Management of cytomegalovirus reactivation in patient with immunotherapy-induced gastritis.

We present the case of a 52-year-old woman diagnosed with stage IV clear cell renal cell carcinoma who received combination of surgery and systemic therapy with nivolumab (anti-PD1) and ipilimumab (anti-CTLA-4). During treatment, patient presented oral intolerance, vomiting and abdominal pain. Computed tomography (CT) and gastroscopy (EGD) were performed, identifying findings suggestive of severe gastro-duodenitis with friability and diffuse oedema of the mucosa and deep ulcers. A gastrointestinal immunotherapy-induced toxicity was suspected so patient was managed with proton pump inhibitors (PPIs) and intravenous corticosteroids 1mg/Kg. Three weeks later, corticosteroid treatment failed. EGD was repeated and gastric biopsies were taken for histological and microbiological tests. Gastric biopsies revealed the presence of cytomegalovirus (CMV) inclusion bodies by immunohistochemistry (IHC). CMV viral load by quantitative PCR in plasma was 2,000 IU/mL so intravenous ganciclovir was prescribed. Then, the patient presented poor clinical course with persistent vomiting due to a failure of first-line corticosteroid and antiviral treatment. Another EGD was performed. Last IHC reveals a low CMV viral load. Second-line treatment with Anti-TNF was performed using a single-dose regimen of intravenous infliximab 5 mg/Kg. Finally, the patient presented a clinical and endoscopic response and a negative CMV DNA test in the blood after completing the antiviral treatment.

Observational real world data with palbociclib associated to hormone therapy for advanced breast carcinoma.

OBJECTIVE: Cyclin-dependent kinase 4/6 inhibitors have a synergistic effect  in combination with endocrine therapy. This combination is used as first and  subsequent-line treatment for advanced luminal breast carcinoma because it  increases progression-free survival. We analysed clinical course and toxicity  in patients treated with palbociclib in our hospital and determined potential  associations between these variables and clinicopathological variables. METHOD: Observational retrospective study including patients with advanced  or metastatic breast cancer treated with palbociclib plus endocrine therapy at  the Hospital Universitario de Cabueñes between 2017 and 2020. We  analysed clinicopathological variables, toxicity, and survival. Results: In total, 72 women and 1 man (median age: 63 years) received palbociclib plus an  aromatase inhibitor or fulvestrant. When used as firstline treatment,  progression-free survival was 22 months, and as second and subsequent-line treatment, progression-free survival was 13 months. Adverse effects (mainly haematological) were experienced by nearly all any patient, although delays  and dose adjustments were common (61.7% and 42.7%, respectively).  Performance status alone had a significant impact on progression-free  survival (22 months in patients with ECOG 0 vs 12 months in patients with  ECOG ≥ 1; P = 0.021). CONCLUSIONS: Disease stage, age, and performance status do not limit the  use of treatment with palbociclib, nor its combination with aromatase inhibitors or fulvestrant for first or subsequent-line treatment.  Toxicity is easily managed. Real-world results are equivalent to those  published to date.

