Aortic dissection during antiangiogenic therapy with sunitinib. A case report

CONTEXT:Sunitinib is an antiangiogenic drug that has been approved for treating metastatic renal cancer. Its action as a tyrosine kinase inhibitor of vascular endothelial growth factor receptors (VEGFRs) and other angiogenesis receptors may lead to adverse effects such as hypertension and heart failure. However, reports in the literature on an association between sunitinib therapy and acute aortic dissection are rare.CASE REPORT:We report the case of a 68-year-old man with metastatic renal carcinoma who developed acute aortic dissection during sunitinib therapy. He had no history of hypertension or any other risk factor for aortic dissection. After aortic dissection had been diagnosed, sunitinib was withdrawn and an aortic endoprosthesis was placed. Afterwards, the patient was treated clinically with antihypertensive drugs and new therapy for renal cancer consisting of temsirolimus, an inhibitor of the mammalian target of rapamycin (mTOR) pathway.CONCLUSION:Hypertension is a common event when antiangiogenic drugs are used in oncology. However, knowledge of other severe cardiovascular events that may occur in these patients, such as acute aortic dissection, is important. Adequate control over arterial pressure and frequent monitoring of patients during the first days of antiangiogenic therapy is essential for early diagnosis of possible adverse events

Evaluation of the impact of chemotherapy on eating habits of women with non-metastatic breast cancer

Introduction: There are few studies that investigated the eating habits of patients with breast cancer undergoing chemotherapy. Objectives: To study the changes in dietary intake during chemotherapy, relating to sociodemographic variables, gastrointestinal side effects, and changes consumption in food groups. Material and Methods: This study was made at Clinical Oncology Department of A.C. Camargo Cancer Center, Sao Paulo, Brazil. We investigated weight, height and food intake as measured using the food frequency questionnaire (FFQ), before and after chemotherapy treatment alone with anthracyclines, with curative intent, for patients with non-metastatic breast cancer. Results: A total of 41 patients participated in the first phase of the study, and 26 completed the second phase. Milk and milk derivatives, beef stroganoff, liver, tuna and sardines, shrimp, papaya, fruit juices such as cashew, acerola (Barbados cherry, Malphighia punicifolia), vegetables with high fat content, and macaroni/pasta had increased consumption (p<0.05) during treatment. In contrast, lettuce and escarole were eaten less (p<0.05). Meat, fish, eggs, and sweets, savory snacks and decorated sweets with icing sugar were all subject to increased consumption (p<0.05). A loss of appetite was associated with meat, fish, and eggs; nausea was associated with bread, cereals, root vegetables and legumes consumption (p<0.05). These changes were not associated with an increase in body mass index, and there was no correlation with sociodemographic variables. Conclusion: Changes in patterns of food intake in patients on chemotherapy was found and deserve attention, as gain weight is related to disease relapse in breast cancer

Meningeal carcinomatosis in breast cancer: prognostic factors and outcome

Meningeal carcinomatosis (MC) occurs in up to 5% of breast cancer patients. Few studies have evaluated prognostic markers in breast cancer patients with MC. Our aim was to describe the treatment of breast cancer patients with MC, and identify prognostic factors related to survival. Sixty breast cancer patients that had a diagnosis of MC between January 2003 and December 2009 were included. The median age was 46 years (range 27-76). Most patients had invasive ductal carcinoma (78.3%) and high histological/nuclear grade (61.7/53.3%). Estrogen and progesterone receptors were positive in 51.7 and 43.3% of patients, respectively, and 15% were HER-2-positive. Symptoms at presentation were headache, cranial nerve dysfunction, seizures, and intracranial hypertension signals. Diagnosis was made by CSF cytology in 66.7% of cases and by MRI in 71.7%. Intrathecal (IT) chemotherapy was used in 68.3% of patients, and 21.6% received a new systemic treatment (chemo- or hormone therapy). Median survival was 3.3 months (range 0.03-90.4). There was no survival difference according to age, nuclear grade, hormonal and HER-2 status, CSF features, sites of metastasis, systemic and IT chemotherapy, or radiotherapy. However, histological grade and performance status had a significant impact on survival in the multivariate analysis. Only four papers have addressed prognostic factors in breast cancer patients with MC in the last two decades. The results of those reports are discussed here. High histological grade and poor performance status seem to impact survival of breast cancer patients with MC. Prospective studies are necessary to clarify the role of IT and systemic treatment in the treatment of those patients