry Academy. Shiny Pokémon are more likely to appear during these special mass outbreaks, so don’t be shocked if you see Pokémon with unusual color schemes. Look for the following Pokémon in these locations:

    • Paldea – Dedenne and Pawmi

    • Kitakami – Pachirisu and Morpeko

    • Blueberry Academy – Plusle and Minun

    Mass outbreaks are a phenomenon in which many of the same species of Pokémon appear in one location. To participate in mass outbreak events, you will need to download the latest Poké Portal News and install the latest update data for your game.

    Get charged up and have fun during this mass outbreak event, Trainers!

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  • Uría Menéndez appoints Salvador Sánchez-Terán as senior partner and Antonio Herrera as managing partner

    Uría Menéndez appoints Salvador Sánchez-Terán as senior partner and Antonio Herrera as managing partner

    At the General Partners Meeting today, Uría Menéndez’s partners have decided to appoint Salvador Sánchez-Terán as the firm’s senior partner and Antonio Herrera as the managing partner. Both appointments will take effect on 1 January 2026. Jesús Remón, who is currently the firm’s senior partner, will remain associated with the firm as partner emeritus.

    Salvador Sánchez-Terán

    Following two terms as managing partner, during which time he has succeeded in further strengthening the firm’s position in the Iberian market, Salvador Sánchez-Terán will become the firm’s new senior partner. “It has been a real privilege to share the firm’s leadership with Jesús; his example will continue to serve as a benchmark for me and my colleagues,” said Salvador.

    Antonio Herrera

    Antonio Herrera joined Uría Menéndez in 1998 and has been a partner since 2007. He began his career in Madrid, later headed the New York office, and subsequently spent over a decade in charge of the Barcelona office. Since July 2024, he leads the Corporate Law Practice. His professional expertise includes M&A transactions, corporate governance, structured finance and advising start-ups. He has also been a professor at ESADE Law School for over ten years.

    “I am grateful to my partners for their trust in me to take on this responsibility; it is an honour and a challenge that I embrace with great enthusiasm. I intend to build on the achievements of both Salvador and my predecessors, while continuing to develop Uría Menéndez in accordance with the principles that have always defined our firm: legal and ethical rigour, client dedication, commitment to internal talent and social responsibility”, said Herrera.

    Following a distinguished career as a partner, Jesús Remón – who will remain at the firm as partner emeritus – stated that these appointments reflect “the continuity of our model, with a focus on long-term planning and generational renewal.” He also thanked the firm and its members for their unwavering support, and for giving him the opportunity to be part of this collective project.

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  • Wimbledon 2025: Hottest ever opening day sees players using ice to keep cool at SW19

    Wimbledon 2025: Hottest ever opening day sees players using ice to keep cool at SW19

    The temperatures did not stop more than 10,000 people joining the queue for day one, at which point the All England Club advised people to stop travelling.

    Two-time Wimbledon runner-up Ons Jabeur was forced to retire from her opening-round match after becoming unwell.

    The Tunisian took a medical time-out in the first set, during which she had her blood pressure taken and had an ice towel draped around her neck.

    She decided she could not continue when trailing 7-6 (7-5) 2-0 against Bulgaria’s Viktoriya Tomova, in a match which took place during the midday heat following an 11:00 BST start.

    There were varying opinions on the temperature among the players.

    “Honestly, I didn’t feel that hot out there. It was hot. I was sweating, but I didn’t really feel like it was that hot, you know,” said American Frances Tiafoe.

    “I don’t know if wearing all white really helps as well, but I didn’t really feel that hot. After this I’ll go to [the Washington] Open and play in DC, with the humidity there there’s no faking that. That’s going to be really hot.”

    But German Eva Lys, who also came through her first-round match, said: “[It was] tough. Really, really tough. I was sweating a lot, so my racquet was very slippery.

    “It’s the first time playing with heat on grass. I feel like it’s really tough on the legs. This is especially what I felt in the third set. I think the spectators didn’t have it easy either, I feel like everyone is kind of struggling with the heat right now.”

    BBC Weather’s senior meteorologist George Goodfellow said similar conditions are expected on Tuesday, which will be “dry, sunny and very hot again, with just a very slight breeze at most”.

    Goodfellow added: “The high will likely be similar to today, above 30C. We’re going with 33C at Kew Gardens – the nearest observation site to Wimbledon.

    “After tomorrow, temperatures will return to nearer normal for the time of year, but that still means above 20C.”

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  • Latent Profile Analysis of Emotional Expression Conflicts and Associat

    Latent Profile Analysis of Emotional Expression Conflicts and Associat

    Introduction

    Breast cancer, a common malignant tumor among women, poses a significant threat in China due to its high incidence and mortality rates.1 Medical advancements have improved early detection and treatment, with surgery combined with adjuvant chemotherapy as the standard treatment.2,3 While this regimen has increased five-year survival rates and reduced recurrence risks,4–7 adjuvant chemotherapy still causes considerable biological toxicity, including side effects such as nausea, vomiting, and hair loss. These side effects severely impact patients’ daily lives and psychological well-being, reducing their overall quality of life.8 Additionally, chemotherapy often leads to physical and psychological stress, contributing to emotional disorders. Addressing these psychological challenges and improving patients’ care experiences have become critical focuses of breast cancer nursing research.9

    Traditional Chinese culture often conceals bad news, especially regarding serious illnesses like cancer, imposing taboos that restrict emotional expression.10,11 Breast cancer patients endure not only physical pain and discomfort during treatment but also enormous psychological stress.12 Patients may feel the urge to express emotions but often struggle with whether others will understand or accept their feelings, leading to emotional expression conflicts.13,14 Emotional expression conflict refers to the internal struggle individuals experience when they want to express emotions—whether positive or negative—while fearing negative social consequences or judgment from others.15,16 This internal-external conflict exacerbates patients’ anxiety and depression, further impeding their treatment progress and negatively affecting their quality of life.17

    Emotional expression conflict significantly contributes to psychological distress, physical discomfort, and social maladjustment among breast cancer patients.18–20 Suppressing emotions and failing to express negative feelings can intensify anxiety, depression, impair immune function, and reduce treatment efficacy, thereby diminishing quality of life. Understanding the sources, characteristics, and influencing factors of emotional expression conflict is crucial for developing personalized interventions to improve patients’ mental health.21

    This study is conceptually guided by the ABC-X model,19,22 a widely used framework in family and psychological stress research. Within this model, A (stressor) refers to the diagnosis and chemotherapy of breast cancer; B (resources) includes individual and environmental protective factors such as family resilience; C (cognitive appraisal) is represented by cognitive fusion, reflecting how patients mentally process and internalize their cancer experience; and X (outcome) denotes the emotional expression conflict, viewed as a psychological adaptation response.

