Sustained complete remission of human epidermal growth factor receptor 2-positive metastatic breast cancer in the liver during long-term trastuzumab (Herceptin) maintenance therapy in a woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>This case report and short review discusses how long trastuzumab should be continued in metastatic breast cancer, the safety issues in case of pregnancy and the risk of relapse with trastuzumab cessation.</p> <p>Case presentation</p> <p>We present the case of a 34-year-old Caucasian woman with human epidermal growth factor receptor 2-positive metastatic breast cancer in the liver who achieved prolonged complete remission within six months of receiving trastuzumab (Herceptin) in combination with vinorelbine and gemcitabine. The patient remains in complete remission seven years later and continues to receive trastuzumab as maintenance therapy.</p> <p>Conclusion</p> <p>Trastuzumab-based therapies have greatly improved the survival rates of patients with human epidermal growth factor receptor 2- positive metastatic breast cancer. Despite such improvements, the safety of trastuzumab administration during pregnancy is yet to be defined.</p

Pancreatic adenocarcinoma-associated polymyositis treated with corticosteroids along with cancer specific treatment: case report

<p>Abstract</p> <p>Background</p> <p>Adenocarcinoma of the pancreas only rarely is associated with inflammatory myopathy. In this setting, polymyositis may be treated with glucocorticoids in combination with cancer specific treatment.</p> <p>Case presentation</p> <p>We present the case of a 52-year-old man with stage IIA pancreatic tail adenocarcinoma who underwent surgical treatment and six months into therapy with gemcitabine he developed symmetrical, painful, proximal muscle weakness with peripheral oedema. Re-evaluation with imaging modalities, muscle histology and biochemistry conferred the diagnosis of polymyositis associated with pancreatic cancer progression. The patient was treated with glucocorticoids along with gemcitabine and erlotinib which resulted in complete remission within six months. He remained in good health for a further six months on erlotinib maintenance therapy when a new computer tomography scan showed pancreatic cancer relapse and hence prompted 2^ndline chemotherapy with gemcitabine.</p> <p>Conclusions</p> <p>Polymyositis associated with pancreatic cancer may respond to glucocorticoids along with cancer specific treatment.</p

Survival in patients with stage IV noncardia gastric cancer - the influence of DNA ploidy and Helicobacter Pyloriinfection

BACKGROUND: Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit. METHODS: The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti- Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis. RESULTS: The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60–70 vs. 90–100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p < 0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. >3.6 HR 3.059; CI 2.185-4.283, p < 0.001 and <2.2 vs. >3.6 HR; 4.207 CI 2.751-6.433 <0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis. CONCLUSION: Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients

Μελέτη DNA πλοειδικότητας σε μεταστατικό καρκίνο του στομάχου και συσχέτιση με λοιπούς προγνωστικούς παράγοντες

