Clinical outcomes of platinum-based chemotherapy in patients with advanced breast cancer: An 11-year single institutional experience.

BACKGROUND/METHODS: Although the prognosis of metastatic breast cancer (BC) has improved, some patients still develop high burden metastases or visceral crisis (VC) and polychemotherapy is commonly used in these cases. Data reporting the real effectiveness of this strategy are scanty. Therefore, the outcomes of patients with metastatic BC treated with platinum-based chemotherapy (P-ChT) at the Jules Bordet Institute during the period of January 2008 and December 2018 were retrospectively reviewed. The presence of VC was defined according to ABC 4 criteria. RESULTS: 441 patients were identified: visceral metastases were observed in 430 (97.5%) while 261 (59.2%) presented VC. As for metastatic BC subtype, 255 (57.8%) had ER-positive/HER2-negative, 41 (9.3%) ER-positive/HER2-positive, 34 (7.7%) ER-negative/HER2-positive and 111 (25.1%) triple-negative BC. Median number of prior treatment lines was 3.8 (0-12). Median OS with P-ChT in the entire cohort was 6.13 months. Patients with VC had lower OS than patients without VC (8.6 vs 3.7 months; p < 0.001). On multivariate analysis, the variables correlated with worse OS were hyperbilirubinemia (HR 1.90; 95% CI 1.34-2.75), ECOG ≥2 (HR 1.77; 95% CI 1.13-2.78) and ECOG ≥3 (HR 2.52; 95% CI 1.48-4.28), and >3 previous treatment lines (HR 2.27; 95% CI 1.53-3.21). Of the 261 patients with VC, 106 (40.5%) presented a resolution of the VC which correlated with better OS (9.3 vs 2.0 months, HR 0.27; 95% CI 0.21-0.36). CONCLUSION: Patients who overcome VC benefit from P-ChT with OS similar to patients without VC. In this analysis, hyperbilirubinemia, poor ECOG and >3 previous treatment lines were significant prognostic factors in the overall study population.

An Uncommon Cause of Diarrhoea and the Importance of an Internist Approach.

BACKGROUND: Human intestinal spirochetosis is a condition defined by the presence of spirochetes attached to the colonic epithelium. Brachyspira aalborgi and Brachyspira pilosicoli may cause the disease in humans. CASE REPORT: We describe the case of a 58-year-old patient who presented with epigastric abdominal pain and diarrhoea. He was thought to be having a myocardial infarction and underwent an angiogram with subsequent stenting of the circumflex coronary artery. However, the pain and diarrhoea were still present after the procedure and the patient now had sepsis. An exploratory laparotomy was inconclusive. The patient improved on intravenous antibiotics and was discharged, but returned to the emergency department 2 days later with the same complaints. He was then admitted to an internal medicine ward where the diagnosis of intestinal spirochetosis was made. The patient was started on metronidazol and completed a 10-day antibiotic course with full recovery of his symptoms. CONCLUSION: This case highlights the importance of an internist-based approach that could have prevented two invasive procedures and the accompanying risks. LEARNING POINTS: Uncommon causes of diarrhoea are a diagnostic challenge.Errors of clinical judgement can lead to invasive and potentially harmful procedures.An internist-based approach can prevent diagnostic mistakes and be in the patient's best interests.