    Based on this framework, we hypothesized that emotional expression conflict in breast cancer patients is shaped not only by objective stressors, but also by subjective interpretations and available resources. Therefore, the inclusion of family resilience and cognitive fusion as key variables in this study is theoretically grounded. Prior studies have supported the association between these factors and emotional regulation in cancer populations.

    Currently, most studies on emotional expression conflict among cancer patients rely on scale scores to assess the overall level of emotional expression, but this approach does not account for the heterogeneity within patient populations.23 Emotional expression conflict levels can vary significantly between individuals due to differences in psychological characteristics, living environments, cultural backgrounds, and disease cognition. To address this issue, this study employs Latent Profile Analysis (LPA) to explore the characteristics of emotional expression conflict and its potential influencing factors in breast cancer patients undergoing postoperative chemotherapy. By conducting a more nuanced group division and analysis, this study aims to provide more targeted psychological intervention strategies to reduce emotional expression conflict, enhance patients’ psychological adaptation, and improve long-term health outcomes.

    In conclusion, this study not only focuses on the physiological treatment outcomes of breast cancer patients but also emphasizes their psychological and emotional responses during treatment. Through more refined emotional management, the goal is to help patients better cope with the physical and psychological challenges posed by cancer, thereby promoting comprehensive improvements in their treatment outcomes and quality of life.

    Methods

    Subjects

    From March 2023 to March 2024, a convenience sampling method was employed to select breast cancer patients from the Breast and Oncology Wards of Fenyang Hospital in Shanxi Province as study participants. Inclusion criteria: ① Patients diagnosed with primary breast cancer based on histopathological examinations; ② Patients who have undergone surgery and completed at least one cycle of chemotherapy; ③ Female patients aged ≥18 years; ④ Patients who are aware of their medical condition and have a certain level of comprehension and expressive ability; ⑤ Patients who provided informed consent and voluntarily participated in the study. Exclusion criteria: ① Patients with recurrent breast cancer or distant metastasis; ② Patients with severe diseases of the heart, lungs, kidneys, liver, or other organs; ③ Patients with a history of mental illness or severe trauma. Based on research on sample size calculations, the required sample size was 5 to 10 times the number of observed variables.24 With 21 independent variables in this study and considering a 20% invalid questionnaire rate, the required sample size ranged from 126 to 252 cases. Ultimately, 238 breast cancer patients were surveyed in this study.

    Research Tools

    Self-Designed Questionnaire: This questionnaire consists of two parts: demographic information and disease-related information. Demographic information includes age, marital status, education level, etc.; disease-related information includes pathological staging, chemotherapy cycles, and other relevant data. Personal information was provided by the patients themselves, while disease-related information was collected by the researchers through a review of the patients’ medical records.

    Ambivalence over Emotional Expressiveness Questionnaire-G28 (AEQ-G28): Developed by King and Emmons,15 and translated and revised into Chinese by Ji Lili et al25 this questionnaire measures emotional expression conflict in breast cancer patients. The Chinese version retains 24 items, which are based on the cognitive patterns of Chinese breast cancer patients, and is a unidimensional scale. It uses a 5-point Likert scale, ranging from “Never” to “Often”, scored from 0 to 4 points. Higher scores indicate a greater degree of emotional expression conflict. The scale demonstrated good reliability and validity, with a Cronbach’s alpha coefficient of 0.897 in this study.

    Cognitive Fusion Questionnaire (CFQ): Developed by Gillanders et al26 and adapted into Chinese by Zhang Weichen et al27 only the CFQ-F version, consisting of 9 unidimensional items, was retained for use across different age groups. It employs a 7-point Likert scale, ranging from “Never” to “Always”, scored from 1 to 7 points, with total scores ranging from 9 to 63 points. Higher scores indicate a higher degree of cognitive fusion, reflecting more severe negative emotions and a tendency toward psychological rigidity. In this study, the scale’s Cronbach’s alpha coefficient was 0.866.

    Family Resilience Assessment (FRA): This is the first family resilience assessment tool specifically developed for women with a history of breast cancer. Developed by Lane et al28 and translated and revised into Chinese by Zhang Shanshan et al29 in 2021, it assesses the family resilience levels of Chinese breast cancer patients. The scale includes five dimensions: positive attitude, family connectedness, social and economic resources, clear communication, and collaborative problem-solving, with a total of 28 items. The scale demonstrated good reliability and validity, with a Cronbach’s alpha coefficient of 0.834 in this study.

    Data Collection

    Before the survey, three investigators underwent standardized training. They used standardized instructions to explain the significance, objectives, and methods of the study to the patients and obtained their informed consent before instructing them to complete the questionnaires independently. Data collection was conducted with paper-based questionnaires. For patients who had difficulties reading or writing, the investigators assisted them in completing the questionnaires using neutral language. During the survey, patients were informed of the methods and precautions for completing the questionnaires. After the survey, the completeness of the questionnaires was checked, and any incomplete questionnaires were returned to the patients for correction. Once verified, the questionnaires were collected. In total, 280 questionnaires were distributed, of which 42 were invalid, leaving 238 valid responses and resulting in an effective recovery rate of 85%.

    Statistical Processing

    Latent profile analysis was performed using Mplus 8.3 software. Latent Profile Analysis (LPA) was employed to identify unobserved subgroups of emotional expression conflict based on 24 continuous item responses. Unlike traditional clustering methods such as K-means—which rely on distance metrics and assume equal variance—LPA models the probability of latent class membership and allows for statistical model selection using fit indices (AIC, BIC, entropy). This approach is especially suitable for uncovering psychological heterogeneity and identifying subtypes with clinical relevance. The model fit indices were the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), Adjusted Bayesian Information Criterion (aBIC), Lo-Mendell-Rubin Likelihood Ratio Test (LMRT), Bootstrap Likelihood Ratio Test (BLRT), and Entropy. Lower values of AIC, BIC, and aBIC indicate a better model fit. The LMRT compares the differences between models with different latent classes. A P-value of <0.05 indicates that the k-class model fits significantly better than the (k-1)-class model. Based on the fit results, the optimal model was selected, categorizing breast cancer patients undergoing postoperative chemotherapy, and profile plots were generated.30

    Data analysis was performed using SPSS 27.0. Normally distributed quantitative data were expressed as means and standard deviations, and categorical data as frequencies and percentages. Chi-square tests and analysis of variance (ANOVA) were used to compare the general characteristics and questionnaire scores across different patient groups. Ordered logistic regression analysis was used to identify the influencing factors of emotional expression conflict among different categories of breast cancer patients. A P-value of <0.05 was considered statistically significant. To assess potential multicollinearity among predictors, we conducted correlation analysis and calculated Variance Inflation Factors (VIFs). All pairwise correlations were below 0.6, and VIF values were less than 3.0, indicating that multicollinearity did not significantly affect the model.

