Phase II study of liposomal doxorubicin, docetaxel and trastuzumab in combination with metformin as neoadjuvant therapy for HER2-positive breast cancer

Background:The aim of this study was to improve activity over single human epidermal growth factor receptor 2 (HER2)-blockade sequential neaodjuvant regimens for HER2-positive breast cancer, by exploiting the concomitant administration of trastuzumab, taxane and anthracycline, while restraining cardiac toxicity with use of liposomal doxorubicin, and by adding metformin, based on preliminary evidence of antitumor activity.Patients and methods:This multi-center, single-arm, two-stage phase II trial, assessed the safety and the activity of a new treatment regimen for HER2-positive, early or locally advanced breast cancer. Patients received six 21-day cycles of non-pegylated liposomal doxorubicin, 50 mg/m(2) intravenously (i.v.) on day 1, docetaxel, 30 mg/m(2) i.v. on days 2 and 9, trastuzumab, 2 mg/kg/week i.v. on days 2, 9, and 16 (with 4 mg/kg loading dose), in association with metformin 1000 mg orally twice daily. The primary endpoint was the rate of pathological complete response (pCR) in the breast and axilla (ypT0/is ypN0). A subgroup of patients performed a 3-deoxy-3-18F-fluorothymidine positron emission tomography (FLT-PET) at baseline and after one cycle.Results:Among 47 evaluable patients, there were 18 pCR [38.3%, 95% confidence interval (CI) 24.5-53.6%]. A negative estrogen-receptor status, high Ki67, and histological grade 3 were related with pCR, although only grade reached statistical significance. FLT-PET maximum standardized uptake value after one cycle was inversely related to pCR in the breast (odds ratio 0.29, 95% CI 0.06-1.30, p = 0.11). Toxicity included grade 3-4 neutropenia in 70% and febrile neutropenia in 4% of patients, grade 1-2 nausea/vomiting in 60%/38%, and grade 3 in 4%/2%, respectively, grade 1-2 diarrhea in 72%, and grade 3 in 6%. There were two cases of reversible grade 2 left-ventricular ejection-fraction decrease, and one case of sharp troponin-T increase.Conclusions:The concomitant administration of trastuzumab, liposomal doxorubicin, docetaxel, and metformin is safe and shows good activity, but does not appear to improve activity over conventional sequential regimens

Studio radioisotopico nella patologia bollosa

Nelle patologie bollose polmonari la medicina nucleare è in grado di offrire informazioni riguardanti sia la distribuzione del flusso ematico polmonare, sia la ventilazione alveolare utilizzando uno studio combinato: la scintigrafia ventilo/perfusoria. La PET-TC con 18F-FDG può dare importanti notizie nel caso in cui, durante il follow-up, la patologia bollosa si complica con la comparsa di un'area di addensamento che potrebbe essere indice di presenza di lesione maligna. La PET-TC, grazie alla possibilità di indagare i processi metabolici, è diventata un mezzo essenziale nel differenziare le lesioni maligne da quelle di altra natura

99mTc-HMPAO Labelled autologous granulocytes scintigraphy in Crohn’s disease

99mTc-HMPAO labelled granulocytes scintigraphy can accurately assess Crohn's disease extent, its severity and relapses, and providing a non-invasive alternative technique to colonoscopy and radiological investigations

Sensitivity and specificity of scintimammography versus magnetic resonance imaging: a comparison in 58 patients with breast lesions using histology as a gold standard

In our study the MRI and scintimammography sensitivity resulted to be superimposable, whereas specificity is greatly in favour of scintimammography: thus, we believe that in the specific clinical conditions, such as in dense breast and in multifocal breast cancer, scintimammography colud be a great help

Peripheral Quantitative Computer Tomography (pQCT), Broad Band Ultrasound Attenuation (BUA) and Speed of Sound (SOS) in a population of normal females aged from 8 to 20 years

The sexual growth influences the position of bone density peak. The results obtained show a statistically significative correlation between BUA and BMD versus age, the menarche-age, and the period of exposure of bone-tissue to the oestrogen. After all, pQCT and ultrasound are useful techniques to evaluate bone density and structure also in a growing population. The results of this study show the possibility to use bidimensional quantitative ultrasound devices in clinical practice also in young population taking in account age and sexual development

Peripheral Quantitative Computer Tomography (pQCT), Broad Band Ultrasound Attenuation (BUA) and Speed of Sound (SOS) in a population of normal females aged from 8 to 20 years

The sexual growth influences the position of bone density peak. The results obtained show a statistically significative correlation between BUA and BMD versus age, the menarche-age, and the period of exposure of bone-tissue to the oestrogen. After all, pQCT and ultrasound are useful techniques to evaluate bone density and structure also in a growing population. The results of this study show the possibility to use bidimensional quantitative ultrasound devices in clinical practice also in young population taking in account age and sexual development

PET features

18F-FDG PET-CT is a sensitive method for detecting, staging, and monitoring the effects of therapy of many tumors. In the evaluation of malignancy with 18F-FDG, a potential pitfall in the assessment of the anterior mediastinum is mistaking normal uptake within the thymus from disease such as adenopathy or local invasion by tumor. Thymic uptake was classified as "normal" on the basis of morphologic features, size, and contour at 18F-FDG PET. The standardized uptake value (SUV) to measure 18F-FDG uptake may be useful in evaluating the differentiation of thymic carcinoma from other thymic neoplasm, and hyperplasia

Splenosis: 99mTc-labelled colloids provide the diagnosis in splenectomised patients

The diagnosis of abdominal splenosis is usually made by surgical biopsy of an abdominal mass incidentally discovered on abdominal ultrasonography, computed tomography or magnetic resonance imaging. To avoid exploratory surgery, 99mTc-sulphur colloid scintigraphy may be used: this technique is the most specific, easily performable, and cost-effective tool for the diagnosis of splenosis