Taste disorders following cancer treatment: report of a case series.

PURPOSE: To present the findings of combined oral assessment and gustometry testing of a series of head and neck and hematologic malignancies in patients with self-reported taste change after cytotoxic therapies. METHODS: Patients with acute myeloid leukemia (AML), multiple myeloma (MM), and head and neck cancer (HNC) were evaluated for taste function. Chemical gustometry was conducted assessing chemosensory qualities that included sweet, sour, salty, bitter, umami, and spicy. NCI Common Terminology Criteria for Adverse Events (CTCAE) 4.0 and the Scale of Subjective Total Taste Acuity (STTA) were used to describe taste symptoms. Saliva flow rates were measured to determine the presence of hyposalivation. Patients were provided treatment trials for taste dysfunction, including zinc supplements, or medications that included clonazepam, megestrol acetate, and the cannabinoid dronabinol. RESULTS: According to STTA, hematology cases reported the incidence of grades 2 and 3 taste disturbances as 60% and 40%, respectively. For HNC patients, the incidence of grades 2 and 3 was 44% each. Gustometry tests confirmed dysgeusia in all patients evaluated. In the hematology group, 80% of patients exhibited a decrease in sweet taste perception, and no patients correctly identified umami taste. In the HNC group, most patients could not identify salt taste, 66% of patients reported "no sensation" with spicy taste, bitter taste was reduced in some, and increased or altered in others, while only one patient could identify umami taste. In the hematologic and HNC patient groups, 80% and 66% reported grade 2 dry mouth, respectively, according to CTCAE 4.0. After treatment for taste dysfunction, 71% of all patients in the present study reported improvements in taste function. CONCLUSIONS: Persisting dysgeusia in cancer survivors may be assessed by patient report and taste testing. The taste most affected in our patients was umami. Treatment trials with current interventions for dysgeusia appeared effective and should be considered in cancer survivors. Understanding taste and flavor function during and following cancer treatment is important in developing rational prospective preventive and interventional strategies.

Checkpoint Blockade Strategies in the Treatment of Breast Cancer: Where We Are and Where We Are Heading.

OPINION STATEMENT: Immunotherapy has become one of the greatest advances in medical oncology over the last century; however, the optimal application for the treatment of breast cancer remains an active area of investigation. Modern immunotherapy strategies augment the immune system and ideally, permit durable tumor-specific immune memory. In fact, several monoclonal antibodies that mediate the immune checkpoint receptors have provided the most clinically meaningful improvement for breast cancer patients to date, particularly for the triple negative subtype. Checkpoint blockade as monotherapy has demonstrated some encouraging results, although some combination strategies appear to augment those responses and may be particularly effective when administered earlier in the course of disease. For example, the combination of atezolizumab and nab-paclitaxel as first-line therapy for metastatic triple negative breast cancer demonstrated significant improvements in progression-free survival when compared with chemotherapy alone. Herein, we review the data for immune therapy in breast cancer and highlight promising future directions.

Hormonioterapia paliativa em câncer de mama: aspectos práticos e revisão da literatura / Palliative hormonal therapy for breast cancer: a practical review literature

JUSTIFICATIVA E OBJETIVOS: O câncer de mama é uma doença altamente prevalente em todo o mundo e com elevada taxa de mortalidade. Na doença metastática, o principal objetivo é a paliação dos sintomas, com benefício em qualidade de vida e aumento da sobrevida do paciente. O objetivo deste estudo foi revisar a literatura relacionada à hormonioterapia no tratamento do câncer de mama avançado, com ênfase nos ensaios clínicos com maior impacto científico, além de contextualizar estes estudos com a prática clínica diária. CONTEÚDO: Dentre os diversos tipos de tratamento, a hormonioterapia tem papel fundamental, pois tem bom perfil de toxicidade, elevada eficácia e diversas opções terapêuticas. CONCLUSÃO: A hormonioterapia é um recurso altamente eficaz para o tratamento paliativo do câncer de mama e seu uso mais difundido será certamente encontrado por clínicos gerais que participem do cuidado destas pacientes.

BACKGROUND AND OBJECTIVES: Breast cancer is a frequent disease worldwide with a high mortality rate. Care of patients with metastatic disease is mainly focused in palliating symptoms and improving the quality of life of patients. This study has evaluated the most important evidence regarding horMédicamonal therapy in metastatic breast cancer in order to come up with a practical approach to the care of these patients. CONTENTS: Among the therapeutic options at this stage, hormonal therapy is very important because of its efficacy, favorable toxicity profile and for the multiple choices of different medications of this type currently available. CONCLUSION: Hormonal therapy is highly effective for the palliative care of breast cancer patients and because of its more widespread use, general internists who also care for these patients may certainly use these medications.