RESPONSE TO NEOADJUVANT THERAPY AND LONG-TERM OUTCOME IN PATIENTS WITH TRIPLE NEGATIVE BREAST CANCER

Background. Triple negative breast cancer (TNBC) is defined by thelack of estrogen receptors (ER), progesterone receptors (PR) and humanepidermal growth factor receptor 2 (HER-2) expression. In this study weinvestigated response to neoadjuvant chemotherapy in TNBC patients and itsimpact on disease free (DFS) and overall survival (OS).Patients and methods. We identified 134 patients with stage I-III TNBCtreated at Riga East University Hospital between 2009-2012. 48 patients withTNBC received neoadjuvant chemotherapy. Correlation of clinical andpathological parameters with pathologic complete response (pCR) rate,disease-free and overall survival measurements and organ specific relapserates were analysed.Results. 48 patients with stage IIB-IIIC TNBC were included, 17 patientsreceived anthracycline based, 31 patients anthracycline and taxane basedneoadjuvant chemotherapy. 8 patients (16%) had pCR, 38 patients hadincomplete response, 2 patients had disease progression during neoadjuvantchemotherapy. pCR correlates with primary tumor size, but not with otherclinical and pathological factors. At a median follow-up of 30 months, 100%patients who reached pCR were disease-free versus 55% in those withoutpCR (p=0.017). Overall survival was 100% in patients who had pCR versus50% in those without pCR (p=0.020). 2 patients are alive after diseaserecurrence, 20 patients died. The most common sites of disease recurrencewere brain, lung and liver.Conclusions. Patients with TNBC who have a pCR in the breast and axillarynodes have a significantly improved disease-free and overall survival ratecompared with patients with residual disease after neoadjuvantchemotherapy

Metastatic breast cancer in patient with clinical neurofibromatosis type 1

Patients with neurofibromathosis have a high risk of associated cancers and specialized cancer screening guidelines1. However for most of these cancer types early detection methods currently do not exist. For some cancer types, such as breast cancer, where screening is available, it is important to note that this patient group has increased risk of breast cancer and may present at an earlier age than general population.Here, we describe a case of 48-year-old female with clinical diagnosis of neurofibromathosis type 1, who presented with skin color changes, itching and induration in left breast between multiple skin neurofibromas. She was diagnosed with stage IV HER2 positive breast cancer with hepatic and bilateral axillary lymph node metastasis, treated with chemotherapy and anti-HER2 antibodies. CT scan also described structural lung parenchyma alterations and scoliosis.The aim of this case study is to emphasize the need of neurofibromathosis patient education in encouraging them to seek advice as soon as new symptoms appear and to prompt medical providers to use additional caution in this patient group

How do international gastric cancer prevention guidelines influence clinical practice globally?

Q3Q1Clinical guidelines recommend particular approaches, including ‘screen-and-treat’ strategy for Helicobacter pylori, to prevent gastric cancer. However, little of this is implemented in clinical practice. The aim of the study was to identify barriers to implementation of international guidelines. A web-based questionnaire distributed globally to specialists in the field. Altogether 886 responses from 75 countries were received. Of the responders, 570 (64%) were men of mean age 47 years. There were 606 gastroenterologists and 65 epidemiologists among the responders. Altogether, 79.8% of the responders disagreed that the burden of gastric cancer is a diminishing problem. ‘Screen-and-treat’ strategy for H. pylori in the responder’s country was considered appropriate by 44.4%, inappropriate by 24.3%, with 31.3% being uncertain. Population-based screening for gastric cancer was considered appropriate in the respective home-country by 62.2%, in other areas – but not the home country – by 27.6%, and inappropriate by 10.2%. As a screening tool, upper endoscopy was acceptable by 35.6%, upper X-ray series by 55.3%, pepsinogens by 26.2% and breath-tests by 23.4%; accuracy, cost-effectiveness and feasibility among the tests varied widely. The attitude towards H. pylori vaccination was that 4.6% of the responders were eager to start vaccination immediately, 55.9% were supporting vaccination but considered that more data are required 12% were negative, and 27.6% did not have an opinion. In general, the attitude of the specialists was in line with guidelines, but was not always translated into clinical practice, particularly in the case of ‘screen-and-treat’ strategy.https://scholar.google.com/citations?user=xFiKCkMAAAAJ&hl=eshttp://scienti.colciencias.gov.co:8081/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000264474Revista Nacional - Indexad