Objetivo: Los inhibidores de quinasas dependientes de ciclina CDK4 y CDK6  poseen efecto sinérgico al asociarse con hormonoterapia. Su uso está  extendido en primera y sucesivas líneas de carcinoma de mama avanzado  tipo luminal por mejorar la supervivencia libre de progresión. Los objetivos  de nuestro estudio se basaron en analizar la evolución clínica y la toxicidad  presentada en las pacientes tratadas en nuestro centro con palbociclib, así  como relacionar la evolución con las diferentes variables clínico-patológicas.Método: El estudio, de tipo observacional y retrospectivo, recogió datos de  pacientes con cáncer de mama avanzado o metastásico tratados con hormonoterapia y palbociclib en el Hospital Universitario de Cabueñes  entre los años 2017 y 2020. Se analizaron diferentes variables  clínicopatológicas, así como información sobre toxicidad y supervivencia. Resultados: Un total de 72 mujeres y 1 varón con una mediana de edad de  63 años recibieron palbociclib asociado a inhibidor de aromatasa o  fulvestrant. En primera línea la supervivencia libre de progresión fue de 22  meses, y en segunda o sucesivas líneas de 13 meses. El 95,9% de Abstract las pacientes presentaron algún tipo de efecto adverso, principalmente hematológico. No se produjo ningún abandono por toxicidad, aunque los  retrasos y los ajustes de dosis fueron frecuentes (61,7% y 42,7%,  respectivamente). Solo la situación funcional al inicio del tratamiento influyó de manera significativa en la supervivencia libre de progresión (22 meses en  ECOG 0 versus 12 meses en ECOG ≥ 1; p = 0,021).Conclusiones: La extensión de la enfermedad, edad o status menopáusico no impiden el tratamiento con palbociclib, ya se administre con inhibidores de aromatasa o fulvestrant y en una u otra línea  metastásica. La toxicidad del fármaco es manejable, y los resultados de vida  real obtenidos son superponibles a los de los ensayos publicados hasta la actualidad.

Breast metastases as the first sign of recurrence of a cutaneous melanoma.

Malignant melanoma is the most rapidly increasing cancer in the world. Metastatic disease occurs in 20% of patients, and prognosis in these cases is poor. We report the case of a woman who presented breast metastasis as the first sign of recurrence of a melanoma.

Brain metastases in metastatic breast cancer patients receiving trastuzumab-based therapies.

INTRODUCTION: CNS metastases mean a great challenge. It has been suggested that the brain metastases incidence could be high in metastasic breast cancer patients receiving trastuzumab based-therapies. MATERIAL AND METHODS: We performed a descriptive analysis of our experience in this setting. 86 patients met the criteria (From Oct/99 to Oct/03). RESULTS: CNS progression occurred in 17 patients (19.5%). Mean age of CNS progression disease patients was 45.4 years while mean age for all the patients was 50.5 years. Response rate for the entire group of patients was: OR 39.7%; CB (OR + SD) 69%. Response rate to trastuzumab based-therapy was OR 82.4% and CB 88.2 at the time of CNS progression. Median time from the start of trastuzumab therapy up to the CNS progression was 10 months. OS was 23.4 weeks. CONCLUSIONS: The incidence of CNS involvement is high in young metastasic breast cancer women responding to trastuzumab-based therapies. This may lead to prophylactic cranial irradiation strategies or to the early detection in asymptomatic patients to improve surgery or radiosurgery results in these patients.

Estudio observacional de práctica habitual con palbociclib y hormonoterapia para carcinoma de mama avanzado / Observational real world data with palbociclib associated to hormone therapy for advanced breast carcinoma

Objetivo: Los inhibidores de quinasas dependientes de ciclina CDK4y CDK6 poseen efecto sinérgico al asociarse con hormonoterapia. Suuso está extendido en primera y sucesivas líneas de carcinoma de mamaavanzado tipo luminal por mejorar la supervivencia libre de progresión.Los objetivos de nuestro estudio se basaron en analizar la evolución clínica y la toxicidad presentada en las pacientes tratadas en nuestro centrocon palbociclib, así como relacionar la evolución con las diferentes variables clínico-patológicas.Método: El estudio, de tipo observacional y retrospectivo, recogió datosde pacientes con cáncer de mama avanzado o metastásico tratados conhormonoterapia y palbociclib en el Hospital Universitario de Cabueñesentre los años 2017 y 2020. Se analizaron diferentes variables clínicopatológicas, así como información sobre toxicidad y supervivencia.Resultados: Un total de 72 mujeres y 1 varón con una mediana deedad de 63 años recibieron palbociclib asociado a inhibidor de aromatasa o fulvestrant. En primera línea la supervivencia libre de progresión fuede 22 meses, y en segunda o sucesivas líneas de 13 meses. El 95,9% de las pacientes presentaron algún tipo de efecto adverso, principalmentehematológico. No se produjo ningún abandono por toxicidad, aunquelos retrasos y los ajustes de dosis fueron frecuentes (61,7% y 42,7%, respectivamente). Solo la situación funcional al inicio del tratamiento influyóde manera significativa en la supervivencia libre de progresión (22 mesesen ECOG 0 versus 12 meses en ECOG ≥ 1; p = 0,021). (AU)

Objective: Cyclin-dependent kinase 4/6 inhibitors have a synergisticeffect in combination with endocrine therapy. This combination is usedas first and subsequent-line treatment for advanced luminal breast carcinoma because it increases progression-free survival. We analysed clinicalcourse and toxicity in patients treated with palbociclib in our hospital anddetermined potential associations between these variables and clinicopathological variables.Method: Observational retrospective study including patients withadvanced or metastatic breast cancer treated with palbociclib plus endocrine therapy at the Hospital Universitario de Cabueñes between 2017and 2020. We analysed clinicopathological variables, toxicity, and survival.Results: In total, 72 women and 1 man (median age: 63 years) receivedpalbociclib plus an aromatase inhibitor or fulvestrant. When used as firstline treatment, progression-free survival was 22 months, and as secondand subsequent-line treatment, progression-free survival was 13 months.Adverse effects (mainly haematological) were experienced by nearly all patients (95.9%). Treatment was not discontinued because of toxicity inany patient, although delays and dose adjustments were common (61.7%and 42.7%, respectively). Performance status alone had a significantimpact on progression-free survival (22 months in patients with ECOG 0vs 12 months in patients with ECOG ≥ 1; P = 0.021). (AU)

48th Annual Meeting of the American Society of Clinical Oncology: aspectos relevantes en cáncer de mama / 48th Annual Meeting of the American Society of Clinical Oncology: Novel findings in breast cancer

El congreso más importante a nivel mundial sobre cáncer es el de la American Society of Clinical Oncology, que tiene carácter anual y en el que se presentan las novedades más relevantes en los diferentes campos de la Oncología. Respecto al cáncer de mama, la principal novedad ha sido en la primera línea de tratamiento en pacientes HER2 con la llegada del pertuzumab. A continuación, resumimos lo más destacado que se ha presentado en relación con el cáncer de mama(AU)

The most important world congress on cancer is the Annual Meeting of the American Society of Clinical Oncology (ASCO), where the most notable findings in the distinct fields of oncology are presented. This year, the main novelty in breast cancer was related to the first line treatment of metastatic HER2 disease with the development of pertuzumab. This article summarizes the innovations presented in the field of breast carcinoma(AU)

Breast metastases as the first sign of recurrenceof a cutaneous melanoma

Malignant melanoma is the most rapidly increasingcancer in the world. Metastatic disease occurs in20% of patients, and prognosis in these cases ispoor. We report the case of a woman who presentedbreast metastasis as the first sign of recurrence of amelanoma

Brain metastases in metastatic breast cancer patients receiving trastuzumab-based therapies

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Introduction. CNS metastases mean a great challenge.It has been suggested that the brain metastasesincidence could be high in metastasic breastcancer patients receiving trastuzumab based-therapies.Material and methods. We performed a descriptiveanalysis of our experience in this setting. 86 patientsmet the criteria (From Oct/99 to Oct/03).Results. CNS progression occurred in 17 patients(19.5%). Mean age of CNS progression disease patientswas 45.4 years while mean age for all the patientswas 50.5 years. Response rate for the entiregroup of patients was: OR 39.7%; CB (OR + SD)69%. Response rate to trastuzumab based-therapywas OR 82.4% and CB 88.2 at the time of CNS progression.Median time from the start of trastuzumabtherapy up to the CNS progression was 10 months.OS was 23.4 weeks.Conclusions. The incidence of CNS involvement ishigh in young metastasic breast cancer women respondingto trastuzumab-based therapies. This maylead to prophylactic cranial irradiation strategies orto the early detection in asymptomatic patients toimprove surgery or radiosurgery results in these patients