Background: Most patients with gastric cancer present with locally advanced or metastatic disease on diagnosis, despite the availability of advanced imaging techniques. For patients with unresectable disease at time of diagnosis and for those whose disease recurs after primary therapy, gastric cancer is incurable and therapy is palliative. The aim of this study was to investigate possible prognostic factors of survival in such patients.Methods: 311 such patients were studied retrospectively. 20 potential prognostic variables such as demographics, clinical parameters, biochemical markers, treatment modality and DNA ploidy index were examined. Results: On multivariate analysis favorable factors of response to chemotherapy were: younger age, lymph node metastases, absence of liver metastases, good performance status, normal CA19.9, LDH, albumin values and a low DNA ploidy index. Unfavorable factors that influenced survival increasing the risk of death were: liver metastases, local recurrence, abdominal and peritoneal metastases, poor performance status, increased CA19.9 and LDH values, blood transfusion, weight loss >10% and a high DNA ploidy index. Factors that unfavorably influenced both response to chemotherapy and survival were presence of liver metastases, poor performance status, increased LDH and CA19.9 values and a high DNA ploidy index.Conclusion: We defined factors that are related to the outcome in patients with metastatic, unresectable gastric cancer undergoing chemotherapy. We conclude that in the above setting the main factors that may improve survival and response to therapy are normal LDH and CA19.9 values, absence of liver metastases, good performance status and a low DNA ploidy index.ΣΚΟΠΟΣ Οι περισσότεροι ασθενείς με αδενοκαρκίνωμα στομάχου κατά τη στιγμή της διάγνωσης έχουν τοπικά προχωρημένη ή μεταστατική νόσο, παρά τις προηγμένες διαγνωστικές μεθόδους. Στους ασθενείς με ανεγχείρητη νόσο κατά τη διάγνωση και σε εκείνους που η νόσος υποτροπιάζει μετά από πρωτογενή θεραπεία, η νόσος θεωρείται μη ιάσιμη και η θεραπεία είναι παρηγορητική. Ο σκοπός της παρούσας μελέτης είναι η διερεύνηση πιθανών προγνωστικών παραγόντων επιβίωσης σε αυτούς τους ασθενείς.ΑΣΘΕΝΕΙΣ ΚΑΙ ΜΕΘΟΔΟΙ Μελετήθηκαν αναδρομικά 311 ασθενείς σε υλικό αρχείου και εξετάστηκαν 20 προγνωστικές παράμετροι (δημογραφικές και κλινικές παράμετροι, βιοχημικοί δείκτες, θεραπευτικές μέθοδοι και η DNA πλοειδικότητα). ΑΠΟΤΕΛΕΣΜΑΤΑ Σε πολυπαραγοντική ανάλυση οι παράμετροι που ευνοούσαν την ανταπόκριση στη θεραπεία ήταν η μικρή ηλικία, οι λεμφαδενικές μεταστάσεις, η απουσία ηπατικών μεταστάσεων, η καλή γενική σωματική κατάσταση (Performance status), τα φυσιολογικά επίπεδα CA19.9, LDH και αλβουμίνης και ο χαμηλός δείκτης DNA πλοειδικότητας. Παράγοντες που επηρέαζαν δυσμενώς την επιβίωση ήταν οι ηπατικές μεταστάσεις, η τοπική υποτροπή, οι κοιλιακές και περιτοναϊκές μεταστάσεις, το μειωμένο Performance Status, τα αυξημένα επίπεδα CA19.9 και LDH, η μετάγγιση αίματος, η απώλεια βάρους >10% και ο υψηλός δείκτης DNA πλοειδικότητας. Οι παράμετροι που επηρέαζαν δυσμενώς τόσο την ανταπόκριση στη θεραπεία όσο και την επιβίωση ήταν η ύπαρξη ηπατικών μεταστάσεων, το μειωμένο Performance Status, τα υψηλά επίπεδα του δείκτη CA19.9 και της LDH, καθώς και ο υψηλός δείκτης DNA πλοειδικότητας. Οι παράγοντες αυτοί σε συνδυασμό είναι στοιχεία πολύ προχωρημένης νόσου.ΣΥΜΠΕΡΑΣΜΑΤΑ Καθορίσαμε τους παράγοντες που σχετίζονται με την επιβίωση ασθενών με μεταστατικό, ανεγχείρητο καρκίνο του στομάχου υπό χημειοθεραπεία. Καταλήγουμε ότι οι σημαντικότεροι παράγοντες που ευνοούν την επιβίωση και την ανταπόκριση στη θεραπεία είναι τα φυσιολογικά επίπεδα LDH και CA19.9, η καλή γενική σωματική κατάσταση, η απουσία ηπατικών μεταστάσεων και ο χαμηλός δείκτης DNA πλοειδικότητας

Mucinous cystadenocarcinoma of the breast: the challenge of diagnosing a rare entity

Mucinous cystadenocarcinoma is an extremely rare variant of primary breast tumor which is histologically similar to mucinous cystadenocarcinoma of the ovary and pancreas. Herein we report a case of a 63 years old woman diagnosed with diverse histological types of non-synchronous rare primary breast tumors, a medullary carcinoma of the right breast and a mucinous cystadenocarcinoma of the left breast. Macroscopically the neoplasm appeared multilocular filled with mucoid material. Under light microscopy the cystic areas were lined by columnar cells with abundant intracellular and extracellular mucin. Solid areas were composed of tall columnar cells with intracellular mucin. Moderate to marked atypia was noticed and tumor cells stained positive for cytokeratin 7 and negative for cytokeratin 20. Moreover tumor cells displayed a basal like immunophenotype expressed as followed: ER negative, PR negative, HER-2 negative, cytokeratin (CK5/6) positive and EGFR positive

Cardiotoxicity of fluoropyrimidines in different schedules of administration: a prospective study