    Results

    General Characteristics of Breast Cancer Patients Undergoing Postoperative Chemotherapy

    A total of 238 breast cancer patients were successfully surveyed, with ages ranging from 25 to 80 (mean age = 54.11 ± 14.52). Of these, 140 patients were from urban areas, and 98 from rural areas. The duration of illness was ≤0.5 years in 20 patients, between 0.5 and 1.5 years in 118 patients, and ≥1.5 years in 100 patients. Of the patients, 173 were married. The number of chemotherapy cycles was ≤3 in 79 patients, between 3 and 6 in 118 patients, and ≥6 in 41 patients. Health insurance covered 230 patients. Additionally, 66 patients had ≥2 comorbidities, and 76 had religious beliefs. A total of 122 patients underwent breast-conserving surgery. Other details are presented in Table 1.

    Table 1 Univariate Analysis of Latent Categories of Emotional Expression Conflict in Breast Cancer Patients

    Scores of Emotional Expression Conflict, Cognitive Fusion, and Family Resilience in Breast Cancer Patients

    The emotional expression conflict score for breast cancer patients was 52.43 ± 16.56; the cognitive fusion score was 38.88 ± 7.37; and the family resilience score was 83.37 ± 14.39. The scores for the five dimensions—positive attitude, family connectedness, social and economic resources, clear communication, and collaborative problem-solving—were 12.53 ± 3.15, 30.58 ± 6.89, 14.98 ± 3.31, 13.50 ± 3.65, and 11.77 ± 3.17, respectively.

    Latent Category Model Analysis and Naming of Emotional Expression Conflict in Breast Cancer Patients

    Based on the 24 items measuring emotional expression conflict, latent category models ranging from 1 to 5 were constructed. Model fit indices, including Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), Adjusted Bayesian Information Criterion (aBIC), Entropy, Lo-Mendell-Rubin Likelihood Ratio Test (LMRT), and Bootstrap Likelihood Ratio Test (BLRT), were used to identify the heterogeneity of emotional expression conflict among breast cancer patients undergoing postoperative chemotherapy. The results of the latent profile analysis and the model fit indices are shown in Figure 1. As the number of models increased, the values of the AIC, BIC, and aBIC model fit indices gradually decreased. The VLMR values for models 4 and 5 were 0.294 and 0.117, respectively, which did not reach significant levels. This indicated that the fit of models 4 and 5 was not as good as that of model 3 (VLMR = 0.019). Moreover, the average probability of category membership in model 3 was 97.7%, 96.1%, and 98.8% for each category— all exceeding 90%, indicating high accuracy of category assignment and credible model results (see Table 2).

    Table 2 Model Fit Indices for Latent Profile Analysis of Emotional Expression Conflict in Breast Cancer Patients (n = 238)

    Figure 1 Latent profile distribution of emotional expression conflict among breast cancer patients receiving postoperative chemotherapy. The figure shows three distinct groups identified through latent profile analysis: ● Low Conflict Emotional Expression Group. ▲ Medium Conflict Emotional Expression Group □ High Conflict-Expression Inhibited Group.

    The comprehensive analysis indicated that model 3 had the best fit, ultimately classifying emotional expression conflict in breast cancer patients into three latent categories. Based on their characteristics, the categories were named as follows:

    Category 1 had low scores on all items, reflecting a low level of emotional expression conflict among breast cancer patients undergoing postoperative chemotherapy. This group was named the “Low Conflict Emotional Expression Group” (33.6%).

    Category 2 had intermediate scores between Categories 1 and 3, with medium-level scores on all items. This group was named the “Medium Conflict Emotional Expression Group” (42.4%).

    Category 3 had the highest emotional expression conflict scores among the three categories, particularly scoring high on the following items: Item 4”: When I am proud of an achievement, I want to tell others, but worry that they will think I am arrogant”. Item 5: “I try not to worry others, even when they should know the truth”. Item 6: “ When I want to express my feelings, I feel as if something is preventing me from doing so”. This group was named the High Conflict-Expression Inhibited Group” (23.9%).

    Univariate Analysis of Latent Profile Analysis of Emotional Expression Conflict in Breast Cancer Patients

    The univariate analysis revealed no statistically significant differences among the three patient groups in terms of marital status, residence, comorbidities, duration of illness, medical payment status, surgical method, number of chemotherapy cycles, or presence of religious beliefs (all P > 0.05), as shown in Table 1.

    Multivariate Analysis of Factors Influencing Emotional Expression Conflict in Breast Cancer Patients

    Using the latent categories of emotional expression conflict in breast cancer patients undergoing postoperative chemotherapy as the dependent variable (Low Conflict Emotional Expression Group = 1, Medium Conflict Emotional Expression Group = 2, High Conflict-Expression Inhibited Group = 3; with the High Conflict-Expression Inhibited Group as the reference), variables found to be statistically significant in the univariate analysis were included as independent variables in the logistic regression model. The parallelism test yielded χ²= 20.532, P = 0.197, confirming the suitability of an ordered logistic regression analysis. The results indicated that age (≤35 years = 1, 35–60 years = 2, ≥60 years = 3; with ≥60 years as the reference), sleep quality (Poor = 1, Fair = 2, Good = 3; with Good sleep quality as the reference), education level (Junior high school and below = 1, High school = 2, College/Vocational and above = 3; with College/Vocational and above as the reference), per capita monthly household income (≤3000 RMB = 1, 3000–5000 RMB = 2, ≥5000 RMB = 3; with ≥5000 RMB as the reference), cognitive fusion (original score input), and family resilience (original score input) were significant factors influencing the latent categories of emotional expression conflict among breast cancer patients undergoing postoperative chemotherapy. The detailed results are presented in Table 3.

    Table 3 Multivariate Analysis of Latent Profiles of Emotional Expression Conflict in Breast Cancer Patients Undergoing Postoperative Chemotherapy (n=238)

    Discussion

    Heterogeneity in Emotional Expression Conflict Among Breast Cancer Patients

    Breast cancer is one of the most common malignant tumors among women globally, and its rising incidence poses a significant threat to women’s health. In recent years, with advancements in early screening and treatment technologies, surgery combined with adjuvant chemotherapy has become the standard treatment regimen, significantly improving the survival rate of patients. However, despite the remarkable progress in treatment, patients still face substantial physiological and psychological stress during the process. Especially during postoperative chemotherapy, patients not only endure severe physical side effects but also experience emotional fluctuations such as anxiety, depression, and fear, which impact their emotional regulation and psychological adaptation. Emotional expression conflict, as a common psychological response, has become an important factor influencing the mental health of breast cancer patients. During treatment, patients often suppress or experience conflict in expressing their emotions due to concerns that others may not understand or accept them. This internal-external emotional conflict not only exacerbates their psychological burden but may also affect their treatment outcomes and quality of life. Therefore, a comprehensive exploration of the sources and influencing factors of emotional expression conflict in breast cancer patients is of great significance for developing more effective psychological interventions to improve patients’ mental health.

    The results of this study indicate that the emotional expression conflict score for breast cancer patients undergoing postoperative chemotherapy was 52.43 ± 16.56, which is consistent with the findings of Li Xuekun25 in middle-aged and young patients. Latent profile analysis revealed that emotional expression conflict among patients was categorized into three groups: the “Low Conflict Emotional Expression Group” (33.6%), the “Medium Conflict Emotional Expression Group” (42.4%), and the “High Conflict, Expression Inhibited Group” (23.9%).

    Low Conflict Emotional Expression Group: This group exhibited a generally low level of emotional expression conflict. This may be attributed to the fact that patients in this group tend to be older, have higher educational levels, and possess extensive life experience. Consequently, they are better equipped to calmly and rationally handle significant life changes and effectively regulate their emotions. For such patients, healthcare providers should maintain effective communication, continuously monitor changes in their emotional states, and proactively address any barriers to emotional expression.

    Medium Conflict Emotional Expression Group: This group comprised the largest number of patients, which may be due to these patients having a preliminary understanding of their illness and basic emotional management skills. However, they may struggle to integrate their cognitive understanding with their actions, resulting in obstacles to emotional expression. Healthcare providers should equip these patients with appropriate emotional expression pathways and techniques, encouraging them to express their emotions. Additionally, it is crucial to actively monitor the emotional distress in this category of patients to prevent their transition into the high conflict group.

    High Conflict-Expression Inhibited Group: Patients in this category exhibited the highest levels of emotional expression conflict. This may be because many study participants are middle-aged and young women who, due to treatment, experience changes in their physical appearance related to breast cancer. As a result, they may be more sensitive to bodily defects and struggle with psychological regulation. Moreover, patients in this group demonstrated lower levels of family resilience and had fewer accessible family and social resources, exacerbating their fear of communicating with family members and making emotional expression more challenging. Therefore, healthcare professionals should proactively identify high-risk patients early on and implement stratified interventions tailored to the different categories of breast cancer patients. Encouraging self-disclosure and reducing emotional expression conflict levels are essential strategies for improving patient outcomes.

    Multiple Factors Affecting the Categories of Emotional Expression Conflict in Breast Cancer Patients Undergoing Postoperative Chemotherapy

    Education Level and Per Capita Monthly Household Income

    Lower-educated patients exhibited significantly higher likelihood of High Conflict-Expression Inhibited Group membership compared to Low/Medium Conflict Groups (all P<0.05). This association may arise through two pathways: (a) Limited health literacy impedes emotional articulation and breast cancer knowledge acquisition, fostering shame-driven expression avoidance;31 (b) Reduced per capita income linked to lower education amplifies treatment-related financial strain,32 exacerbating familial guilt and emotional suppression.

    Higher-educated counterparts demonstrated superior emotional regulation through enhanced illness comprehension. Clinical interventions should prioritize: (a) Simplified health education materials (such as short videos);31 (b) Family communication training using plain language;33 (c) Mitigation of hierarchical doctor-patient dynamics in China to promote therapeutic dialogue.33

    Age and Sleep Quality

    This study found that, compared to the Low Conflict Emotional Expression Group and the Medium Conflict Emotional Expression Group, younger patients and those with poorer sleep quality were more likely to belong to the High Conflict—Expression Inhibited Group (P < 0.05). Studies have shown that younger breast cancer patients have more active hormone metabolism, faster cell proliferation, earlier metastasis, higher risks of disease staging, recurrence, and mortality, and poorer prognosis.34 The patients in this study were mostly middle-aged and young, carrying multiple social roles. Cancer not only increases their economic burdens but also hinders career development, leading to a loss of social roles and preventing them from achieving self-worth. Moreover, anticancer treatments inevitably cause destruction or loss of fertility,35 adding psychological pressure and emotional conflicts to younger patients.14 Additionally, younger women have a higher prevalence and severity of sleep disorders,36 and treatments such as surgery and chemotherapy are common causes of sleep disturbances.37 Patients with poorer sleep quality experience lighter sleep, difficulty falling back asleep after waking, and long-term sleep deprivation, which can easily disrupt physiological rhythms, impair emotional cognition and regulation functions, and lead to emotional expression conflicts.38 Furthermore, these patients are prone to daytime lethargy and drowsiness, leading to difficulties in concentration and handling various tasks. This results in the continuous accumulation of negative emotions, increasing the likelihood of emotional expression conflicts. Therefore, healthcare providers should pay more attention to younger breast cancer patients, disseminate disease knowledge and psychological care, encourage them to face cancer, strengthen health education on disease communication, and encourage them to seek help from their support systems to alleviate physical and mental stress and burdens. Additionally, healthcare providers should help patients improve sleep quality through methods such as mindfulness training to enhance their perception of their physiological states, thereby increasing their sense of self-control and improving their ability to regulate emotions.

    Cognitive Fusion

    The results of this study showed that, compared to the Low Conflict Emotional Expression Group and the Medium Conflict Emotional Expression Group, patients with higher levels of cognitive fusion were more likely to belong to the High Conflict—Expression Inhibited Group. Psychological rigidity can cause patients to experience negative emotions during the rehabilitation process, leading to distorted cognitions influenced by their subjective awareness. This makes it difficult to process their emotions and increases their psychological burden,39 which can lead to emotional expression conflicts. This suggests that healthcare providers should pay attention to patients with different psychological states, help them establish accurate disease cognition, address their doubts, build positive beliefs, and adopt a rational attitude toward coping with the disease. Additionally, healthcare providers should guide patients to appropriately express their needs and improve their emotional management abilities.

    Family Resilience

    Regression analysis showed that patients with lower family resilience were more likely to belong to the High Conflict—Expression Inhibited Group compared to the Low and Medium Conflict Groups. Family resilience refers to a family’s capacity to mobilize internal and external resources to adapt to illness challenges.40 Higher family resilience correlates with harmonious relationships and optimistic disease attitudes, promoting proactive emotional expression and reducing conflicts. When families actively listen to patients, mutual understanding improves, enabling better coping with disease stress and forming a resilience-conflict resilience cycle.

    Therefore, healthcare providers should conduct comprehensive and multi-dimensional assessments for patients, offer sufficient emotional care to patients with low family resilience, establish good communication with patients and their families, encourage family members to participate in the patient’s treatment, and provide patients with more family support. Additionally, healthcare providers should monitor the psychological development trends of patients and offer targeted assistance in a timely manner.

    This study identified age, education, income, sleep quality, cognitive fusion, and family resilience as key predictors of emotional conflict in breast cancer patients. These findings underscore the urgent need for personalized nursing interventions, including cognitive-behavioral and mindfulness therapies to improve emotional regulation, alongside family-centered strategies to strengthen resilience and communication dynamics. While preliminary, the results emphasize the critical role of integrated psychological support and family engagement in oncology care. Future multi-center studies with larger cohorts are warranted to validate these findings and refine culturally adaptive intervention frameworks.

    Limitations and Future Research

    Despite the meaningful findings, several limitations of this study should be considered, which also highlight directions for future research. The use of self-report instruments may introduce bias due to measurement error. Although we employed validated tools with strong psychometric properties, the reliance on observed total scores rather than latent constructs may limit precision. Structural Equation Modeling (SEM), which offers advantages for testing causal pathways and explicitly modeling measurement error, was not employed in this exploratory study, which aimed primarily to identify latent subgroups of emotional expression conflict and examine associated influencing factors.

    Furthermore, while our analysis identified several significant correlates of subgroup membership, we did not examine potential mediating or moderating effects—such as the roles of cognitive fusion or family resilience—due to the cross-sectional design and modest sample size (n = 238). Future research should adopt longitudinal designs and SEM-based frameworks to rigorously explore the psychological mechanisms underlying emotional expression conflict in breast cancer patients.

    Although the variable-to-sample ratio in our regression analysis meets recommended thresholds, the possibility of Type I error cannot be excluded. Future studies should consider larger sample sizes and explore alternative modeling techniques, such as penalized regression (eg, LASSO), to ensure the robustness of the findings.

    Conclusion

    Emotional expression conflicts among breast cancer patients undergoing postoperative chemotherapy exhibit distinct categorical characteristics. Age, education level, per capita monthly income, sleep quality, cognitive fusion, and family resilience are key influencing factors for different categories of emotional expression conflict. It is recommended that nursing staff promptly implement personalized psychological interventions, cognitive-behavioral therapy, mindfulness-based interventions, and other strategies to encourage patients to actively express their emotions and describe their experiences. This can help reduce the sense of guilt following a cancer diagnosis and alleviate emotional expression conflicts. The sample size of this study was relatively small, and future research should involve multi-regional, large-sample surveys to further validate and refine the conclusions drawn in this study. Furthermore, as the global demand for cancer care continues to rise, the findings of this study offer valuable insights for emotional support and psychological health interventions in oncology nursing practices worldwide.

    Ethics Approval

    This study was reviewed and approved by the Ethics Committee of Fenyan College of Shanxi Medical University. The ethics approval number is 2023031. Informed consent was obtained from all patients, and the process was reviewed by the Ethics Committee of Fenyan College of Shanxi Medical University. The study was conducted in accordance with the ethical standards set forth in the 1964 Declaration of Helsinki and its later amendments.

    Author Contributions

    Zhaoxia Tian and Ruishan Sheng contributed equally to this work and are co-first authors. All authors made substantial contributions to the work reported, including in the conception, study design, execution, data acquisition, analysis and interpretation, or in all these areas; participated in drafting, revising, or critically reviewing the manuscript; approved the final version to be published; agreed on the journal to which the article has been submitted; and are accountable for all aspects of the work.

    Funding

    The authors received the following financial support for the research, data collection, authorship, and publication of this article: This study was funded by the Science and Technology Project of Lvliang City, Key Laboratory Project of Clinical Nursing Research (No. 2020ZDSYS15).

    Disclosure

    The authors declare that there are no financial or non-financial competing interests associated with the conduct or publication of this research.

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    13. Tsai W, Lu Q. Ambivalence over emotional expression and intrusive thoughts as moderators of the link between self-stigma and depressive symptoms among Chinese American breast cancer survivors. J Behav Med. 2019;42(3):452–460. doi:10.1007/s10865-018-9996-6

    14. Cao X, Bao Y, Luo J, Zeng L, Chen G. Research progress on emotional expression conflicts in breast cancer patients. Chin J Nurs. 2023;58(21):2598–2603.

    15. King LA, Emmons RA. Conflict over emotional expression: psychological and physical correlates. J Pers Soc Psychol. 1990;58(5):864–877. doi:10.1037/0022-3514.58.5.864

    16. Ji L, Wang L, Q L, Lu G. Reliability and validity of the Chinese version of the emotional expression conflict questionnaire in breast cancer patients. Chin J Behav Med Brain Sci. 2018;27(12):1138–1142. doi:10.3760/cma.j.issn.1674-6554.2018.12.017

    17. IHC W, McNeill LH, Lu Q. Ambivalence over emotional expression and physical functioning and limitations: mediating and moderating effects of PTSD symptoms and acculturation among Chinese breast cancer survivors. Support Care Cancer. 2019;27(1):311–319. doi:10.1007/s00520-018-4329-4

    18. Chen L, Liu Y. A review of research on emotional expression conflict abroad. J Guangzhou Univ. 2012;11(3):43–48.

    19. Lu Q, Man J, You J, LeRoy AS. The link between ambivalence over emotional expression and depressive symptoms among Chinese breast cancer survivors. J Psychosom Res. 2015;79(2):153–158. doi:10.1016/j.jpsychores.2015.01.007

    20. Ji LL, Tsai W, Sun XL, et al. The detrimental effects of ambivalence over emotional expression on well-being among Mainland Chinese breast cancer patients: mediating role of perceived social support. Psycho Oncol. 2019;28(5):1142–1148. doi:10.1002/pon.5069

    21. Han E, Tao X, Zhang Z, Li J, Xu H. Empathy fatigue and its influencing factors among operating room nurses based on the ABC-X model. Chin J Health Psychol. 2021;29(7):1046–1050. doi:10.13342/j.cnki.cjhp.2021.07.020

    22. Li L, Zhang X, Ba R. Application of the ABC-X model in improving negative emotions and quality of life in patients with colorectal cancer. J Pract Tradit Chin Intern Med. 2022;36(3):141–143. doi:10.13729/j.issn.1671-7813.Z20211421

    23. Miaskowski C, Barsevick A, Berger A, et al. Advancing symptom science through symptom cluster research: expert panel proceedings and recommendations. J Natl Cancer Inst. 2017;109(4):djw253. doi:10.1093/jnci/djw253

    24. Ni P, Chen J, Liu N. Sample size estimation in quantitative nursing research. Zhonghua Hu Li Za Zhi. 2010;45(4):378–380. doi:10.3761/j.issn.0254-1769.2010.04.037

