Cancer treatment communications最新文献

The incidence of breast cancer brain metastasis (BCBM) is increasing due in part to improved management of systemic disease and prolonged survival. Despite this growing population of patients, there exists little consensus for the treatment of HER2-positive BCBM. Lapatinib, the only brain permeable targeted agent for HER2-positive cancer, has demonstrated limited intracranial response rates and little improvement in progression free survival (PFS) for HER-2 positive patients. Size constraints are believed to prevent larger monoclonal antibodies, such as pertuzumab and trastuzumab, from crossing the blood brain barrier (BBB). However, emerging evidence reveals that the BBB is perturbed in the setting of metastases, allowing for improved penetrance of these larger targeted agents. The disrupted BBB may allow for passage of ado-trastuzumab emtansine (TDM1), though little clinical information about its activity in BCBM patients is currently known.

Background

Male breast cancer (MBC) is a rare illness and its management is largely based on published data from female breast cancer (FBC). The objective of this review was to evaluate the literature to determine if MBC is adequately understood, studied and treated, both medically and psychologically, despite its rarity.

Methods

A literature search was conducted, using PubMed, ProQuest, EBSCOHOST, and PsycINFO, for all articles containing the term “male breast cancer” or “male breast carcinoma” and published in English up to October 2015. Additional references were obtained from secondary search engines like Google Scholar and the citation lists of sourced articles.

Results

Published literature and public and healthcare awareness of MBC are far more limited than for FBC. Combined with misperception of breast cancer as a ‘female illness’, this may contribute to delayed diagnosis, worse prognosis, stigma and limited psychosocial support for male patients. Inconsistent use of medical treatment modalities, fewer treatment benefits, sparse safety data and a paucity of psychosocial research and services, as compared to FBC, may further contribute to poorer outcomes in MBC. Differences in etiological, diagnostic and treatment data between MBC and FBC also challenge the applicability of FBC management strategies to MBC.

Conclusion

MBC is a distinct condition that is much less understood, significantly understudied, and possibly undertreated, than FBC. Prospective research is essential to establish MBC-specific standards of care and guide medical and psychological interventions. Public and health professional education is also needed to raise awareness of MBC, reduce stigma and facilitate early detection.

Significant advances in the last decade have been made in the management of patients with metastatic renal cell carcinoma (RCC) with targeted therapies, however the toxicities from these new agents are still being discovered. Vascular endothelial growth factor (VEGF) inhibitors and tyrosine kinase inhibitors (TKI) have been associated with many oral mucocutaneous toxicities including the development of Geographic Tongue (GT). We present the first reported case of GT in a 58 year old male patient being treated with Pazopanib as a monotherapy for metastatic RCC which resolved after cessation of the medication during an acute infection. However, GT is a benign condition that often does not require dose reduction or discontinuation of Pazopanib. Although it can be alarming to patients, treatment is focused on reassurance of the benign nature of the disease to patients and the ability to continue on treatment. This case illustrates the continued discovery of new toxicities during a time in which we are seeing rapid development of new therapies. We suspect GT is a class effect of VEGF inhibitors and TKIs due to their disruption of buccal mucosa homeostasis and although GT is considered rare it is likely underreported in the literature.

Background

Five to ten percent of patients with prior breast cancer treated with breast conservation therapy (BCT) will develop ipsilateral breast tumor reoccurrence (IBTR), requiring reoperative sentinel lymph node biopsy (SNLB). IBTR patients may have a history of prior axillary surgery, which can be a SLNB or an axillary lymph node dissection (ALND).

Materials & Methods

A retrospective chart review was conducted on patients with IBTR who received care in the Department of Surgery at William Beaumont Hospital, Royal Oak and Troy, Michigan, from January 2007 to December 2009.

Results

Twenty-eight patients were identified and categorized as Prior ALND (>10 lymph nodes, n=14), Prior SLNB (≤10 lymph nodes, n=10) and an Unknown number of lymph nodes (n=4). Among Prior ALND patients, reoperative SLNB success was increased in the ≥10 years group (25% vs. 50%, p=0.58). Similarly, among Prior SLNB patients, reoperative SLNB success was increased in the ≥10 years group (71% vs. 100%, p=1.0).

Conclusion

Increased duration to IBTR may be associated with success of reoperative SNLB in patients with IBTR with prior ALND or SNLB. Further study is required to better understand this relationship.

Microabstract

The relationship between timing of and success of reoperative sentinel lymph node biopsy (SLNB) has not been studied. We conducted an observational, retrospective analysis of 28 patients with ipsilateral breast tumor recurrence (IBTR). Our results may suggest a higher rate of reoperative SNLB success with increased (≥10 years) duration to IBTR among patients who initially underwent breast conserving therapy with initial axillary lymph node dissection or SNLB. Further research is required to characterize this potential relationship.

Clinical practice points

Specific mechanisms for the regeneration of lymphatic channels in patients with IBTR after original SLNB or ALND are currently being investigated. The time necessary to reestablish significant lymphatic networks is unknown, but likely impacts the success of reoperative SNLB in ITBR patients. Our results may suggest a higher rate of reoperative SNLB success with increased (≥10 years) duration to IBTR among patients who initially underwent BCT with original axillary lymph node dissection or SNLB. Although more advanced research is required to better understand the relationship between timing of and success of reoperative SLNB, the results of this study may suggest that the utility of SLNB may be greater with increased length to IBTR. As a result, clinicians should be somewhat skeptical of the success of SLNB in patients with immediate IBTR until further research can be conducted.

Background

Increased serum carcinoembryonic antigen (CEA) levels have been associated with a poor outcome in lung cancer. The aim of this study was to further clarify the associations between CEA levels and adenocarcinoma subtypes.

Patients and methods

We retrospectively assessed preoperative serum CEA levels and clinicopathological factors in 307 consecutive patients who underwent resection for primary lung adenocarcinoma with curative intent.

Results

Subtypes included adenocarcinoma in situ (AIS) in 20 cases, minimally invasive adenocarcinoma (MIA) in 20, invasive mucinous adenocarcinoma (IMA) in three, lepidic predominant adenocarcinoma (LPA) in 41, papillary predominant adenocarcinoma (PPA) in 106, acinar predominant adenocarcinoma (APA) in 90, solid predominant adenocarcinoma (SPA) in 23, and micropapillary predominant adenocarcinoma (MPA) in four. Serum CEA levels varied according to gender, age, smoking status, clinical stage, lymph node metastasis, pathological stage, and adenocarcinoma subtype. Serum CEA levels were higher in the APA, MPA, IMA, and SA subtypes than in the AIS, MIA, PPA, and LPA subtypes. Multiple regression analysis revealed that the clinical stage and adenocarcinoma subtype were significantly associated with serum CEA levels. Univariate analysis demonstrated that preoperative CEA levels were significantly associated with both the postoperative disease-free survival (DFS) and overall survival. Cox regression analysis revealed that the clinical stage and adenocarcinoma subtype were significantly associated with the postoperative DFS.

Conclusion

The serum CEA level was elevated in advanced disease stages and certain adenocarcinoma subtypes, suggesting the usefulness of CEA as a marker reflecting the malignant behavior of lung adenocarcinomas.

Secondary adult intussusception is associated with a pathological condition involving a lead point, including malignant tumors such as a primary or metastatic adenocarcinoma, GIST, leukemia, lymphoma, or carcinoid tumor. Thirty percent of small intestine intussusception was caused by malignancy. Most of these malignancies were metastases, while primary small intestinal malignancy were rare. Intussusception in lymphoma patients has been reported, with predominant location of intussusception in the ileo-colica region. Intussusception occuring after chemotherapy has been reported in four cancer patient following chemotherapy, but no report about this condition in lymphoma patient. A 44-year-old female patient with DLBCL was diagnosed of intussusception eight days after the initiation of chemotherapy. Plain abdominal radiology and CT scan confirmed intussusception on the ileo-colica region. No surgical intervention was done due to the condition of the patient. This is the first reported case of inssusception in a DLBCL patient that had undergone chemotherapy for the lymphoma.

