Tumor lysis syndrome following trastuzumab for breast cancer: a case report and review of the literature.

Tumor lysis syndrome, a complication of anticancer chemotherapy, results from rapid lysis of malignant cells. We report tumor lysis syndrome in a patient treated with trastuzumab for metastatic breast carcinoma. A 69-year-old woman was diagnosed with multiple liver metastases 1 month after mastectomy. As her liver functions had deteriorated, chemotherapeutic agents were contraindicated and she was treated with trastuzumab alone. On day 6 of the first course of trastuzumab, she developed tumor lysis syndrome. As her liver functions showed deterioration due to multiple hepatic metastases, hemodialysis was contraindicated. Acute renal failure worsened and she died 11 days after the administration of trastuzumab.

Application of a 70-Gene Expression Profile to Japanese Breast Cancer Patients.

BACKGROUND: As data on using MammaPrint®, a 70-gene expression profile for molecular subtyping of breast cancer, are limited in Japanese patients, we aimed to determine the gene profiles of Japanese patients using MammaPrint and to investigate its possible clinical application for selecting adjuvant treatments. PATIENTS AND METHODS: 50 women treated surgically at our institution were examined. The MammaPrint results were compared with the St Gallen 2007 and intrinsic subtype risk categorizations. RESULTS: Of 38 cases judged to be at intermediate risk based on the St Gallen 2007 Consensus, 11 (29%) were in the high-risk group based on MammaPrint. 1 of the 30 luminal A-like tumors (3%) was judged as high risk based on MammaPrint results, whereas 7 of the 20 tumors (35%) categorized as luminal B-like or triple negative were in the low-risk group. There have been no recurrences to date in the MammaPrint group, and this is possibly attributable to most of the high-risk patients receiving chemotherapy that had been recommended on the basis of their MammaPrint results. CONCLUSIONS: Our results indicate that MammaPrint is applicable to Japanese patients and that it is of potential value in current clinical practice for devising individualized treatments.

An osteogenesis imperfecta case with breast cancer.

Osteogenesis imperfecta (OI) is a rare connective tissue disease characterized by abnormalities of type 1 collagen and an increased risk of bone fractures. Several OI cases with malignancies have been reported. Herein, we describe an OI case with breast cancer. A 36-year-old premenopausal woman with OI was admitted to our hospital for evaluation of a right breast lump. We diagnosed right breast cancer with axillary and parasternal lymph node metastasis (T2N3M0 stage IIIC). The tumor had increased in size and tumor markers were elevated after 10 months of hormone therapy. We performed a right mastectomy and axillary dissection. She subsequently received adjuvant chemotherapy and radiotherapy. She is currently taking trastuzumab and tamoxifen. Anesthesia is challenging in OI patients because of difficulty with airway control and intubation. We performed the mastectomy in this case without difficulty by working in cooperation with experienced anesthesiologists, orthopedists, and other medical personnel. Some OI patients reportedly have severe 5-fluorouracil (5-FU) toxicity related to dihydropyrimidine dehydrogenase (DPD) deficiency. DPD is the main enzyme involved in the catabolism of 5-FU. Our present case also had low DPD activity and we thus chose epirubicin and cyclophosphamide for chemotherapy. Our search of the literature yielded only two OI cases with breast cancer as of April 2011. To our knowledge, this is the first case reported in Japan.