    25. Li X, Du R, Cui P, et al. Mediating effect of fear of progression between emotional expression conflict and social alienation in young and middle-aged breast cancer patients. Chin J Health Psychol. 2022;30(11):1632–1637. doi:10.13342/j.cnki.cjhp.2022.11.007

    26. Gillanders DT, Bolderston H, Bond FW, et al. The development and initial validation of the cognitive fusion questionnaire. Behav Ther. 2014;45(1):83–101. doi:10.1016/j.beth.2013.09.001

    27. Cao J, Ji Y, Zhu Z. Reliability and validity of the Chinese version of the acceptance and action questionnaire-II among college students. Chin Ment Health J. 2013;27(11):873–877. doi:10.3969/j.issn.1000-6729.2013.11.014

    28. Duncan-Lane C, Meszaros PS, Savla J. Measuring Walsh’s family resilience framework: reliability and validity of the family resilience assessment among women with a history of breast cancer. Marriage Fam Rev. 2016;53(7):667–682. doi:10.1080/01494929.2016.1263588

    29. Zhang S, Li H, Song J, Zhou M, Gao J, Li J. Sinicization and psychometric evaluation of the family resilience assessment scale in breast cancer patients. J Nurs Sci. 2021;28(24):1–5. doi:10.16460/j.issn1008-9969.2021.24.001

    30. Zeng X, Xiao L, Zhang Y. Principles and application of latent class analysis: an example-based study. Chin J Health Stat. 2013;30(6):815–817.

    31. Qin R, Zhang Y, Wang N, Ma S. Influencing factors and intervention research progress on alexithymia in breast cancer patients. Chin Gen Pract Nurs. 2023;21(27):3803–3806. doi:10.12104/j.issn.1674-4748.2023.27.015

    32. Li J, Shen Z, Li J, Wang S, Xie J, Zhang Q. Research progress on influencing factors of alexithymia in elderly patients with chronic diseases. J Clin Pathol Res. 2023;43(10):1880–1887. doi:10.11817/j.issn.2095-6959.2023.230086

    33. Guo C, Yan J, Zhao Y. Analysis of doctor–patient communication barriers in China. Chin Med Ethics. 2018;31(7):845–850.

    34. Li M, Li H, Zhang J, et al. Analysis of positivity and its influencing factors in young and middle-aged postoperative breast cancer patients. J Nurs. 2024;39(1):52–55.

    35. Liu C, Chen L, Chen C, et al. Latent profile analysis of fertility-related anxiety characteristics and nursing strategies in young female breast cancer patients. Zhonghua Hu Li Za Zhi. 2023;58(16):1989–1995.

    36. Lu T, Chen S, Ying Y, Xu Y. Research progress on factors influencing sleep disorders in postoperative breast cancer patients undergoing chemotherapy. Evid Based Nurs. 2023;9(22):4036–4041.

    37. Li R, Luo F. Research progress on sleep disorders in breast cancer patients undergoing chemotherapy. Mod Med Health. 2023;39(11):1893–1900.

    38. Ku M, Zhou Q, Zhou J, Wu H. Status and influencing factors of alexithymia among empty-nest elderly in the community. J PLA Nurs. 2020;37(4):19–22.

    39. Zhao W, Li L, Zhang M, Bai X, Li X. Psychological distress and its related factors of psychological inflexibility in breast cancer patients during postoperative chemotherapy. J Nurs. 2020;35(13):65–68.

    40. Wang Z, Zhang X, Ding Y, Yu X, Wang T. Concept analysis of family resilience in adult cancer patients. J Nurs. 2021;36(19):12–15.

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  • Emily Ratajkowski Puts a Sexy Spin on Adam Sandler-Core

    Emily Ratajkowski Puts a Sexy Spin on Adam Sandler-Core

    For Adam Sandler, there is no event formal enough to keep him from wearing basketball shorts: the 2025 Academy Awards, film premieres, and, naturally, the court. While, contrary to popular belief, they aren’t the only bottoms he owns (he also wears track pants), Sandler has become inextricably linked to baggy athletic gear.

    Yesterday, Emily Ratajkowski offered her interpretation of Sandler’s uniform while taking her dog Colombo for a stroll in New York City, donning a pair of burgundy Nike basketball shorts with white stripes, worn low-slung across her hips.

    Christopher Peterson / SplashNews.com

    EmRata gave the look a sexy spin, styling her oversized, knee-length shorts with a cropped black tube top that showed off her midriff, and a pair of woven ballet flats from Mango. And while Sandler is more partial to aviators and wraparounds, the model accessorized with a pair of green-framed rectangular sunglasses. She finished off her look with a vintage Prada bowling bag.

    While we know Emily Ratajkowski would look good in anything, nailing Adam Sandler’s signature look is a feat.

    Image may contain Adam Sandler Madge Gill Slash People Person Clothing Footwear Shoe Crowd Adult and Child

    Adam Sandler at the 2025 Academy Awards.

    PATRICK T. FALLON/Getty Images

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  • Earth is accumulating more heat than scientists predicted — the rate has doubled in 20 years • Mezha.Media

    Earth is accumulating more heat than scientists predicted — the rate has doubled in 20 years • Mezha.Media

    The Earth’s atmosphere is now trapping far more heat than climate models predicted. This energy imbalance has doubled since 2005, from 0.6 to 1.3 watts per square meter, according to researchers from Australia, France and Sweden. The Conversation reports.

    Scientists believe the acceleration is due to the accumulation of greenhouse gases and changes in cloud cover. In particular, the area of white reflective clouds has decreased, while darker ones have increased. This weakens the planet’s ability to reflect the sun’s heat back into space.

    Most of the additional energy (up to 90%) is absorbed by the oceans, but there is also melting of glaciers and warming of land. This accumulation of heat has already raised the average temperature of the Earth by 1.3–1.5°C compared to the pre-industrial period.

    The authors emphasize that real changes are happening faster than the models predict. If the trend continues, the world could face increased heat waves, droughts and storms. What is particularly worrying is that only models with high sensitivity to emissions come close to the recorded values – they predict more severe warming in the future.

    An additional threat is a possible reduction in funding for satellite climate monitoring in the United States, a key tool that allows us to capture such changes at an early stage.

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  • Gedatolisib Displays Early Efficacy in mCRPC and Pretreated HER2+ Breast Cancer

    Gedatolisib Displays Early Efficacy in mCRPC and Pretreated HER2+ Breast Cancer

    Image Credit: © Axel Kock – stock.adobe.com

    Treatment with the pan-PI3K and mTORC1/2 inhibitor gedatolisib (PF-05212384) generated clinical activity in patients with metastatic castration-resistant prostate cancer (mCRPC) and patients with metastatic HER2-positive breast cancer, according to data from 2 separate clinical trials evaluating the agent.1

    Findings from the phase 1 portion of a phase 1/2 trial (NCT06190899) showed that patients with mCRPC (n = 36) treated with darolutamide (Nubeqa) in combination with gedatolisib at 120 mg (cohort 1) or 180 mg (cohort 2) experienced a 6-month radiographic progression-free survival (rPFS) rate of 66%. In this study, treatment-related adverse effects (TRAEs) did not lead to treatment discontinuation in any patients, and no patients required dose reductions of either agent due to TRAEs. No instances of grade 3 hyperglycemia were reported, and patients experienced grade 2/3 stomatitis at a rate of 10.5%.

    “We are very encouraged by this preliminary efficacy and safety data,” Igor Gorbatchevsky, MD, chief medical officer of Celcuity, stated in a news release “The 66% 6-month rPFS rate for this novel combination therapy compares favorably to published data for androgen receptor inhibitors in this setting. With no treatment-related discontinuations and less than 3% of patients experiencing grade 3 stomatitis, we believe it is important to explore additional dose options for gedatolisib. Available gedatolisib pharmacokinetic data from other clinical trials in solid tumors suggests a relationship between efficacy and dose levels. Since this preliminary data indicates that the optimal gedatolisib dose for patients with mCRPC may not yet have been reached, the company amended the clinical trial protocol to enable exploration of additional doses in the phase 1/1b portion of this clinical trial to determine the recommended phase 2 dose.”

    In a phase 2 study (NCT03698383), patients with pretreated, metastatic HER2-positive breast cancer harboring PIK3CA mutations (n = 44) administered the combination of gedatolisib and trastuzumab-pkrb (Herzuma) experienced an overall response rate (ORR) of 43% and a median PFS of 6.0 months (95% CI, 5.0-7.7). The median overall survival (OS) was 24.7 months (95% CI, 17.3-not applicable). Grade 3 hyperglycemia occurred in 1 patient (2.3%), and no patients discontinued gedatolisib due to TRAEs.

    “The 43% ORR reported in patients who received at least 3 prior lines of anti-HER2 treatment for their disease is very encouraging and compares favorably to published data for other available therapies in this group of patients,” Gorbatchevsky stated. “The regimen was well tolerated, and no patients discontinued gedatolisib due to treatment-related AEs. While additional clinical studies are needed, this data suggests gedatolisib in combination with HER2 targeted therapy may be an effective and well tolerated therapeutic option for patients with HER2-positive metastatic breast cancer.”

    mCRPC Trial Background

    The phase 1/2 study is enrolling patients at least 18 years of age with histologically or cytologically confirmed adenocarcinoma of the prostate without a small cell component that is comprised of less than 10% neuroendocrine-type cells.2 Patients need to have progressive mCRPC with prior treatment with a next-generation androgen receptor signaling inhibitor in the metastatic setting. An ECOG performance status of 0 or 1, along with adequate bone marrow, hepatic, renal and coagulation function, is also required.

    In phase 1, patients are receiving gedatolisib at 120 mg or 180 mg once per week for 3 weeks on and 1 week off in combination with darolutamide at 600 mg per day in 28-day cycles. Phase 2 will evaluate the recommended dose of gedatolisib in combination with the same darolutamide regimen. Safety and determining the recommended phase 2 dose are the primary end points of phase 1. The primary end point of phase 2 is rPFS.

    HER2-Positive Breast Cancer Trial Info

    This phase 2 study enrolled patients at least 19 years of age with histologically or cytologically confirmed diagnosis of HER2-positive breast cancer with suspected PI3K pathway dependence.3 At least 2 HER-2 directed therapies, including trastuzumab (Herceptin) in the metastatic setting, was required. Patients also needed to have at least 1 measurable lesion per RECIST 1.1 criteria, an ECOG performance status of 0 to 1, and adequate bone marrow and organ function.

    All enrolled patients received trastuzumab-pkrb at 6 mg/kg on day 1 of each 21-day cycle following a loading dose of 8mg/kg in cycle 1 in combination with gedatolisib at 180 mg on days 1, 8, and 15 of every 21-day cycle.

    ORR was the trial’s primary end point. Secondary end points included PFS and OS.

    References

    1. Celcuity reports clinical data from two early phase studies of gedatolisib. News release. Celcuity. June 30, 2025. Accessed June 30, 2025. https://ir.celcuity.com/press-releases/?qmodStoryID=5588407709789214
    2. Gedatolisib in combination with darolutamide in metastatic castration-resistant prostate cancer. ClinicalTrials.gov. Updated March 21, 2025. Accessed June 30, 2025. https://clinicaltrials.gov/study/NCT06190899
    3. Phase II study of Herzuma plus gedatolisib in patients with HER-2 positive metastatic breast cancer. ClinicalTrials.gov. Updated February 18, 2021. Accessed June 30, 2025. https://clinicaltrials.gov/study/NCT03698383

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  • Study shows the evolution of biomass over 500 million years

    Study shows the evolution of biomass over 500 million years

    Ecosystems aren’t just defined by what species exist, but by how much life they contain. While scientists understand species diversity and where marine life is most abundant today, we still lack a clear picture of how biomass, the total weight of living organisms, has changed over time.

    Biomass reveals the real impact and energy flow of life in an ecosystem, like knowing not just the cast of a play, but who the lead actors are and how powerful their performances can be. It’s a vital clue to understanding an ecosystem’s true strength and health across deep time.

    While scientists have long known that biodiversity has increased throughout Earth’s history, a new Stanford study adds a key piece: biomass, or the total amount of ocean life, has also mostly grown over the last 500 million years.

    Despite some dips during mass extinction events, the overall trend is upward, just like biodiversity. This suggests a powerful link: as life became more diverse, it also became more abundant, filling the oceans with both variety and volume.

    Scientists uncover massive, diverse ecosystem deep beneath Earth’s surface

    Imagine if ancient seas left behind a diary, not in words, but in shells and skeletons. That’s exactly what the team is decoding. Researchers studied thousands of rock samples packed with the fossilized remains of marine organisms, shells, algae, and tiny protists. These fossils recorded the biomass of their time, that is, the total “living material” preserved across Earth’s history.

    Why does it matter?

    Biomass reveals how much life an ecosystem could support, and how much energy it moves around, making it a key sign of past ocean health.

    Although it once seemed too complex to measure across deep time, researchers took on the challenge. They analyzed over 7,700 limestone samples spanning 540 million years, using a method called petrographic point-counting to examine the amount of fossilized shell material.

    By combining decades of studies with new data, they created a clearer picture of how life in Earth’s oceans has ebbed and flowed through deep history.

    Some sea life could face extinction over the next century

    They found that in the Cambrian Period, fewer than 10% of rocks had shell material. As life diversified during the Ordovician, that percentage rose, evidence of the Cambrian Explosion.