Management Strategies for Hyperglycemia Associated with the α-Selective PI3K Inhibitor Alpelisib for the Treatment of Breast Cancer

Alpelisib is an α-selective phosphatidylinositol 3-kinase inhibitor used for treating hormone receptor-positive (HR+), human epidermal growth receptor 2-negative (HER2–), PIK3CA-mutated locally advanced or metastatic breast cancer following disease progression on or after endocrine therapy. Hyperglycemia is an on-target effect of alpelisib affecting approximately 60% of treated patients, and sometimes necessitating dose reductions, treatment interruptions, or discontinuation of alpelisib. Early detection of hyperglycemia and timely intervention have a key role in achieving optimal glycemic control and maintaining alpelisib dose intensity to optimize the benefit of this drug. A glycemic support program implemented by an endocrinology–oncology collaborative team may be very useful in this regard. Lifestyle modifications, mainly comprising a reduced-carbohydrate diet, and a designated stepwise, personalized antihyperglycemic regimen, based on metformin, sodium–glucose co-transporter 2 inhibitors, and pioglitazone, are the main tools required to address the insulin-resistant hyperglycemia induced by alpelisib. In this report, based on the consensus of 14 oncologists and seven endocrinologists, we provide guidance for hyperglycemia management strategies before, during, and after alpelisib therapy for HR+, HER2–, PIK3CA-mutated breast cancer, with a focus on a proactive, multidisciplinary approach

Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer

BACKGROUND Among patients with resectable early-stage non-small-cell lung cancer (NSCLC), a perioperative approach that includes both neoadjuvant and adjuvant immune checkpoint inhibition may provide benefit beyond either approach alone.METHODS We conducted a randomized, double-blind, phase 3 trial to evaluate perioperative pembrolizumab in patients with early-stage NSCLC. Participants with resectable stage II, IIIA, or IIIB (N2 stage) NSCLC were assigned in a 1:1 ratio to receive neoadjuvant pembrolizumab (200 mg) or placebo once every 3 weeks, each of which was given with cisplatin-based chemotherapy for 4 cycles, followed by surgery and adjuvant pembrolizumab (200 mg) or placebo once every 3 weeks for up to 13 cycles. The dual primary end points were event-free survival (the time from randomization to the first occurrence of local progression that precluded the planned surgery, unresectable tumor, progression or recurrence, or death) and overall survival. Secondary end points included major pathological response, pathological complete response, and safety.RESULTS A total of 397 participants were assigned to the pembrolizumab group, and 400 to the placebo group. At the prespecified first interim analysis, the median follow-up was 25.2 months. Event-free survival at 24 months was 62.4% in the pembrolizumab group and 40.6% in the placebo group (hazard ratio for progression, recurrence, or death, 0.58; 95% confidence interval [CI], 0.46 to 0.72; P<0.001). The estimated 24-month overall survival was 80.9% in the pembrolizumab group and 77.6% in the placebo group (P = 0.02, which did not meet the significance criterion). A major pathological response occurred in 30.2% of the participants in the pembrolizumab group and in 11.0% of those in the placebo group (difference, 19.2 percentage points; 95% CI, 13.9 to 24.7; P<0.0001; threshold, P = 0.0001), and a pathological complete response occurred in 18.1% and 4.0%, respectively (difference, 14.2 percentage points; 95% CI, 10.1 to 18.7; P<0.0001; threshold, P = 0.0001). Across all treatment phases, 44.9% of the participants in the pembrolizumab group and 37.3% of those in the placebo group had treatment-related adverse events of grade 3 or higher, including 1.0% and 0.8%, respectively, who had grade 5 events.CONCLUSIONS Among patients with resectable, early-stage NSCLC, neoadjuvant pembrolizumab plus chemotherapy followed by resection and adjuvant pembrolizumab significantly improved event-free survival, major pathological response, and pathological complete response as compared with neoadjuvant chemotherapy alone followed by surgery. Overall survival did not differ significantly between the groups in this analysis