Cystoid Macular Edema following Treatment with Nanoparticle Albumin-Bound Paclitaxel and Atezolizumab for Metastatic Breast Cancer.

Cystoid macular edema (CME) is a rare side effect associated with chemotherapy. Although the development of CME has been reported to occur following treatment with taxane drugs, such as nanoparticle albumin-bound paclitaxel (Nab-PTX), the occurrence of CME with treatment with atezolizumab has not yet been reported. Here, we report the case of a 49-year-old woman who developed CME 19 months into chemotherapy with Nab-PTX and atezolizumab. Improvement was not achieved with steroid injections into the Tenon's sac, and Nab-PTX and atezolizumab treatments were ceased. One month later, there was subjective improvement in her symptoms. Although many reports have indicated that cessation of chemotherapy has successfully improved CME, a specific treatment for CME has not yet been established. Clinicians should be aware of the ophthalmologic side effects and offer immediate treatment if symptoms develop.

[A Case of Spinal Cord Metastasis from Breast Cancer Successfully Treated with Trastuzumab Deruxtecan].

OBJECTIVE: Intramedullary spinal cord metastases(ISCM)are very rare in patients with breast cancer and have a poor prognosis with no established treatment. We report a case of ISCM in a patient with HER2-positive breast cancer who was successfully treated with a novel anti-HER2 agent, trastuzumab deruxtecan(T-DXd, ENHERTU®). CASE: The patient was a 44- year-old woman who underwent surgery for right breast cancer. T-DXd was introduced as the fourth-line metastatic treatment for multiple metastases, including liver, bone, pituitary, brain, and spinal cord metastases. Hematologic and non- hematologic toxicities did not occur during the treatment with T-DXd. T-DXd could be administered continuously for 25 cycles, and symptoms such as numbness in the left lower limb were controlled without progression of the brain and spinal cord, although T-DXd-induced interstitial lung disease was a concern. DISCUSSION: ISCM is a rare metastatic lesion that is difficult to treat with chemotherapy due to the blood-brain barrier (BBB), and there is no established treatment for ISCM. T-DXd has shown promising results in previous clinical trials, including in patients with central nerve system (CNS) metastases, and is expected to be a good treatment option for CNS metastases in clinical practice. CONCLUSION: This successful case of T-DXd for ISCM suggests that T-DXd is an effective treatment option for patients with breast cancer and CNS metastases.

Persistent weekly paclitaxel-induced peripheral neuropathy in early breast cancer patients enrolled in a randomized trial of cryotherapy.

Chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect of weekly paclitaxel-based chemotherapy for breast cancer, that can persist for years. Cryotherapy therapy is effective for preventing early CIPN, but its protective effect on persistent CIPN is uncertain. This is a cross-sectional study conducted as an ancillary analysis of a randomized trial investigating the preventive effect of cryotherapy on CIPN in breast cancer patients receiving weekly paclitaxel-based chemotherapy (UMIN000034966). Eligible patients were evaluated for CIPN at more than a year after completion of the chemotherapy (persistent CIPN). CIPN was defined as a 6 or more points reduction from baseline in the Functional Assessment of Cancer Therapy-Neurotoxicity (FACT-NTX) score. The incidence of early and persistent CIPN was compared between cryotherapy and control groups. Thirty-eight patients were examined for both early and persistent CIPN. The median time from completion of the weekly paclitaxel-based chemotherapy to the questionnaire for persistent CIPN was 2.3 (1.3-3.1) years. In all 38 patients, persistent CIPN was demonstrated in 10 (26.3%), respectively. There was a numerical, however not significant, reduction in the incidence of persistent CIPN (15.8% vs 36.8%, P = .1) in the cryotherapy group compared with the control group, respectively. In multivariate logistic regression analysis, age ≥ 65 was a substantial risk factor for persistent CIPN (HR: 14.7, 95%CI: 1.7-130.7, P = .01). In breast cancer patients receiving adjuvant weekly paclitaxel-based chemotherapy, cryotherapy resulted in a numerical, however not significant, reduction in the incidence of persistent CIPN and age>=65 was a risk factor for persistent CIPN.

[Two Cases of Therapy-Related Myeloid Neoplasms after Docetaxel with Cyclophosphamide Therapy for Breast Cancer].