    Calcifying sponges were among the early biomass leaders but were soon overtaken by echinoderms (like early starfish) and marine arthropods (like trilobites and crab ancestors).

    Over the past 230 million years, oceans saw dramatic rises and falls in life, recorded in the shell content of marine rocks. Shell material stayed above 20%, signaling healthy ocean life, until the Late Devonian extinction (~375–360 million years ago) caused a notable drop.

    Then came the worst: the Great Dying (~250 million years ago), the Permian-Triassic extinction, when shell content plunged to just 3%, reflecting a massive collapse in marine life.

    Even after major extinctions like the end-Triassic and the one that ended the dinosaurs, marine life bounced back. In today’s era, the Cenozoic, shell remains now make up over 40% of marine rocks, largely due to mollusks and corals thriving.

    To be sure, this rise reflected real increases in ocean life, not just fewer shell-destroying predators or sampling bias, researchers ran thorough tests. They analyzed fossil samples across shallow and deep waters, various latitudes, and different ancient continental setups.

    Animal poop helps ecosystems adapt to climate change, study

    The result? The trend held strong across the board, showing that the growth in shell content truly reflects a long-term rise in ocean biomass.

    As ocean organisms became more specialized, they got better at using energy and nutrients, boosting ecosystem productivity. This efficient recycling from phytoplankton to decomposers helped support more life, reflected in greater biomass.

    But today, human impacts like pollution, overfishing, and climate change threaten that balance. Scientists warn we may be entering a sixth mass extinction, where shrinking biodiversity could reduce biomass, and future fossil records might carry the traces of this decline.

    Jonathan Payne, Dorrell William Kirby Professor of Earth and Planetary Sciences, said, “Our findings show that overall biomass is linked to biodiversity and that losses in biodiversity may suppress productivity for geologically meaningful intervals, adding one more argument for why conserving biodiversity is essential for the health of humans and our planet.”

    Journal Reference:

    1. Pulkit Singh, Jordan Ferré, Bridget Thrasher, et al. Macroevolutionary coupling of marine biomass and biodiversity across the Phanerozoic. Current Biology. DOI: 10.1016/j.cub.2025.06.006

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  • WTC Final sets new live broadcast and digital records  | ICC World Test Championship Final, 2025

    WTC Final sets new live broadcast and digital records  | ICC World Test Championship Final, 2025

    Jay Shah, Chairman of the ICC, reflected that these encouraging numbers were a testament to the continued popularity of the most traditional format of the game.

    “The remarkable viewership numbers for the ICC World Test Championship Final, across both broadcast and digital platforms, are a powerful testament to the appeal of high-quality Test cricket and the elevated context of the WTC Final. This format continues to command a loyal and passionate global following and remains an integral part of our sport’s identity.

    “What makes this success even more special is the enthusiasm shown by fans in regions beyond the two competing nations, reaffirming that cricket’s reach is truly international, and that the purest form of the game can thrive beyond national affiliations.

    “A special mention to JioStar, whose innovative and immersive coverage, captured the drama, emotion, and atmosphere of the ‘Ultimate Test’ in a way that deeply resonated with audiences around the world.”

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  • Bemarituzumab Plus Chemo Improves OS in FGFR2b+ Gastric Cancer

    Bemarituzumab Plus Chemo Improves OS in FGFR2b+ Gastric Cancer

    Gastric cancer cells: © LASZLO – stock.adobe.com

    First-line treatment with bemarituzumab plus chemotherapy (mFOLFOX6) demonstrated a statistically significant and clinically meaningful improvement in overall survival (OS) vs placebo plus chemotherapy in patients with unresectable locally advanced or metastatic gastric or gastroesophageal junction (G/GEJ) cancer with FGFR2b overexpression and who are non-HER2 positive, according to findings from the phase 3 FORTITUDE-101 trial (NCT05052801).1

    In the study, FGFR2b overexpression was defined as 2+/3+ staining in ≥10% of tumor cells by centrally performed immunohistochemistry testing. With this, the primary end point of the phase 3 FORTITUDE-101 trial (NCT05052801) was met at its prespecified interim analysis.

    Looking at safety, the most frequently reported treatment-emergent adverse events (TEAEs) occurring in more than 25% of patients receiving the bemarituzumab plus chemotherapy regimen included decreased visual acuity, punctate keratitis, anemia, neutropenia, nausea, corneal epithelial defects, and dry eye. Ocular toxicities, which were consistent with findings from the phase 2 trial, occurred in both treatment arms but were notably more frequent and more severe in the bemarituzumab arm of the phase 3 study.

    Full results from the trial will be presented at a future medical meeting.

    “Most patients with gastric cancer are diagnosed at an advanced stage, with poor prognosis, low survival rates, and limited therapeutic options,” said Jay Bradner, MD, executive vice president of research and development at Amgen, in a press release. “These first positive topline results of an FGFR2b targeted monoclonal antibody from our phase 3 FORTITUDE-101 study mark a meaningful advance in the development of effective targeted therapy for gastric cancer.”

    The randomized, multicenter, double-blind, placebo-controlled, phase 3 FORTITUDE-101 trial evaluated bemarituzumab plus mFOLFOX6 vs placebo plus mFOLFOX6 as first-line therapy in 547 patients with advanced G/GEJ cancer with FGFR2b overexpression. The FORTITUDE-101 trial included 300 sites across 37 countries.

    Enrollment was open to patients with histologically documented unresectable, locally advanced/metastatic G/GEJ cancer not amenable to curative therapy who had FGFR2b overexpression. Patients were required to have an ECOG performance status of 1 or less; measurable disease or nonmeasurable but evaluable disease, according to RECIST v1.1; no contraindications to mFOLFOX6 chemotherapy; and adequate organ and bone marrow function.2

    The primary end point of the study is OS, and secondary end points include progression-free survival, overall response rate, number of patients who experience a TEAE, duration of response, disease control rate, pharmacokinetics.

    In addition to FORTITUDE-101, a phase 3 trial (NCT05111626) is currently evaluating bemarituzumab plus chemotherapy and nivolumab (Opdivo) in patients with first-line gastric cancer. Data from this study are expected to read out in the second half of 2025.

    REFERENCES:
    1. Amgen announces positive topline phase 3 results for bemarituzumab in fibroblast growth factor receptor 2b (FGFR2B) positive first-line gastric cancer. News release. Amgen. June 30, 2025. Accessed June 30, 2025. https://tinyurl.com/2vck8tjj
    2. Bemarituzumab or placebo plus chemotherapy in gastric cancers with fibroblast growth factor receptor 2b (FGFR2b) overexpression (FORTITUDE-101). News release. February 7, 2025. Accessed June 30, 2025. https://clinicaltrials.gov/study/NCT05052801

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