The treatment recommendations for patients with inoperable residual intrapulmonary metastases from mesenchymal chondrosarcoma after completion of chemotherapy are sometimes controversial. We describe a case of simultaneous bilateral stereotactic body radiation therapy (SBRT) of two relatively large inoperable central pulmonary lesions in a patient with metastatic mesenchymal chondrosarcoma. The primary tumor was treated with complete surgery alone. Pulmonary failure with multiple lesions developed 5 years later. After systemic treatment with eight cycles of doxorubicin/ifosfamide, two relatively large bilateral centrally located metastases (4.7 and 2.1 cm) remained that were deemed inoperable. The metastases were treated by simultaneous bilateral SBRT. Because of the size and localization of the residual lesions, ablative SBRT protocols seemed unfavorable in respect to awaiting excessive pulmonary toxicity. We therefore used an individualized moderate dose prescription concept. Nevertheless SBRT resulted in excellent long-term outcome without any relevant toxicity.

A 56 year old retired theatre nurse who has metastatic breast carcinoma complains of reduced vision in the left eye since being started on Docetaxel (Taxotere), an oral anti-mitotic chemotherapeutic agent. Best corrected visual acuity was 6/18 in the left eye, and 6/9-1 in the right. Clinical examination and subsequent examination with optical coherence tomography and Intravenous Fluorescein angiography revealed evidence suggestive of drug related maculopathy. No abnormal findings were present in the right eye. As far as we are aware, this is the first reported case of maculopathy following commencement of Docetaxel with the absence of macular oedema.

Phlegmasia cerulea dolens (PCD) is a rare presentation of deep vein thrombosis (DVT) which clinically mimicks arterial ischemia and is caused by extensive thrombotic occlusion of the venous outflow of a major vein of an extremity. DVT is a common and potentially life-threatening complication in patients with lung cancer. We report the case of a patient who developed PCD in an upper limb while receiving anticoagulation treatment with low-molecular-weight heparin (LMWH) for recurrent venous thromboembolism (VTE) events at presentation of EML4-ALK translocated metastasic lung adenocarcinoma. Crizotinib therapy was associated not only with response of metastatic lesions but with a dramatic improvement of cancer-associated hypercoagulability. To our knowledge, this is the first case reporting PCD in an ALK-rearranged advanced NSCLC patient.

Introduction

The incidental detection of multiple secondaries in the lung, in an asymptomatic individual calls for detailed evaluation, especially if the 18-fluoro-deoxyglucose positron emission tomography (FDG PET) scan results are inconclusive or unusual.

Presentation of case

A 45 year old lady, asymptomatic, presented to us for evaluation of incidentally diagnosed, bilateral pulmonary metastases with a provisional diagnoses of advanced lung cancer. FDG PET scanning was inconclusive and revealed low positive FDG uptake. The biopsy revealed it to be metastatic ameloblastoma. She refused surgery but took only one cycle of chemotherapy with paclitaxel and carboplatin, which she then subsequently discontinued but continues to be asymptomatic at last followup.

Discussion

She gave history of previous ameloblastoma of the left mandible 13 years back, and recurrences 3 and 6 years later, which had been resected. For the last seven years she had no evidence of disease. History of past illness including operative interventions done for apparently benign or locally aggressive lesions of the oral cavity such as an ameloblastoma is important in evaluation of such cases.

Conclusion

Pulmonary metastases arising from an ameloblastoma maybe associated with low FDG positive uptake, and even though they are rare, it is important to diagnose them, since the prognosis and management of lesions from lung or other primaries and those from ameloblastoma are markedly different.