Docetaxel with cyclophosphamide(TC)is used as a perioperative chemotherapy. Therapy-related myeloid neoplasms(t- MN)are a rare adverse event of TC therapy. We report 2 cases of t-MN after TC therapy for breast cancer. Case 1 involved a 72-year-old woman who received 4 courses of TC therapy and radiation therapy after surgery. Two years and eight months after surgery, she presented with night sweats, coughing, headaches, and a low-grade fever. Laboratory examination revealed leukocytosis, and a bone marrow aspiration biopsy confirmed acute myelogenous leukemia with myeloid morphology- related changes and secondary acute myelogenous leukemia. Case 2 involved a 71-year-old woman who received 4 courses of TC therapy and radiation therapy after surgery. Three years and six months after surgery, ultrasonography detected right cervical lymphadenopathy. Resection of the right cervical lymph nodes and bone marrow aspiration biopsy confirmed mixed-phenotype acute leukemia(MPAL). Both patients are currently being treated.

[A case of pleomorphic malignant fibrous histiocytoma with multiple lung metastases with bilateral pneumothorax after chemotherapy].

A 70-year-old man diagnosed with pleomorphic malignant fibrous histiocytoma of the left thigh underwent tumor resection. After 10 months, he underwent extended resection due to local recurrence. However, because multiple lung metastases was detected at this time, chemotherapy with ifosfamide and doxorubicin was administered. After three courses of chemotherapy, the lung metastases enlarged and the patient received ifosfamide and etoposide as second line chemotherapy. Even after three courses of second line treatment, the disease progressed, for which docetaxel and gemcitabine were administered as third line chemotherapy. After three courses of third line treatment, multiple lung metastases reduced and were replaced with scar and cystic lesions (reduction ratio 85.9%). After four courses of treatment, the patient developed left pneumothorax. Partial resection of the left upper lobe was performed by thoracoscopic surgery. Histopathological examination revealed rupture of the visceral pleura in a scar lesion leading to air leakage. After 13 courses of treatment, he developed right pneumothorax. Partial resection of the right middle lobe was performed. Histopathological examination revealed a cystic lesion without tumor remnants. After 15 courses of third line treatment, lung metastasis could be controlled. Chemotherapy with docetaxel and gemcitabine resulted in few adverse effects that were within tolerance limits.

[A case of cStage III B non-squamous non-small-cell lung cancer completely resected after downstaging with chemotherapy].

A 64-year-old man was diagnosed with a gastric ulcer, and a tumor shadow was observed in the right lower lung field on a chest radiograph. Chest computed tomography (CT) revealed the tumor shadow to be 33 × 25 mm in the right lower lobe; it also revealed a 7-mm nodule in the right S3, and lymph node swelling in the upper and lower mediastinum. Positron emission tomography (PET)-CT revealed an SUVmax of 12.8, 1.2, 7.6, and 10.0 for the right lower lobe tumor, right S3 nodule, and the No. 4 and No. 7 lymph nodes, respectively. The right lower lobe tumor was diagnosed as an adenocarcinoma via transbronchiall ung biopsy. The patient was diagnosed with cT4N2M0, cStage III B cancer. Four courses of carboplatin, pemetrexed, and bevacizumab were administered. After the fourth course, chest CT revealed that the right lower lobe tumor and the right S3 nodule significantly reduced to 14 × 7 mm and 5mm respectively, and the mediastinal lymph node swelling was nearly eliminated. Subsequent PET-CT examination revealed an SUVmax of 1.3 and 0.8 in the right lower lobe tumor and right S3 nodule, respectively. The patient was diagnosed with ycT4N0M0, ycStage III A cancer, and he underwent right lower lobe resection, right S3 partial resection, and lymph node. Postoperative pathological analysis was used to make a diagnosis of mixed type adenocarcinoma for the right lower lobe tumor, and a diagnosis of papillary adenocarcinoma for the right S3 nodule. Both tumors were diagnosed as primary lung cancers. There were no metastatic cancer cells in the dissected lymph nodes.

[A case of lung cancer in an elderly patient with malignant pleural effusion and pneumothorax treated with carboplatin, pemetrexed, and bevacizumab].