Background Cardiotoxicity associated with 5-Fluorouracil (5FU) administration has been infrequently reported in literature, albeit various series of acute coronary syndromes have recorded a low but definite incidence of the above toxicity. In the present study, patients undergoing 5FU-based and oral capecitabine (Xeloda (R))-based chemotherapy were tested for the potential development of cardiac-related symptoms during their administration. Patients and methods Six hundred and forty-four patients entered the study. Those experiencing any cardiac-related symptoms during 5FU infusion or oral capecitabine were subjected to ECG and serum cardiac enzymes determination. If cardiotoxicity was confirmed, 5FU infusion or oral capecitabine were interrupted, sublingual nitrates administered and cardiac monitoring initiated, while patients with &gt; two-fold enzyme elevation were followed in a coronary care unit for at least 72 h. Cases with acute myocardial infarction were excluded from further 5FU or oral capecitabine treatment. Results Overall 26 patients (4.03%) developed symptoms and/or ECG abnormalities due to 5FU and capecitabine. Patients with continuous 5FU infusion presented a higher incidence of cardiotoxicity [14/209; 6.7%, 95% confidence interval (CI) = 3.3-10.1%] than the remaining (7/317; 2.3%, 95% CI = 0.8-3.3%) (P &lt; 0.012). Specifically, an increased incidence of cardiac-related events was encountered in patients with continuous 24-h 5FU + LV infusion for 5 days (12.5%, 95% CI = 2.3-22.7%) rather than in patients with the same schedule without LV (5.3%, 95% CI = 1.95-8.67%) (P &lt; 0.027), as well as in patients with short 5FU + LV administration (2.4%, 95% CI = 0.9 3.9%) (P &lt; 0.019). Overall, 3/54 patients (5.5%, 95% CI = -0.6-11.1%) on oral capecitabine developed cardiac-related events. Seven out of the 20 patients suffered an acute myocardial infarction, 6 developed ischemia only, while 4 more patients had ECG consistent with coronary vasospasm and 3 with conduction disturbances, of which one subsequently died. Patients administered oral capecitabine had a similar incidence of cardiac-related events; 1/22 (4.5%) patients with advanced breast cancer and 2/32 (6.2%) with colorectal cancer. Conclusions The present study supports the toxic effect of 5-FU on the myocardium, which is largely schedule-dependent, whereas a low but finite risk of such toxicity has been observed with oral capecitabine. A high level of alertness is required when using fluoropyrimidines (i.v. 5FU or oral capecitabine), while their toxic effect on the coronary endothelium and myocardium merits further investigation

Distinct patterns of angiogenic factor expression as a predictive factor of response to chemotherapy in stage IIIA non-small-cell lung cancer patients.

The expression of various angiogenic factors was assessed in tumour samples of patients with stage III non-small-cell lung cancer (NSCLC) and further evaluated in terms of response to induction paclitaxel-ifosfamide-cisplatin chemotherapy. Freshly isolated lung tumour specimens obtained by bronchoscopy from 70 stage IIIA NSCLC chemotherapy-naïve patients were sampled and analysed for vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2 and VEGFR-3. Microvessel density was assessed through evaluating the angiogenic markers CD34 and CD105. Immunostaining scores were calculated by multiplying the percentage of labeled cells by the intensity of staining for each examined parameter. The overall mean immunostaining score value from all NSCLC samples was 7.83, 5.56 and 15.86 for VEGFR-1, VEGFR-2 and VEGFR-3, respectively. The overall mean value of the endothelial antigen CD34 was 16.29, whereas the expression of the CD105 antigen in endothelial cells yielded a multivariate distribution. Patients who responded to chemotherapy expressed significantly higher VEGFR-1 and VEGFR-3 mean values compared with non-responders (P&lt;0.001). No significant difference was noted in VEGFR-2 mean values between these two groups (P=0.06). The CD34 mean value was significantly higher in responders (P&lt;0.001), whereas there was no significant difference in CD105 expression between the two groups (P=0.07). Angiogenic marker expression proved to be a potential predictive factor of response to chemotherapy in stage III NSCLC. which merits further investigation

Survival in patients with stage IV noncardia gastric cancer - the influence of DNA ploidy and Helicobacter Pylori infection

Background: Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit. Methods: The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti-Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis. Results: The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60-70 vs. 90-100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p&lt;0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. &gt;3.6 HR 3.059; CI 2.185-4.283, p&lt;0.001 and &lt;2.2 vs. &gt;3.6 HR; 4.207 CI 2.751-6.433 &lt;0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis. Conclusion: Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients