Complete Response With Trametinib in Advanced Low-Grade Serous Ovarian Carcinoma: A Case Report.

Low-grade serous ovarian carcinoma (LGSOC) is an uncommon subtype of ovarian cancer, and it is usually associated with reduced sensitivity to chemotherapy and worse outcomes. We present a case involving a 45-year-old female patient diagnosed with stage III-C low-grade serous ovarian carcinoma (LGSOC) in 2013. She achieved a complete response for 29 months after undergoing platinum-based chemotherapy and interval cytoreduction. However, in 2016, both local and distant relapses were observed. As there was no benefit from hormonal therapy and the patient refused chemotherapy, bevacizumab was initiated, resulting in disease stabilization for 30 months. At disease progression, trametinib was proposed, and the patient experienced an ongoing sustained complete response for over 36 months. To the best of our knowledge, this is the first report, outside of a clinical trial, regarding a complete response with single agent MEK inhibitor therapy in a patient with recurrent LGSOC, with unknown BRAF V600E mutation. We present the following case in accordance with the CAse REports (CARE) checklist.

Comparing Prognosis for BRCA1, BRCA2, and Non-BRCA Breast Cancer.

BACKGROUND: Germline pathogenic variants (PV) in BRCA1 and BRCA2 genes, which account for 20% of familial breast cancer (BC) cases, are highly penetrant and are associated with Hereditary Breast/Ovarian Cancer Syndrome. Previous studies, mostly including higher numbers of BRCA1 BC patients, yielded conflicting results regarding BRCA1/2 BC outcomes. In the Portuguese population, BRCA2 BC is diagnosed more frequently than BRCA1 BC. We aimed to compare clinicopathological characteristics and prognosis between BC patients with BRCA1 and BRCA2 mutations and a control group without germline PV (BRCA-wt). Furthermore, we explored the frequency and outcomes of risk-reducing surgeries in BRCA-mutated patients. METHODS: Prospective follow-up was proposed for patients with a diagnosed BRCA1/2 PV. For this study, a matched control group (by age at diagnosis, by decade, and by stage at diagnosis) included BC patients without germline PV. We compared overall survival (OS) and invasive disease-free survival (iDFS) within the three groups, and the use of risk-reducing surgeries among the BRCA cohort. RESULTS: For a mean follow-up time of 113.0 months, BRCA-wt patients showed longer time to recurrence (p = 0.002) and longer OS (p < 0.001). Among patients with BRCA mutations, no statistical differences were found, although patients with BRCA2 BC had longer iDFS and OS. Uptake of risk-reducing surgeries (contralateral prophylactic mastectomy and salpingo-oophorectomy) were negative predictors of invasive disease and death, respectively. CONCLUSIONS: Testing positive for a BRCA PV is associated with a higher risk of relapse and death in patients with BC in the Portuguese population. Risk-reducing mastectomy and salpingo-oophorectomy were associated with lower incidence of relapse and longer median iDFS and OS, respectively.

The Use of Sentinel Lymph Node Biopsy in BRCA1/2 Mutation Carriers Undergoing Prophylactic Mastectomy: A Retrospective Consecutive Case-Series Study.

INTRODUCTION: Sentinel lymph node biopsy in prophylactic mastectomy is controversial. It avoids lymphadenectomy in occult carcinoma but is associated with increased morbidity. Women with BRCA mutations have a higher incidence of occult carcinoma and our objective was to assess the clinical utility of sentinel lymph node biopsy when these women undergo prophylactic mastectomy. MATERIALS AND METHODS: Seven-year retrospective consecutive case-series study of women, with a BRCA deleterious mutation, admitted to prophylactic mastectomy, at our center. Breast MRI < 6 months before surgery was routine, unless contraindicated. RESULTS: Fifty-seven patients (43% BRCA1; 57% BRCA2) underwent 80 prophylactic mastectomies. 72% of patients had had breast cancer treated before prophylactic mastectomy or synchronously to it. The occult carcinoma incidence was 5%, and half of the cases were invasive. SLNB was performed in 19% of the prophylactic mastectomies; none of these had tumor invasion. Women with invasive carcinoma who had not undergone sentinel lymph node biopsy were followed closely with axillary ultrasound. The median follow-up was 37 months, with no local recurrence; 1 patient died of primary tumor systemic relapse. CONCLUSIONS: Our data do not support this procedure for routine (in agreement with previous literature), in this high risk for occult carcinoma population.

Surgery vs. primary radiotherapy in early-stage oropharyngeal cancer.

BACKGROUND: Early-stage oropharyngeal squamous cell carcinoma (OPSCC) can currently be treated by surgical resection or definitive radiotherapy (RT). The aim of this study is to review the outcomes of early-stage OPSCC submitted to surgery or primary RT. Preliminary results have shown similar overall survival (OS) and locoregional recurrence-free survival (LRFS). MATERIAL/METHODS: Retrospective study of patients with cT1-T2 cN0-N1 OPSCC, diagnosed between January 2009 and December 2014, treated with surgery or primary RT. RESULTS: 61 patients with cT1-T2 cN0-N1 OPSCC were included. Forty-two (69%) were submitted to surgical resection, of which 37 (88%) had adjuvant treatment (24 received RT and 13 chemoradiotherapy). Nineteen (31%) were treated with primary RT, and 3 of them had concurrent chemotherapy. RT was given with intensity-modulated radiation therapy (IMRT) (71%) or three-dimensional conformal radiation therapy (3D-CRT) (29%). At a median follow-up of 5.4 years, there were 3 tumor persistences, 5 local failures, 2 regional failures and no distant metastasis. The 3-year and 5-year OS were 77% and 71% in the RT group vs. 71% and 59% in the surgery group, respectively (HR 0.60, 95% CI 0.22-1.61; p = 0.30). The 3-year and 5-year LRFS were 71% and 64% in the RT group vs. 66% and 50% in the surgery group, respectively (HR 0.59, 95% CI 0.24-1.45; p = 0.24). Up to 34% had acute grade 3 toxicity and 11% had grade 4 osteoradionecrosis of the jaw. CONCLUSIONS: Longer follow-up still does not show a significant difference in OS and LRFS between both treatments. Because most patients submitted to surgery required adjuvant RT and since its side-effects were not negligible, further studies are warranted to better suit the first treatment for each patient and to prevent the need for adjuvant treatment and the risk of toxicity.

Creímos en la lactancia materna. Una aproximación de la experiencia en tres generaciones / We believed in breast feeding. An approach to the experience of three generations

Los cambios en la sociedad conducen a que los bebés no se alimenten con leche materna, por lo que se están llevando a cabo proyectos de concienciación e investigación sobre los beneficios de la leche materna y los factores que conducen a las madres a elegir una u otra opción. Objetivo: Analizar el significado, a través de tres generaciones, de ciertas prácticas y creencias mediante sus experiencias vividas. Metodología: Estudio cualitativo, entrevista semidirigida. Muestreo intencionado (círculo de familiares y amistades). En 12 mujeres con edades comprendidas entre 21 años y 81 años. Resultados: La media de crianza de la primera generación estuvo entre 18 y 24 meses. Actualmente la mantienen hasta los seis o siete meses. El rol de las nodrizas ha contribuido a idealizar la lactancia materna y a fomentar lazos afectivos. La decisión de amamantar está muy influida por las creencias sociales adquiridas y el apoyo del entorno. El trabajo de la mujer constituye una dificultad si se quiere prolongar la lactancia. Conclusión: Los cambios socio-culturales y sanitarios no han sido obstáculo para seguir manteniendo su práctica. El amamantamiento se considera un proceso natural y la relación emocional no puede ser reemplazada con la lactancia artificial

Our changing society is not encouraging breastfeeding, thus research and awareness projects are being carried out regarding the benefits of breastfeeding and the factors influencing mothers’ decision. Objective: To analyze the meaning, through three generations, of certain practices and beliefs by their living experiences. Methodology: Qualitative study, semi-supervised interviews. Deliberate sampling (family and friends) of 12 women between 21 and 81 years old. Results: The average breastfeeding of first baby used to be 18-24 months. Presently it is maintained for 6- 7 months. The role of wet nurses has contributed to the idealisation of breastfeeding and the reinforcement of affective bonds. The decision of breastfeeding is highly influenced by the acquired social beliefs and the social support network. Women's jobs constitute a difficulty towards prolonging breastfeeding. Conclusion: Socio-cultural changes and health issues have not been an obstacle to the maintenance of breastfeeding. Breastfeeding is considered a natural process and the emotional relationship cannot be replaced with artificial feeding (AU)