We report a case of an elderly patient with non-squamous non-small cell lung cancer who was successfully treated with chemotherapy using carboplatin(CBDCA), pemetrexed(PEM), and bevacizumab(Bev). The patient was an 84-year-old man who presented with a chief complaint of dyspnea. The right lung was completely collapsed due to malignant pleural effusion, and the mediastinum was shifted to the left. Right thoracic drainage was performed, but this was complicated by pneumothorax and a thoracotomy was performed. An absorbent tissue reinforcing agent was attached to the site of the air leakage and fibrin glue was applied. After discharge, the patient was administered 500mg/m / 2 PEM plus 15 mg/kg Bev for the first course of chemotherapy and experienced no serious side effects. CBDCA(area under the curve[AUC]4)was added from the second course. After the administration of seven courses, pleural effusion had almost disappeared and the primary tumor in the upper right lobe was observed to have shrunk. Administration of PEM+Bev was continued thereafter. The right pleural effusion was well controlled for up to 12 months(14 courses)from the start of the administration of chemotherapy, and shrinkage of the primary tumor was maintained. The side effects were mild and chemotherapy was administered safely. After the administration of 16 courses, a left malignant pleural effusion was observed, and the patient died 15 months after the initiation of chemotherapy.

[A case of advanced gastric cancer with recurrence-free long survival showing disappearance of distant lymph node metastases by S-1/docetaxel therapy followed by curative resection].

A screening CT of a 78-year-old man suffering from a laryngeal foreign body revealed multiple lymph nodes swelling at the left subclavicular, mediastinal, perigastric, and paraaortic space. He was diagnosed as advanced gastric cancer. After five courses of S-1/docetaxel therapy, the primary tumor became flat and lymph nodes became undetectable. After seven courses, he received operation(total gastrectomy and D2 lymph nodes dissection)because of tumor bleeding and severe adverse effects. The pathological chemotherapeutic effect was Grade 1b for the primary tumor and Grade 3 for lymph nodes. He received S-1 maintenance therapy for three years afterward, and is now still in good condition without recurrence 53 months after the first administration. S-1/docetaxel therapy was thought to be a useful optional regimen for highly advanced gastric cancer.

Quantitative analysis and localization of mRNA transcripts of type I collagen, osteocalcin, MMP 2, MMP 8, and MMP 13 during bone healing in a rat calvarial experimental defect model.

The study examined the expression of matrix metalloproteinases (MMPs), type I collagen and osteocalcin during bone healing in a rat calvarial experimental defect model. Twelve-week-old male Wistar rats were used. A full-thickness standardized trephine defect was made in the parietal bone, with the rat under anesthesia. RNA was extracted from tissue that filled the original bone defect on days 1 and 3 and in weeks 1, 2, 3, 5, 8, 10, 12, 18, and 24 and processed for quantitative analysis of expression of type I collagen, osteocalcin and matrix metalloproteinases (MMPs) 2, 8, and 13 by using real-time polymerase chain reaction. Alternatively, the rats were fixed by perfusion through the aorta and resected calvaria were processed for in situ hybridization for these molecules. The expression of type I collagen, osteocalcin and MMPs 2 and 13 increased toward week 2 and decreased thereafter, whereas the expression of MMP 8 was the highest on day 1. The mRNA transcripts of type I collagen and osteocalcin were localized in osteoblasts and osteocytes, some of which expressed MMPs 2, 8, and 13. Osteoblasts and osteocytes may play a role in the remodeling of extracellular matrices with MMPs during healing of a defect in bone.

[Pancreatic acinar cell carcinoma successfully treated with combination of oral TS-1 and intra-arterial cisplatin].

Pancreatic acinar cell carcinomas are rare, and little is reported on their chemotherapy. We report a 49-year old male patient with pancreatic acinar cell carcinoma and multiple liver metastases, which responded to oral TS-1 and hepatic arterial infusion of cisplatin. The patient underwent a partial hepatectomy, MCT abrasions and excision of the pancreatic tumor. Postoperative pathological studies revealed metastases of acinar cell carcinoma to the liver and lymph nodes; the primary lesion was undetermined. After surgery, the patient was treated with hepatic arterial infusion of cisplatin and oral TS-1. Metastatic tumors completely disappeared, and serum lipase decreased to normal levels. Abdominal CT one year after surgery revealed a pancreatic body tumor, which was surgically removed. Pathological studies showed primary pancreatic acinar cell carcinoma, while previous metastases remained under control. To summarize, TS-1 and cisplatin can be effective treatments for pancreatic acinar cell carcinomas.